摘要
目的探究术前纤维蛋白原与血浆白蛋白比值(fibrinogen to albumin ratio,FAR)与直肠癌患者临床病理特征及预后的相关性,以明确凝血功能及营养状态在肿瘤发生发展中的作用。方法回顾性分析2013年1月至2016年12月西安交通大学第一附属医院收治的647例行直肠癌根治术患者的临床病理资料。将647例直肠癌患者按照受试者工作特征(receiver operating characteristic,ROC)曲线确定的术前FAR水平的最佳截点值分为高水平FAR组与低水平FAR组。分析直肠癌患者术前FAR不同水平与临床病理特征间的关系,采用多因素COX回归分析方法分析直肠癌患者预后的独立危险因素。应用R软件构建列线图,并使用C指数及校准图评价列线图预测效能。结果术前FAR水平对直肠癌患者预后有较好的预测价值,ROC曲线下面积为0.771,最佳截点值为0.092,约登指数为0.446。术前不同水平FAR直肠癌患者年龄、T分期、N分期、TNM分期、血清中癌胚抗原(CEA)及糖链抗原(CA19-9)差异均有统计学意义(P<0.05)。术前不同FAR水平的直肠癌患者总生存期(overall survival,OS)与无病生存期(disease-free survival,DFS)差异有统计学意义(均P<0.05)。在多因素COX回归分析中,术前FAR水平(≥0.092,HR=3.298,95%CI:2.365~4.600,P<0.001)、年龄(≥60岁,HR=2.110,95%CI:1.479~3.012,P<0.001)、TNM期(Ⅲ期,HR=6.743,95%CI:2.771~16.771,P<0.001)、分化程度(低分化,HR=1.639,95%CI:1.104~2.432,P=0.014)、术前CA19-9水平(≥37,HR=2.205,95%CI:1.529~3.180,P<0.001)以及术后未行辅助放化疗(HR=1.792,95%CI:1.294~2.480,P<0.001)是直肠癌患者预后的独立危险因素。将多因素结果纳入R语言构建直肠癌患者OS、DFS列线图,C指数分别为0.781,95%CI:0.749~0.815;0.754,95%CI:0.693~0.760,列线图1、3、5年OS、DFS校准图均展现了较好的拟合度。结论术前高水平FAR是直肠癌患者预后的独立危险因素,其可与TNM分期等病理因素相互补充作为直肠癌患者的预后指标,为患者术后长期管理和治疗提供参考。
Objective To explore the correlation of preoperative fibrinogen-to-albumin ratio(FAR)with the clinicopathological characteristics and prognosis of patients with rectal cancer so as to clarify the role of coagulation function and nutritional status in the occurrence and progression of tumors.Methods We retrospectively analyzed the clinicopathological data of 647 patients with rectal cancer who underwent radical resection in The First Affiliated Hospital of Xi’an Jiaotong University from January 1,2013 to December 31,2016.According to the optimal cut-off point value of FAR determined by receiver operating characteristic curve,647 rectal cancer patients were divided into high FAR level group and low FAR level group.The correlation between different preoperative FAR levels and clinicopathological characteristics of rectal cancer patients was analyzed.Multivariate Cox regression analysis was used to analyze the independent risk factors for the prognosis of rectal cancer patients.R software was used to construct the nomogram,and C index and calibration chart were used to evaluate the prediction efficiency of the nomogram.Results Preoperative FAR levels had a good predictive value for the prognosis of rectal cancer patients.The area under ROC curve was 0.771,the optimal cut-off point was 0.092,and the Youden index was 0.446.There were statistically significant differences in age,T stage,N stage,TNM stage,preoperative CEA levels and preoperative CA19-9 levels between rectal cancer patients with different preoperative FAR levels(P<0.05).The overrall survival and disease-free survival of rectal cancer patients with different preoperative FAR levels had statistically significant differences(P<0.05).In the multivariate analysis,preoperative FAR levels(≥0.092,HR=3.298,95%CI:2.365―4.600,P<0.001),age(≥60 years,HR=2.110,95%CI:1.479―3.012,P<0.001),TNM stage(Ⅲgrade,HR=6.743,95%CI:2.771―16.771,P<0.001),grade of differentiation(poor,HR=1.639,95%CI:1.104―2.432,P=0.014),preoperative CA19-9 levels(≥37 U/mL,HR=2.205,95%CI:1.529―3.180,P<0.001)and not perform postoperative chemoradiotherapy(HR=1.792,95%CI:1.294―2.480,P<0.001)were independent risk factors of overall survival for patients with rectal cancer.OS and DFS nomograms of rectal cancer were established by the Rlanguage software,and the C-index was(0.781,95%CI:0.749―0.815;0.754,95%CI:0.693―0.760),respectively.The calibration curve of the nomogram showed high consistence between predictions and actual results for 1-year,3-year,5-year OS and DFS.Conclusion The preoperative high FAR level was an independent risk factor for the prognosis of patients with rectal cancer.It can be supplemented with pathological factors such as TNM stage as prognostic indicators for patients with rectal cancer,which may be helpful for clinicians to follow up or make beneficial treatment for rectal cancer patients.
作者
张磊
王黎昭
时飞宇
刘改霞
胡晨浩
佘军军
ZHANG Lei;WANG Lizhao;SHI Feiyu;LIU Gaixia;HU Chenhao;SHE Junjun(Department of General Surgery,The First Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710061;Highland of Talents,The First Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710061,China)
出处
《西安交通大学学报（医学版）》
CAS
CSCD
北大核心
2021年第5期755-762,共8页
Journal of Xi’an Jiaotong University（Medical Sciences）
基金
西安交通大学第一附属医院重大新医疗新技术项目(No.XJYFY-2019ZD004)。
