血清胆碱酯酶在189例晚期胃癌患者预后预测中的价值分析

Analysis of the Value of Serum Cholinesterase Level in Prognosis Prediction of 189 Patients with Advanced Gastric Cancer

[目的]探讨血清胆碱酯酶(cholinesterase,CHE)水平在晚期胃癌患者预后预测中的价值,建立晚期胃癌患者预后预测模型并验证。[方法]回顾性收集2011年5月至2019年12月在马鞍山市人民医院诊治的189例晚期胃癌患者临床资料并进行统计学分析,利用X-tile程序软件计算出CHE的最佳截断值(cut-off值),通过Cox比例风险模型分别评估CHE、白蛋白(albumin,ALB)、血红蛋白(hemoglobin,HB)、中性粒细胞与淋巴细胞比值(neutrophil-to-lymphocyte ratio,NLR)等临床病理参数对总生存期(overall survival,OS)的影响;采用多因素Cox风险比例回归模型筛选晚期胃癌独立预后影响因素;通过R软件绘制列线图并验证。[结果]CHE的最佳截断值为3611 U/L,CHE与年龄、ECOG评分、ALB、NLR、HB相关(P<0.05)。单因素Cox回归分析结果显示,CHE、ALB、NLR、ECOG评分、是否接受一线化疗与预后相关。多因素Cox回归分析结果显示,性别、ECOG评分、CHE、NLR、HB以及是否接受一线化疗是影响晚期胃癌预后的独立因素;基于上述6个参数构建的列线图预测OS的C指数为0.753(95%CI:0.722~0.784),校准曲线基本沿45°线分布。[结论]CHE在晚期胃癌患者的预后评估中有一定的临床价值,基于CHE等参数构建的列线图可较为准确地预测晚期胃癌患者预后。

[Objective]To explore the value of serum cholinesterase(CHE)level in the prognosis prediction of patients with advanced gastric cancer,and to construct and validate a nomogram of prognosis prediction for patients with advanced gastric cancer.[Methods]Clinical data of 189 patients with advanced gastric cancer admitted in Ma’anshan People’s Hospital from May 2011 to December 2019 were retrospectively analyzed.Serum cholinesterase(CHE),albumin(ALB)and hemoglobin(HB)levels,neutrophil-to-lymphocyte ratio(NLR)and other clinicopathological parameters were meaured and the optimal cut-off value of CHE was calnculated by X-tile sofware.The factors related to the overall survival(OS)of patients was analyzed with multivariate Cox proportional hazard regression model.A nomogram was developed based on the prognostic factors patients and verified using the R software.[Results]The optimal cut-off value of CHE was 3611 U/L and CHE was associated with age,ECOG scores,ALB,NLR,HB(P<0.05).Univariate Cox regression analysis revealed that CHE,ALB,NLR,ECOG scores,and first-line chemotherapy were associated with the prognosis.Multivariate Cox regression analysis showed that gender,ECOG score,CHE,NLR,and HB levels,and first-line chemotherapy were independent prognostic factors for advanced gastric cancer.A nomogram was constructed based on these 6 parameters and the c-index for predicting OS as 0.753(95%CI:0.722~0.784).Moreover,the calibration curve was closed to the 45-degree line.[Conclusion]In this study CHE has been proved its clinical value in prognosis prediction and a nomogram has been developed based on CHE and other 5 parameters,which may be used to predict the prognosis of patients with advanced gastric cancer.