术前血清白蛋白水平对胃癌预后的影响

The significance of preoperative serum albumin level to prognosis in gastric cancer

1989年～1993年本院外科施行胃癌切除术者468例，男328例，女140例，平均年龄57．7岁。早期、进展期和晚期患者分别占总数的16．4％、54.5％和29.1％。术前血清白蛋白水平平均达到38.32g／L，术后并发症发生率为3．9％，干均住院天数33．4天，五年生存率达45．5％。通过Logistic回归分析各水手段Alb与性别、年龄、肿瘤分期、并发症发生率、住院天数、生存率的关系。结果：（1）肿瘤越早期，术前Alb水平越趋向正常值上限；（2）年龄越轻，术前Alb水平越趋于正常；（3）Alb＜35g／L的病人组中约1／3女性病人的白蛋白水平表现为＜30g／L；（4）存在术前Alb水平越低，术后并发症发生率越高。住院无数越长、生存率越不理想的趋势，但无统计学意义。提示胃癌患者入院时的白蛋白水平在一定程度上反映了肿瘤对机体代谢所造成的侵害，对临床诊治过程及预后仍具有一定的参考价值。患者存在明显低白蛋白血症时，应注重防治手术并发症。

Objective To analyze retrospectively the relationship between the properative serum albumin (Alb) level and clinical condition, Prognosis in gastric cancer patients.Method: 468 gastric cancer patients consisting of 328 males and 140 females under went gastrectomy in our surgery departrnent from 1989 to 1993 with the average age of 57. 7 years 16. 4 %. 54. 5 % and 29.1% of total patients belonged to early,advanced and late stage respectively. The average preopera tive serum albumin level reached 38. 32g/L and t he postoperative morbidity was 3. 9 %, with the mean hospital stay of 33.4 days. The five-ycar survival rate got to 45. 5 %. We analyzed the relationship between the albumin level intervals and sex,age, stage of tumor, complication rat, length of hospital stay, survival rate by Logistic regression. Result (1) the eartier the tumer stage, the closer the preoperative serum alburnin to the upper limit of normal value; (2) the younger the patient, the closer the preoperative serum albumin to the norrual value; (3) In the group with albumin level less than 35g/L, there were nearly one third female patients with the albumin less than 30g/L; (4) there lied a tend that the lower the preoperative albumin level, the higher the post operative morbidity, the longer the hospital stay and the worse the survival rate. However, the results were of no statistic significance.Conclusion: Although there are quite a few factors affecting the serum albumin level, the preoperative albumin level of gastric cancer patients reflects the tumor invasion to the organic metabolism to a certain degree. It may be of contribution to the clinical treatment and prognosis. It is necessary to improve or correct the existent hypoalbuminemia.