术前血清白蛋白水平对胃癌根治术患者的预后评估价值

Prognostic significance of preoperative serum albumin level in patients with gastric cancer

目的探讨术前血清白蛋白水平对胃癌根治术患者的预后评估价值。方法回顾分析天津医科大学附属肿瘤医院2001年1月至2003年12月间行胃癌根治术的146例患者的临床病理资料，其中术前血清白蛋白正常者115例（〉35g／L，正常组），降低者31例（≤35g/L，降低组）。结果血清白蛋白正常组和降低组术后分别有50例（43．5％）和28例（90．3％）复发，差异有统计学意义（P〈0．01）。两组术后5年生存率分别为57．4％和9．7％，差异有统计学意义（P〈O．01）。经多因素预后分析显示，术前血清白蛋白水平是胃癌根治术患者的独立预后因素（P〈0．01）。进一步分层分析显示，无论有无淋巴结转移，两组患者5年生存率的差异均有统计学意义（P〈0．05）；对于胃下部癌，两组患者5年生存率的差异有统计学意义（P〈0．01）；但对于胃中上部癌。两组差异则无统计学意义（P〉0．05）。结论术前血清白蛋白降低的胃癌患者（尤其胃下部癌者）根治术后预后不佳．应予以积极的术后辅助治疗．

Objective To evaluate the prognostic significance of preoperative serum albumin in patients with gastric cancer undergoing radical resection. Methods A total of 146 patients with gastric cancer underwent radical resection from January 2001 to December 2003. Clinicopathological data were analyzed retrospectively. Patients were divided into two groups, including patients with a normal preoperative serum albumin level （〉35 g/L, n=l15） and patients with hypoalbuminemia （~〈35 g/L, n=31）. Results Patients with a low albumin level were associated with a higher postoperative recurrence rate （90.3% vs. 43.5%, P〈0.01）. The overall 5-year survival rate in patients with a normal serum albumin level was significantly higher than that in patients with a low serum level （57.4% vs. 9.7%, P〈0.01）. On multivariate analysis, preoperative serum albumin level was an independent factor associated with survival （P〈0.01）. When stratified by nodal metastasis, normal serum albumin level was still associated with higher survival rate （P〈0.05）. Prognostic significance was found in patients with lower stomach cancer（P〈0.01）, but not in patients with cancer in the upper and middle stomach （P〉0.05）. Conclusion Hypoalbuminemia is associated with worse survival in patients with cancer in the lower stomach and adjuvant therapy should be considered.