Ⅰ期非小细胞肺癌患者术前C反应蛋白水平的临床意义

Clinical significance of C-reactive protein in patients with stage Ⅰ non-small cell lung cancer

目的研究Ⅰ期非小细胞肺癌（NSCLC）患者术前C反应蛋白（CRP）水平与临床病理特征之间的关系，以及对预后的影响。方法对1999年3月至2004年7月间，在上海市胸科医院接受手术治疗的105例Ⅰ期NSCLC患者的临床资料进行回顾性分析。用χ^2检验分析不同临床病理特征患者CRP水平之间的差异，Logistic回归分析影响CRP水平的相关因素，Kaplan—Meier法和Cox回归模型分析与生存相关的因素。结果105例患者中，CRP水平正常（≤5mg／L）组69例，增高（〉5mg／L）组36例。男性（P〈0．001）、有吸烟史（P=0．002）、鳞癌（P〈0．001）、肿瘤的分化程度低（P〈0．001）、肿瘤最大径〉3cm（P〈0．001）的患者术前CRP水平较高。肿瘤最大径大是引起Ⅰ期NSCLC患者CRP水平增高的独立因素（P=0．037）。CRP增高组患者的5年生存率和5年无疾病生存率分别为55．6％和41．7％，均较CRP正常组（分别为79．7％和68．1％）明显降低（均P〈0．05）。Cox多因素分析的结果表明，CRP水平是影响Ⅰ期NSCLC患者总生存期（P=0．009）和无疾病生存期（P=0．019）的独立因素。结论肿瘤最大径大是引起Ⅰ期NSCLC患者CRP水平增高的独立因素，CRP增高组患者的预后较差。

Objective The aim of this study was to investigate the association between preoperative C-reactive protein （CRP） level and pathologic features in patients with stage Ⅰ non-small cell lung cancer （NSCLC）, and also to analyze if CRP provides prognostic information for NSCLC patients. Methods The clinicopathological data of 105 patients with stage Ⅰ NSCLC, who underwent pulmonary resection in Shanghai Chest hospital from Mar 1999 to Jul 2004, were retrospectively reviewed. The association between preoperative CRP levels and several clinical variables was analyzed by chi square test. Logistic regression analysis was used for multivariate analysis. Kaplan-Meier method and Cox multivariate regression model was used to examine the prognostic significance of the covariates on survival. Results Among the 105 cases, 69 had CRP at normal level （ ≤5 mg/L） and 36 at increased level（ 〉5 mg/L）. The patients who were male （ P 〈 0. 001 ）, smoking （ P = 0. 002 ）, with squamous cell carcinoma （ P 〈 0. 001 ）, poor differentiation （P 〈 0. 001 ）, tumor size larger than 3 cm （P 〈 0.001 ） had a higher serum CRP level. The maxmal tumor diameter （P = 0.037） was an independent risk factor for preoperative serum CRP level elevation. The five- year survival rate and five-year disease free survival rate of the higher CRP group were lower than that in the normal CRP group （55.6% vs. 79.7%, P 〈0.05, and 41.7% vs. 68.1%, P 〈0.05, respectively）. Cox regression analysis demonstrated that the CRP level had effect on overall survival （ P = 0. 009） and disease free survival （P = 0. 019）. Conclusions Our findings indicate that the maximal tumor diameter is an independent risk factor for preoperative serum CRP level elevation. The overall survival, disease free survival, five-year survival rate and five-year disease free survival rate of the higher CRP group are lower than that in the normal CRP group.