术前C反应蛋白/白蛋白比值在预测肾透明细胞癌患者预后方面的价值

Prognostic value of preoperative C-reactive protein /albumin ratio in patients with clear cell renal cell carcinoma

目的探讨术前C反应蛋白/白蛋白（CRP/Alb）比值在预测肾透明细胞癌（ccRCC）患者预后方面的价值。 方法回顾性分析2003年1月至2012年12月我院406例行手术治疗的ccRCC患者的临床资料。男253例，女153例。年龄24～80岁，中位年龄58岁。临床分期：Ⅰ期335例，Ⅱ期38例，Ⅲ期30例，Ⅳ期3例。376例伴肿瘤坏死。395例伴脉管侵犯。分析患者术前CRP/Alb比值与患者临床病理参数及总生存率（OS）的相关性。根据受试者工作特征（ROC）曲线的曲线下面积（AUC）比较CRP/Alb比值、格拉斯哥预后评分（GPS）、改良格拉斯哥预后评分（mGPS）预测ccRCC患者预后的价值。 结果CRP/Alb比值与患者年龄（P＝0.007）、临床分期（P〈0.001）、肿瘤坏死（P〈0.001）、脉管侵犯（P〈0.001）、OS（P〈0.001）相关。多因素回归分析结果显示，CRP/Alb比值（P〈0.001）、GPS（P＝0.001）、mGPS（P＝0.019）、年龄（P＝0.035）和临床分期（P〈0.001）均是预测ccRCC患者预后的独立因素。CRP/Alb（连续变量）、CRP/Alb（分段变量）、GPS、mGPS预测患者3年生存率的AUC分别为0.88、0.84、0.85、0.80；预测患者5年生存率的AUC值分别为0.80、0.79、0.76、0.72 ，CRP/Alb比值预测3年或5年生存率的能力优于GPS和mGPS。 结论CRP/Alb比值是ccRCC患者的独立预后因素，在预测预后生存方面CRP/Alb比值比GPS、mGPS更具有优势。

ObjectiveTo assess the prognostic value of C-reactive protein/albumin （CRP/Alb） ratio in patients with clear cell renal cell carcinoma （ccRCC）. MethodsThe study comprised 406 ccRCC patients undergoing nephrectomy between January 2003 and December 2012 in our hospital. There were 253 males and 153 females, aged 24-80 years, with a median age of 58 years. There were 355 cases with TNM Ⅰ stage, 38 cases with Ⅱ stage, 30 cases with Ⅲ stage, 3 cases with Ⅳ stage. There were 376 cases with tumor necrosis and 40 cases without tumor necrosis. There were 395 cases of vascular invasion, 21 cases without vessel invasion. The correlations among the pretreatment CRP/Alb ratio, clinicopathological parameters, and overall survival （OS） were evaluated. We compared the prognostic value of the CRP/Alb ratio with GPS and mGPS using the area under the curve （AUC）. ResultsCRP/Alb ratio was associated with age at surgery （P=0.007）, TNM stage （P〈0.001）, tumor necrosis （P〈0.001） and lymphovascular invasion （P〈0.001）, and OS （P〈0.001）. The multivariate analysis confirmed that the CRP/Alb ratio independently predicted the OS of patients with ccRCC （P〈0.001）, the Glasgow prognostic score （GPS） （P=0.001） and modified GPS （mGPS） （P=0.019） were also independent prognostic factors. For predicting 3-year survival, the AUC values for CRP/Alb （continuous）, CRP/Alb （categorical）, GPS and mGPS were 0.88, 0.84, 0.85, 0.80. For predicting 5-year survival, the AUC values for CRP/Alb （continuous）, CRP/Alb （categorical）, GPS and mGPS were 0.80, 0.79, 0.76, 0.72. The CRP/Alb ratio was superior to GPS and mGPS in predicting the 3- or 5-year survival rate of ccRCC patients. ConclusionsThe CRP/Alb ratio could be an independent prognostic factor in ccRCC patients. The CRP/Alb ratio could take the place of the GPS and mGPS in terms of predicting prognosis in ccRCC.