术前C-反应蛋白/清蛋白比值评估非小细胞肺癌预后的价值

Value of preoperative C-reactive protein/albumin ratio in evaluating the prognosis of non-small cell lung cancer

目的探讨C-反应蛋白/清蛋白比值(CAR)对评估非小细胞肺癌(NSCLC))预后的临床价值。方法回顾性分析该院284例NSCLC手术患者的临床资料。采用受试者工作特征曲线(ROC曲线)分析CAR的截断值,按截断值分为高值组和低值组,比较两组临床资料;采用Kaplan-Meier分析两组NSCLC的总生存时间(OS);采用Cox比例风险模型分析影响NSCLC预后的危险因素。结果 ROC曲线分析显示,CAR=0.465为NSCLC患者的最佳截断点;CAR高值组和低值组患者的性别、体质量指数、病理分型、肿瘤分级、肿瘤分期差异均有统计学意义(P<0.05);两组OS比较差异均有统计学意义(P<0.05),高值组预后差;单因素Cox分析结果显示,与OS相关的因素有年龄、吸烟、肿瘤分级、肿瘤分期、格拉斯哥预后评分(GPS)、CAR、中性粒细胞/淋巴细胞比值(NLR)和血小板/淋巴细胞比值(PLR)(P<0.05);多因素Cox分析结果显示,与OS相关的因素有吸烟、肿瘤分级、肿瘤分期、CAR、GPS评分、NLR。高水平CAR比低水平CAR增加了1.67倍的死亡风险(95%CI:1.19~2.36)。结论术前高水平CAR为NSCLC的预后独立危险因素,具有较大的临床指导意义。

Objective To explore the clinical value of C-reactive protein/albumin ratio （CAR） in evaluating the prognosis of non-small cell lung cancer （NSCLC）. Methods Clinical data of 284 patients with NSCLC sur-gery were retrospective analyzed in the hospital. Receiver-operating characteristic （ROC） curve analysis was applied to determine the best cut off values for CAR. According to the cut off value, it was divided into two groups： high value group and low value group. The overall survival time of two groups of NSCLC was analyzed by Kaplan-Meier. Cox proportional hazards models were used to analyze the risk factors affecting the progno-sis of NSCLC. Results ROC analysis showed that the optimal cut off point for the prognosis of patients with NSCLC was CAR=0. 465. There were significant differences in gender, body mass index, pathological type, tumor grade,and tumor stage between the high value group and the low value group （P〈0.05）. Overall sur vival time, between the two group were statistically different （P〈0.05）. Univariate Cox analysis showed that OS related factors were age, smoking, tumor grade, tumor stage, Glasgow Outcome Score （GPS score） , CAR, neutrophil/lymphocyte ratio （NLR） and platelet/lymphocyte ratio （PLR） （P〈0.05）. Multi-factor-Cox analy-sis results showed that OS- related factors were smoking, tumor grade, tumor stage, CAR, GPS score and NLR. The risk of high level of CAR was 1.67 times higher than the low level of CAR （95%CI：1.19-2. 36）. Conclusion Preoperative CAR is an independent risk factor for prognosis of NSCLC and have great clinical guiding significance.