结肠癌患者化疗前后血清白蛋白水平与临床病理特征及预后的关系研究

Relationship between serum albumin level pre-and post-chemotherapy and clinicopathological features and prognosis in patients with colon cancer

目的分析结肠癌患者化疗前后血清白蛋白(ALB)水平与患者临床病理特征及预后的关系。方法纳入2014年1月至2015年6月接受一线含氟尿嘧啶方案化疗的结肠癌患者205例为研究对象,开展回顾性分析。检测患者化疗前后血清ALB等生化指标水平,分析不同近期疗效及临床病理特征患者的ALB水平情况,并根据随访资料,分析不同ALB水平患者的生存情况,探讨ALB对患者预后的影响。结果化疗后205例研究对象中CR、PR、SD、PD患者分别为3例(1.46%)、104例(50.73%)、72例(35.12%)、26例(12.68%);化疗后ALB<35 g/L的患者占比高于化疗前(P<0.05),化疗后ALB平均水平低于化疗前(P<0.05)。化疗前后,PD患者ALB水平均低于其他3组(均P<0.05)。化疗后,PR、SD患者ALB水平均下降(均P<0.05)。化疗前,年龄<60岁者ALB水平高于年龄≥60岁者,肝转移患者ALB水平低于未发生肝转移患者;化疗后,年龄<60岁者ALB水平高于年龄≥60岁者,ZPS评分0分者ALB水平高于1~2分者,CEA>4.3 ng/m L者ALB水平低于≤4.3 ng/mL者(均P<0.05)。患者1年、2年、3年累积生存率分别88.2%、69.3%、50.9%,中位生存时间40个月;化疗前后ALB≥35 g/L者总生存时间均长于ALB<35 g/L者(均P<0.05)。单因素分析显示化疗前后ALB水平、肝转移与否、化疗前CEA水平与患者累积生存时间有关(均P<0.05);多因素分析显示化疗后ALB水平是患者累积生存时间的独立影响因素(P<0.05)。结论化疗后患者的ALB平均水平较化疗前下降,不同近期疗效及临床病理特征的患者其化疗前后ALB水平不同,化疗后ALB水平是累积生存时间的独立影响因素。

Objective To analyze the relationship between the albumin level（ALB） pre-and post-chemotherapy and the clinicopathological features and prognosis in patients with colon cancer. Methods We retrospectively analyze clinical data of 205 patients with colon cancer who received first-line chemotherapy with fluorouracil from January 2014 to June 2015. The serum ALB level and other biochemical indices pre-and post-chemotherapy were recorded. The ALB levels were compared among patients with different short-term efficacy and different clinicopathological features. Survival data of patients with different ALB levels were obtained during follow-ups and analyzed to investigate factors that affect prognosis. Results After chemotherapy, there were 3（1.46%）, 104（50.73%）, 72（35.12%）, 26（12.68%） of patients with CR, PR, SD and PD, respectively. Proportion of patients with ALB level 35 g/L was higher post-chemotherapy than pre-chemotherapy（P〈0.05）. ALB level decreased after chemotherapy（P〈0.05）. Both preand post-chemotherapy ALB levels were lower in patients with PD then other three groups of patients（P〈0.05）. After chemotherapy,ALB levels decreased in patients with PR and SD. Before chemotherapy, ALB level was higher in patients aged 60 years old than those aged ≥ 60 years old and was lower in patients with liver metastasis than those without. After chemotherapy, ALB level was higher in patients aged 60 years old than those aged ≥ 60 years old and in patients with ZPS score of 0 than those with ZPS score higher than 1-2, and was lower in patients with CEA level 4.3 ng/m L than those with CEA level ≤ 4.3 ng/m L（P〈0.05）. The cumulative1-year, 2-year, and 3-year survival rates were 88.2%, 69.3%, 50.9%, respectively, and median survival time was 40 months. Total survival time was longer in patients with pre-and post-chemotherapy ALB level ≥35 g/L than those with ALB level 35 g/L（P〈0.05）. Univariate analysis showed that pre-and post-chemotherapy ALB level, liver metastasis and pre-chemotherapy CEA level were significantly associated with cumulative survival time（P〈0.05）. Multivariate analysis showed that post-chemotherapy CEA level was independent explanatory factor for cumulative survival time（P〈0.05）. Conclusion ALB levels decrease after chemotherapy. ALB levels differ among patients with different short-term efficacy and clinicopathological features. Post-chemotherapy ALB level is an independent explanatory factor for cumulative survival time.