术前C反应蛋白和清蛋白比值对可切除胰腺癌患者预后的影响

Preoperative C-reactive protein/albumin ratio predicts the prognosis of patients with resectable pancreatic cancer

目的探讨术前C反应蛋白（CRP）和清蛋白（Alb）比值对可切除胰腺癌患者术后生存的影响，评估其在胰腺癌预后中的潜在临床价值。方法回顾性分析2005年1月至2015年12月在苏州大学第三附属医院肝胆胰外科接受手术治疗的97例胰腺癌患者的临床资料。按照受试者工作特征曲线选取CRP／Alb的临界值。并按临界值将CRP／Alb≥0．109和CRP／Alb〈0．109分别定义为高CRP／AIb组和低CRP／Alb组。采用χ^2检验分析CRP／Alb与临床观察的相关性；Kaplan-Meier法评估两组患者术后中位生存期及1年总体生存率的差异；单因素及多因素的Cox比例风险回归模型分析影响胰腺癌患者不良预后的预后因素。结果CRP／Alb与肿瘤TNM分期（χ^2=4．280，P=0．039）、肿瘤分化程度（χ^2=6．635，P=0．01）显著相关；高CRP／Alb组与低CRP／Alb组患者术后中位生存期分别为15个月与23个月，高CRP／Alb组患者术后1年生存率较低比值组显著下降，差异有统计学意义（x。10．207，｜P=0．001）。此外，术后中位生存期及1年生存率在高龄（≥65岁：x。=5．338，P=0．021）、高临床TNM分期（ⅡB-Ⅲ期：χ^210．529，P：0．001）、有血管侵犯（χ^27．856，P：0．005）、肿瘤中．低分化（χ^2=5．380，P=0．020）及切缘阳性（χ^2=9．059，P=0．003）患者中均明显下降；高CRP／Alb是胰腺癌患者的独立预后不良因素（HR=1．832，95％CI：1．067-3．144，P=0．028），此外，高龄（职=1．684，P=0．014）、高肿瘤TNM分期（HR=1．666，P=0．031）、有血管侵犯（HR：1．834，P=0．024）及切缘阳性（HR=2．205，P=0．023）也是患者的独立预后因素。结论术前CRP／Alb在评估可切除胰腺癌患者的预后中具有重要的临床价值，CRP／Alb高提示预后不良。

Objective To evaluate the clinical significance of C-reactive protein/albumin ratio in predicting the postoperative prognosis of pancreatic cancer patients. Methods The clinical date of 97 patients with resectable pancreatic cancers who treated at Department of Hepatobiliary and Pancreatic Surgery,the third Affiliated Hospital of Soochow University from January 2005 to December 2015 were analyzed retrospectively. The cut-off value of CRP/Alb ratio was determined by the receiver operating characteristic （ROC） curve. According to the CRP/Alb ratio, patients were respectively divided into two groups ： the high group （ CRP/Alb ratio ≥ 0. 109） and the low group （ CRP/Alb 〈 0. 109）. The relationships between CRP/Alb ratio and clinical characteristics were analyzed by test. Median survival and 1-year overall survival rate （ OS ） was calculated by Kaplan-Meier method. The risk factors of patients with poor prognosis were analyzed by univariate and multivariate Cox regression analysis model. Results Tumor TNM stage（ χ^2 = 4. 280, P = 0. 039 ） and differentiation （ χ^2 = 6. 635, P = 0. 010 ） had significant relationship with CRP/Alb ratio. The median survival of higher CRP/Alb ratio group and lower CRP/Alb ratio group was 15 months and 23 months respectively. Compared with lower CRP/Alb ratio group, the 1-year OS of higher CRP/Alb ratio group decreased remarkablely, and the difference was statistically（ χ^2= 10. 207,P= 0. 001 ）. Moreover, median survival and OS were decreased in patients with advanced age （≥ 65 years old：χ^2=5. 338, P = 0. 021 ） , high TNM stage （Ⅱ B- Ⅲ ： χ^2= 10. 529, P = 0. 001 ） , poor tumor differentiation （χ^2 = 5. 380, P = 0. 020）, vascular invasion （ χ^2 = 7. 856, P = 0. 005 ） and positive surgical margin （χ^2 = 9. 059, P = 0. 003 ）. A high CRP/Alb ratio was identified as an independent risk factor of poor prognosis for patients with pancreatic cancer（HR= 1. 832,95% CI： 1. 067-3. 144,P = 0. 028）. Besides, old age （HR = 1. 684,P = 0. 014）, high TNM stage （ HR = 1. 666, P = 0. 031 ） , vascular invasion （ HR = 1. 834, P = 0. 024） arid positive surgical margin （HR = 2. 205, P = 0. 023 ） were also included. Conclusion Preoperative CRP/Alb ratio can be an important clinical factor for assessing the prognosis of patients with resectable pancreatic cancers, and high CRP/Alb ratio suggests poor prognosis.