术前外周血中纤维蛋白原水平与肾癌患者预后的关系

The relationship between preoperative plasma fibrinogen level and prognosis of renal cell carcinoma

目的探讨术前外周血中纤维蛋白原水平与经手术治疗的肾癌患者预后的关系。方法回顾性分析北大医院2010至2012年行手术治疗的280例肾癌患者的临床病理资料和术后随访资料,采用受试者工作特征曲线法确定纤维蛋白原的最佳临界值,根据临界值将患者分入高水平纤维蛋白原组和低水平纤维蛋白原组。χ^2检验分析两组间多种临床病理特征的区别,并采用Kaplan-Meier法计算生存率,Log-rank检验分析组件差距,使用Cox风险回归模型分析肾癌患者预后的独立预测因子。结果术前血浆纤维蛋白原水平与年龄、高血压、肿瘤分级、肿瘤病理分期密切相关(P=0.035,P=0.006,P<0.001,P<0.001)。单因素分析结果显示,血浆纤维蛋白原水平、肿瘤的分级、病理分期与患者总生存时间显著相关(P均<0.001)。进一步通过Cox回归模型分析发现,术前血浆纤维蛋白原水平是肾癌术后患者总体生存时间和肿瘤特异生存时间的独立预后因子,但并非无病生存时间的独立预后因子。结论术前血浆中高纤维蛋白原水平是肾癌术后患者不良预后的独立预测因素。

ObjectiveTo investigate the relationship between preoperative plasma fibrinogen level and the prognosis of resectable renal cell carcinoma. MethodsThe clinicopathological information and follow-up data of 280 patients with renal cell carcinoma treated with surgery during 2010 and 2012 were retrospectively analyzed.The optimal cut-off value of plasma fibrinogen was determined with receiver operating characteristics (ROC) curve,based on which the patients were divided into high fibrinogen group and low fibrinogen group.The differences in clinicopathological characteristics between the two groups were analyzed with Chi-square test.The overall survival (OS),cancer-specific survival (CSS) and disease-free survival (DFS) were assessed using the Kaplan-Meier method and compared with Log-rank test.The independent prognostic factors were analyzed with Cox regression model. ResultsThe preoperative plasma fibrinogen level was associated with age,hypertension,tumor grade and pathological stage (P=0.035, P =0.006, P<0.001, P<0.001).Multivariate analysis showed that plasma fibrinogen level,tumor grade and pathological stage were significantly related to OS (all P<0.001).Cox regression model indicated that plasma fibrinogen level was an independent predictor for OS and CSS,but not for DFS. ConclusionHigh preoperative plasma fibrinogen level is an independent negative prognostic factor for patients with renal cell carcinoma.