术后C-反应蛋白/白蛋白比值对胃癌根治术后早期并发症的预测价值

Value of postoperative C-reactive protein/albumin ratio in predicting short-term complication occurrence following radical gastrectomy for gastric cancer

目的探讨术后C-反应蛋白/白蛋白比值(C-reactive protein/albumin ratio,CAR)对胃癌根治术后早期并发症的预测价值。方法回顾性分析2016年3月-2018年8月在解放军总医院第一医学中心普通外科203例行R0胃癌根治术患者病历资料,采用单因素和多因素分析确定胃癌根治术后早期并发症的危险因素。绘制受试者工作特征(ROC)曲线对比CAR与C-反应蛋白(C-reactive protein,CRP)预测胃癌根治术后早期并发症的准确性,并计算出两者的临界值(cut-off value)。根据CAR的临界值将患者分为高CAR组和低CAR组,比较两组间轻度(Clavien-Dindo分级Ⅰ级或Ⅱ级)、重度(Clavien-Dindo分级Ⅲ级及以上)并发症发生情况及术后中位住院时间。结果203例患者中53例(26.1%)发生了术后早期并发症。单因素分析中胃癌根治术后早期并发症与术后CRP水平[OR(95%CI):7.737(3.828~15.636),P<0.001]、CAR值[OR(95%CI):8.757(4.244~18.069),P<0.001]和手术术式[OR(95%CI):2.110(1.077~4.132),P=0.028]的相关性有统计学意义。多因素风险分析显示,术后CAR值[OR(95%CI):5.540(1.021~30.075),P=0.047]是术后早期并发症的独立预测因素。ROC曲线显示,术后CAR对术后早期并发症的预测准确性略高于CRP(AUC:0.767 vs 0.752,灵敏度:0.741 vs 0.724,特异度:0.740 vs 0.707,约登指数:0.481 vs 0.431),CAR的临界值为2.83。高CAR组(CAR≥2.83,n=79)与低CAR组(CAR<2.83,n=124)对比,并发症发生率更高(50.6%vs 10.5%,P<0.001),术后中位住院时间更长[9(8,13)d vs 9(7,10)d,P=0.036]。结论术后CAR值是胃癌根治术后早期并发症的独立预测因素,且其预测价值略高于CRP。

Objective To investigate the value of postoperative C-reactive protein/albumin ratio(CAR)in predicting short-term complication occurrence following radical gastrectomy for gastric cancer.Methods Clinical data about 203 patients undergoing curative gastrectomy(R0)in the first medical center of Chinese PLA General Hospital from March 2016 to August 2018 were retrospectively analyzed.Univariate and multivariate analyses were performed to identify clinical factors in predicting postoperative complications.The receiver-operating characteristic(ROC)curves were plotted to compare the accuracy of CAR and CRP in predicting early complications,and their cut-off values were calculated.According to the cut-off value of CAR,patients were divided into high CAR group and low CAR group.The incidence of mild(Clavien-Dindo classification gradesⅠandⅡ)and severe(Clavien-Dindo classification gradesⅢor above)complications as well as average postoperative hospital stay between the two groups were compared.Results Of all the patients,53(26.1%)cases developed early postoperative complications.In univariate analysis,the correlations between early postoperative complications after radical gastrectomy and postoperative CRP(OR,7.737;95%CI,3.828 to 15.636;P<0.001),postoperative CAR(OR,8.757;95%CI,4.244 to 18.069;P<0.001)and surgical method(OR,2.110;95%CI,1.077 to 4.132;P=0.028)were statistically significant.Multivariate analysis identified postoperative CAR(OR,5.540;95%CI,1.021 to 30.075;P=0.047)was an independent risk factor for early postoperative complications.ROC curves showed that the accuracy of CAR in predicting early postoperative complications was a little higher than that of postoperative CRP(AUC:0.767 vs 0.752;sensitivity:0.741 vs 0.724;specificity:0.740 vs 0.707,Youden’s index:0.481 vs 0.431).The optimal cut-off value of CAR was 2.83.Compared with the low CAR group(CAR<2.83,n=124),the high CAR group(CAR≥2.83,n=79)had a higher incidence of complications(50.6%vs 10.5%,P<0.001)and a greater median postoperative hospital stay[9(8,13)d vs 9(7,10)d,P=0.036].Conclusion Postoperative CAR is an independent predictor for short-term complication following radical gastrectomy for gastric cancer,and the diagnostic accuracy is a little higher compared to CRP alone.