术前血清ALT水平与胃癌患者预后的相关性研究

Correlation between preoperative serum alanine transaminase and the prognosis of postoperative gastric cancer patients

目的探讨胃癌患者术前血清ALT水平与预后的相关性。方法回顾性分析2008年1月至2010年12月期间在哈尔滨医科大学附属肿瘤医院胃肠外科行胃癌手术治疗的491例胃癌患者的临床资料。以血清ALT最佳ROC曲线截点为参考对患者进行分组,分析血清ALT与患者临床因素之间的关系,并进行单因素和多因素生存分析。结果血清ALT矣20.05U/L组患者有201例,血清ALT>20.05U/L组患者有290例。血清ALT与患者的年龄(X^2=11.231,P<0.001)、肿瘤浸润深度(X^2=23.178,P<0.001)、血清GGT(X^2=19.190,P<0.001)及血清AST(X^2=30.771,P<0.001)均有关。血清ALT:S20.05 U/L组和血清ALT>20.051;几组患者的1、3、5年生存率分别为83.5%、51.4%、42.1%和66.2%、27.4%、15.7%,两组比较差异均有统计学意义(X^2=41.711,P<0.001)。多因素分析显示,肿瘤TNM分期(HR=1.882,95%CI:1.468-2.413,P<0.001)、肿瘤浸润深度(HR=1.161,95%CI:1.020-1.322,P=0.024)、淋巴结转移(HR=1.177,95%CI:l.042-1.329,P=0.009)、Hb(HR=0.726,95%CI:0.579-0.909,P=0.005)、中性粒细胞/淋巴细胞比值(HR=1.275,95%CI:1.002-1.623,P=0.048)及血清ALT(HR=2.191,95%CI:1.754~2.738,P<0.001)均为影响胃癌患者预后的独立危险因素。结论血清ALT是胃癌患者预后的独立危险因素。

Objective To study the relationship between preoperative serum ALT and clinicopathological factors in patients with gastric cancer after radical gastrectomy.Methods At the Department of Gastrointestinal Surgery,Tumor Hospital of Harbin Medical University from Jan 2008 to Dec 2010,491 patients were grouped according to ROC curve cut-off point of serum ALT.The relationship between ALT and clinical factors was analyzed,and single-factor and multi-factor survival analysis was performed.Results There were 201 patients with ALT≤20.05 U/L,and 290 patients with ALT>20.05 U/L Serum ALT was associated with age(X^2=11.231,P<0.001),depth of tumor invasion(X^2=23.178,P<0.001),GGT(X^2=19.190,P<0.001)and AST(X^2=30.771,P<0.001).The 1-,3-,and 5-year survival rates of patients with ALT≤20.05U/L and ALT>20.05U/L were 83.5%,51.4%,42.1%and 66.2%,27.4%,15.7%.There was significant difference between the two groups(X^2=41.711,P<0.001).Multivariate analysis showed that tumor TNM stage(HR=1.882,95%CI:1.468-2.413,P<0.001),tumor infiltration depth(HR=1.161,95%C I::1.020-1.322,P=0.024),lymph node metastasis(HR=1.177,95%CI:1.042-1.329,P=0.009),Hb(HR=0.726,95%CI:0.579-0.909,P=0.005),neutrophil to lymphocyte rate(HR=1.275,95% CI:1.002-1.623,P=0.048)and ALT(HR=2.191,95%CI:1.754-2.738,P<0.001)were independent risk factors for the prognosis.Conclusions Serum ALT is an independent risk factor for the prognosis of gastric cancer patients after radical gastrectomy.