纤维蛋白原/白蛋白比值比对可手术乳腺癌患者预后的影响

Effect of fibrinogen to albumin ratio on prognosis of operable breast cancer patients

目的探讨纤维蛋白原/白蛋白比值比(FAR)对可手术乳腺癌患者预后的影响。方法依据纳入、排除标准,收集中国医学科学院北京协和医院2013年1~12月收治的520例Ⅰ~Ⅲ期可手术乳腺癌患者临床资料进行回顾性研究。在术前检测血浆纤维蛋白原和白蛋白水平。将纤维蛋白原与白蛋白质量浓度比值乘以100定义为FAR。根据受试者工作特征曲线确定FAR最佳临界值,并依据最佳临界值将受试者分为高FAR组(FAR>6.99)147例和低FAR组(FAR≤6.99)343例。采用Kaplan-Meier法和log-rank检验评估2组患者的DFS和OS,用Cox比例风险回归模型分析患者DFS和OS的影响因素。结果log-rank检验显示,高FAR组患者的DFS和OS均比低FAR组差(χ2=32.885、16.320,P均<0.001)。Cox比例风险回归模型单因素分析和多因素分析均显示:高FAR为患者DFS的独立危险因素(HR=4.092,95%CI:2.425~6.903,P<0.001;HR=4.226,95%CI:2.476~7.212,P<0.001);高FAR为患者OS的独立危险因素(HR=3.907,95%CI:1.913~7.978,P<0.001;HR=4.320,95%CI:2.087~8.942,P<0.001)。结论术前高FAR患者的无疾病进展时间更短,OS率更低。术前FAR水平有望成为预测乳腺癌患者预后的有效指标。

Objective To investigate the effect of preoperative fibrinogen to albumin ratio(FAR)on prognosis of operable breast cancer patients.Methods According to the inclusion and exclusion criteria,520 patients with stageⅠtoⅢoperable breast cancer in the Peking Union Medical College Hospital,Chinese Academy of Medical Sciences from January to December 2013 were involved in this retrospective study.Serum levels of fibrinogen and albumin were measured before operation.FAR was defined as the concentration ratio of fibrinogen and albumin multiplied by 100.Subjects were divided into two groups according to the cutoff value determined by the receiver operating characteristic curve:high FAR group(FAR>6.99)(147 patients)and low FAR group(FAR≤6.99)(343 patients).DFS and OS in two groups were assessed using the Kaplan-Meier method and log-rank test.Cox proportional hazard regression model was used to identify the influencing factors of DFS and OS.Results The log-rank test showed that high FAR group had significantly lower DFS and OS compared with low FAR group(χ2=32.885,16.320,both P<0.001).The univariate and multivariate analyses showed that high FAR was an independent risk factor of DFS(HR=4.092,95%CI:2.425-6.903,P<0.001;HR=4.226,95%CI:2.476-7.212,P<0.001)and OS(HR=3.907,95%CI:1.913-7.978,P<0.001;HR=4.320,95%CI:2.087-8.942,P<0.001).Conclusion The patients with preoperative high FAR are prone to short progression-free survival and low OS rate,so preoperative FAR is a potential prognostic factor of breast cancer.