白蛋白与纤维蛋白原表达比对230例乳腺浸润性导管癌预后影响分析

Analysis of the effect of albumin to fibrinogen ratio expression on the prognosis of 230 cases of breast invasive ductal carcinoma

目的选择合适的预后指标对提高乳腺癌患者的生活质量具有重要意义。本研究探讨白蛋白与纤维蛋白原比(albumin to fibrinogen ratio,AFR)在乳腺浸润性导管癌组织中的表达及预后意义。方法选取河北医科大学第四医院乳腺中心2009-01-01-2012-04-30行手术切除的230例原发性乳腺浸润性导管癌患者石蜡包埋组织为研究对象,收集术前患者血清的纤维蛋白原和白蛋白数值,并采用Kaplan-Meier法及Cox比例回归风险模型进行生存分析,探讨AFR表达与无病生存率(disease free survival,DFS)的关系,并根据多因素结果,将P <0.05建立DFS预后模型。结果 AFR采用二分类法,将AFR分为2组,当AFR≥13.1时,无病生存期为(59.97±17.19)个月,当AFR<13.1时,无病生存期为(65.30±13.74)个月,二者相比差异有统计学意义,Z=1.178,P=0.010。单因素分析结果表明红细胞(Wald=3.962,P=0.047)、AFR(Wald=44.042,P=0.008)、TNM(Wald=6.754,Ⅰ期与Ⅱ期P=0.016,Ⅰ期与Ⅲ期P=0.014)、核分级(Wald=16.947,1级与2级P=0.099,1级与3级P=0.001)、p53(Wald=19.481,<25%与≥25%~<50%P=0.471,<25%与≥50%~<75%P=0.072,<25%与≥75%P=0.014)、Ki-67(Wald=9.223,P=0.002)及脉管瘤栓(Wald=21.171,P<0.001)与无病生存期相关。多因素结果表明AFR(HR=1.346,95%CI为1.107~1.636,P=0.003)、TNM(Ⅰ期与Ⅱ期HR=5.604,95%CI为1.859~16.891,P=0.002;Ⅰ期与Ⅲ期HR=3.674,95%CI为0.856~15.766,P=0.080)、核分级(1级与2级HR=4.450,95%CI为0.749~26.447,P=0.101;1级与3级HR=25.315,95%CI为3.483~183.984,P=0.001)、p53(<25%与≥25%~<50%HR=0.343,95%CI为0.100~1.174,P=0.088;<25%与≥50%~<75%HR=0.051,95%CI为0.009~0.308,P=0.001;<25%与≥75%HR=6.235,95%CI为2.112~18.405,P<0.001)、Ki-67(HR=7.934,95%CI为1.483~42.457,P=0.016)及脉管瘤栓(HR=11.336,95%CI为4.602~27.924,P<0.001)与无病生存期相关,以多因素分析里P<0.05的因素为变量建立乳腺浸润性导管癌患者DFS预后模型,预测患者3年及5年DFS,模型受试者工作特征曲线(receiver operating characteristic curve,ROC)下面积为0.834。结论 AFR低表达是改善乳腺癌DFS的独立预后因素,预后模型预测效能良好。

OBJECTIVE The incidence of breast cancer continues to rise,and it is important for patients to choose appropriate prognostic indicators to improve their quality of life.This article explores the ratio of albumin to fibrinogen ratio(AFR)in breast invasive ductal carcinoma.Expression and its prognostic significance.METHODS A total of230 paraffin-embedded specimens of breast invasive ductal carcinoma admitted to the Breast Center of the Fourth Hospital of Hebei Medical University from January 2009 to April 2012 were collected.A retrospective study was conducted to collect fibrinogen and albumin indicators from preoperative patients.Survival analysis was performed by using Kaplan-Meier method and Cox proportional regression risk model to explore the relationship between AFR expression and prognosis.RESULTS AFR adopted a two-category method to divide AFR into 2 groups,namely AFR <13.1 and AFR≥13.1,when AFR≥13.1,the disease-free survival period was(59.97±17.19)months,when AFR <13.1,the disease-free survival period was(65.30±13.74)months,and the difference between the two was statistically significant(Z=1.178,P=0.010).Univariate analysis showed that red blood cells(Wald=3.962,P=0.047),AFR(Wald=44.042,P=0.008),TNM [Wald=6.754,phaseⅠand phaseⅡ (P=0.016),phase I and phaseⅢ (P=0.014)],Nuclear classification[Wald=16.947,Level 1 and Level 2(P=0.099),Level 1 and Level 3(P=0.001)],p53 [Wald=19.481,<25% and≥20%-<50%(P=0.471),Level<25% and ≥50%-<75%(P=0.072),Level<25% and ≥75%(P=0.014)],Ki-67(Wald=9.223,P=0.002)and vascular tumor thrombus(Wald=21.171,P=0.000)were associated with disease-free survival.This study included these factors in multivariate analysis.Factor results showed that AFR(HR=1.346,95%CI=1.107-1.636,P=0.003),TNM(PhaseⅠ and Ⅱ,HR=5.604,95%CI=1.859-16.891,P=0.002;PhaseⅠandⅢ,HR=3.674,95%CI=0.856-15.766,P=0.080),nuclear classification(level 1 and 2,HR=4.450,95%CI=0.749-26.447,P=0.101;level 1 and 3,HR=25.315,95%CI=3.483-183.984,P=0.001),p53(<25% and ≥25-<50%,HR=0.343,95%CI=0.100-1.174,P=0.088,<25% and ≥50%-<75% HR=0.0511,95%CI=0.009-0.308,P=0.001;<25%and≥75%;HR=6.235,95%CI=2.112-18.405,P<0.001),Ki-67(HR=7.934,95%CI=1.483-42.457,P=0.016)and vascular tumor thrombus(HR=11.336,95%CI=4.602-27.924,P<0.001)were related to the disease-free survival period.Factors that P<0.05 in multivariate analysis were used to establish a DFS prognosis model for patients with invasive ductal carcinoma of the breast,predicting patients to be disease-free for 3 and 5 years Survival rate,the area under the receiver operating characteristic curve(ROC)of the model was 0.834.CONCLUSION AFR low expression is an independent prognostic factor for improving breast cancer DFS,the prognostic model established in this study has good predictive performance.