肾癌患者术前血清γ-谷氨酰转肽酶水平与术后生存的相关性研究

Correlation between preoperative serumγ⁃gultamyl transferase level and postoperative survival in patients with renal cell carcinoma

目的探讨肾癌患者术前血清γ-谷氨酰转肽酶(GGT)水平与术后生存的相关性。方法回顾性分析中国矿业大学附属医院2005年12月至2011年12月235例接受手术治疗的肾癌患者临床资料。根据术前血清GGT水平1.5倍正常值上限90 U/L(本研究样本正常值上限为60 U/L),将患者分成GGT≤90 U/L组(218例)及GGT>90 U/L组(17例)。分析GGT与肾癌患者临床病理特征及术后生存的相关性。结果GGT≤90 U/L组与GGT>90 U/L组性别、年龄、天冬氨酸氨基转移酶水平、丙氨酸氨基转移酶水平、中性粒细胞与淋巴细胞比值、淋巴结转移、远处转移、肿瘤分期比较,差异均有统计学意义(均P<0.05)。Kaplan-Meier生存分析结果显示,GGT≤90 U/L组中位总生存时间为84个月,GGT>90 U/L组为54个月,两组差异有统计学意义(χ^(2)=4.334,P=0.037)。单因素Cox回归分析结果显示,病理类型、病理T分期、术前GGT水平、乳酸脱氢酶水平、丙氨酸氨基转移酶水平是肾癌患者术后总生存的影响因素(均P<0.05)。多因素Cox回归分析结果显示,病理类型(HR=2.323,95%CI 1.228~4.396,P=0.010)、GGT水平(HR=2.406,95%CI 1.077~5.376,P=0.032)、乳酸脱氢酶水平(HR=2.320,95%CI 1.080~4.981,P=0.031)是肾癌患者术后总生存的独立影响因素。结论肾癌患者术前血清GGT水平升高与不良预后相关,监测GGT有助于评估肾癌患者预后,为制订个体化治疗方案提供参考。

Objective To investigate the correlation between preoperative serumγ-glutamyl transferase(GGT)level and the postoperative survival of patients with renal cell carcinoma.Methods The clinical data of 235 patients with renal cell carcinoma who underwent nephrectomy from December 2005 to December 2011 in the Affiliated Hospital of China University of Mining and Technology were retrospectively analyzed.According to the preoperative serum GGT level at 1.5 times the upper limit of normal value 90 U/L(the upper limit of normal value of samples in this study was 60 U/L),patients were divided into 2 groups:GGT≤90 U/L group(218 cases)and GGT>90 U/L group(17 cases).The correlation between GGT and clinicopathological characteristics as well as postoperative survival of patient with renal cell carcinoma was also analyzed.Results There were statistically significant differences in gender,age,the level of the aspartate aminotransferase(AST),the level of alanine aminotransferase(ALT),the neutrpphil-to-lymphocyte ratio(NLR),lymph node metastasis,distant metastasis,neoplasm staging between GGT≤90 U/L group and>90 U/L group(all P<0.05).Kaplan-Meier survival analysis showed that the median overall survival time was 84 months and 54 months,respectively in GGT≤90 U/L group and GGT>90 U/L group,and the difference was statistically significant of both groups(χ^(2)=4.334,P=0.037).Univariate Cox proportional risk regression model showed that pathologic type,pathology T staging,preoperative GGT level,lactate dehydrogenase(LDH)level,ALT level were influencing factors of postoperative overall survival in patient with renal cell carcinoma(all P<0.05).The multivariate Cox regression model analysis showed that the pathological type(HR=2.323,95%CI 1.228-4.396,P=0.010),GGT level(HR=2.406,95%CI 1.077-5.376,P=0.032),LDH level(HR=2.320,95%CI 1.080-4.981,P=0.031)were independent influencing factors of postoperative overall survival in patient with renal cell carcinoma.Conclusions Preoperative elevated serum GGT level is associated with poor prognosis of patients with renal cell carcinoma,and the monitoring of it may help to evaluate the prognosis of patients and provide guidelines for individual treatment method.