术前血小板与白蛋白比值对Ⅰ~Ⅲ期胃癌患者预后的预测价值

Prognostic Value of Preoperative Platelet-to-albumin Ratio in Patients with Stage Ⅰ-Ⅲ Gastric Cancer

目的:探讨术前血小板与白蛋白比值(platelet-to-albumin ratio,PAR)对Ⅰ~Ⅲ期胃癌患者术后生存的预测价值。方法:回顾性分析2010年1月-2015年9月中国人民解放军联勤保障部队第九〇四医院收治的242例行胃癌根治术治疗的Ⅰ~Ⅲ期胃癌患者的临床资料。采用受试者工作特征(receiver operating character,ROC)曲线确定PAR最佳截断值,根据最佳截断值将患者分为低PAR组和高PAR组。比较两组病理特征及总生存期(overall survival,OS)。通过单因素和多因素Cox比例危险回归模型分析胃癌患者术后OS的影响因素。结果:ROC曲线显示PAR最佳截断值为4.52×10^(9),以此将患者分为低PAR(≤4.52×10^(9))组86例和高PAR(>4.52×10^(9))组156例。低PAR组和高PAR组的年龄、肿瘤最大径、肿瘤浸润深度、淋巴结是否转移及病理分期比较,差异均有统计学意义(P<0.05)。低PAR组术后1、3、5年生存率分别为92.6%、77.2%、60.3%均优于高PAR组的72.5%、36.3%、23.5%,差异均有统计学意义(P<0.01)。单因素分析结果显示:术前PAR、肿瘤最大直径、浸润深度、淋巴结转移、TNM分期均为胃癌患者根治性手术术后OS的影响因素(P<0.05);多因素分析结果显示:TNM分期和术前PAR以及淋巴结转移均为胃癌根治性术后OS的独立危险因素(P<0.05)。结论:术前PAR与胃癌患者的病理特征存在一定联系,是术后OS的独立危险因素之一,可作为判断胃癌患者预后的指标。

Objective:To explore the predictive value of preoperative platelet-to-albumin ratio (PAR) for postoperative survival of patients with stageⅠ-Ⅲ gastric cancer.Method:From January 2010 to September 2015,the clinical data of 242 patients with stageⅠ-Ⅲ gastric cancer underwent radical gastrectomy were collected retrospectively in the 904th Hospital of the Chinese PLA Joint Logistics Support Force.The receiver operating character (ROC) curve was used to determine the best cut-off value of PAR,and the patients were divided into low PAR group and high PAR group according to the best cut-off value.The pathological features and overall survival (OS) were compared between the two groups.The influencing factors of postoperative OS in patients with gastric cancer were analyzed by univariate and multivariate Cox proportional hazard regression models.Result:ROC curve showed that the best cut-off value of PAR was 4.52×10^(9),which divided the patients into 86 cases with low PAR (≤4.52×10^(9)) group and 156 cases with high PAR (>4.52×10^(9)) group.There were significant differences in age,greatest tumor diameter,tumor invasion depth,lymph node metastasis and pathological stage between low PAR group and high PAR group (P<0.05).The 1-,3-and 5-year survival rates of low PAR group were 92.6%,77.2% and 60.3% respectively,which were better than those of high PAR group,which were 72.5%,36.3% and 23.5%,the differences were statistically significant (P<0.01).Univariate analysis showed that preoperative PAR,tumor maximum diameter,invasion depth,lymph node metastasis and TNM stage were all influencing factors of OS after radical operation for gastric cancer patients (P<0.05).Multivariate analysis showed that TNM staging,preoperative PAR and lymph node metastasis were independent risk factors for OS after radical gastrectomy (P<0.05).Conclusion:Preoperative PAR is related to the pathological features of patients with gastric cancer,which is one of the independent risk factors of OS after operation,and can be used as an index to judge the prognosis of patients with gastric cancer.