C反应蛋白/白蛋白比值与食管癌微转移及术后复发的关系

Relationship between C-reactive protein/albumin ratio and micrometastasis and postoperative recurrence of esophageal cancer

目的分析C反应蛋白(CRP)/白蛋白(Alb)比值与食管癌外周血循环肿瘤细胞(CTC)—上皮细胞黏附分子(EpCAM)阳性率及术后复发的关系。方法选取2019年2月—2021年2月西部战区总医院肿瘤科收治行胸腔镜根治手术治疗的食管癌患者97例,根据术后随访1年期间是否复发分为复发组47例和未复发组50例,检测2组术前CRP、Alb水平,外周血CTC-EpCAM阳性率。Pearson相关性分析CRP、Alb、CRP/Alb比值与外周血CTC-EpCAM阳性率的相关性;Kaplan-Meier生存曲线分析不同CRP/Alb比值患者生存情况;COX风险比例回归分析影响食管癌术后复发的因素。结果复发组cTNM分期Ⅲ~Ⅳ期比例、淋巴结转移比例高于未复发组(χ^(2)/P=6.147/0.013、8.594/0.003);CRP、CRP/Alb比值、CTC-EpCAM阳性率高于未复发组,Alb水平低于未复发组[t(χ^(2))/P=21.908/<0.001、16.179/<0.001、9.854/<0.001、15.657/<0.001]。CRP、CRP/Alb比值与CTC-EpCAM阳性率呈正相关(r=0.512、0.679,P均<0.001),Alb与CTC-EpCAM阳性率呈负相关(r=-0.496,P<0.001)。高CRP/Alb比值患者无复发生存率低于低CRP/Alb比值患者(χ^(2)=4.516,P<0.001)。CTC-EpCAM阳性率高、CRP/Alb比值高是食管癌术后复发的危险因素[OR(95%CI)=2.821(1.725~4.613)、1.956(1.361~2.811)]。结论高CRP/Alb比值与食管癌微转移及术后复发有关。

Objective To investigate The relationship between the ratio of C-reactive protein(CRP)/albumin(Alb),the positive rate of epithelial cell adhesion molecule(EpCAM)in peripheral blood circulating tumor cells(CTC)and postoperative recurrence of esophageal cancer.Methods A total of 97 patients with esophageal cancer who underwent thoracoscopic radical resection from February 2019 to February 2021 in the Department of Oncology,Western Theater General Hospital were selected,and were divided into a recurrence group of 47 cases and a non-recurrence group of 50 cases according to whether there was recurrence during one-year postoperative follow-up.For example,the preoperative CRP and Alb levels and the positive rate of CTC EpCAM in peripheral blood were detected in the two groups.The correlation between CRP,Alb,CRP/Alb ratio and the positive rate of CTC EpCAM in peripheral blood was analyzed by Pearson correlation.Kaplan Meier survival curves were used to analyze the survival of patients with different CRP/Alb ratios.Cox hazard proportional regression analysis of factors affecting postoperative recurrence of esophageal cancer.Results The proportion of cTNM stages Ⅲ to Ⅳ and lymph node metastasis in the recurrence group were higher than those in the non-recurrence group(χ^(2)/P=6.147/0.013,8.594/0.003).CRP,CRP/Alb ratio and CTC EpCAM positive rate were significantly higher than those in the non-recurrence group,and Alb levels were significantly lower than those in the non-recurrence group[t(χ^(2))/P=21.908/<0.001,16.179/<0.001,9.854/<0.001,15.657/<0.001].The ratio of CRP and CRP/Alb was positively correlated with the positive rate of CTC EpCAM(r=0.512,0.679,P<0.001),while Alb was negatively correlated with the positive rate of CTC EpCAM(r=-0.496,P<0.001).The recurrence-free survival rate of patients with high CRP/Alb ratio was lower than that of patients with low CRP/Alb ratio(χ^(2)=4.516,P<0.001).High positive rate of CTC EpCAM and high CRP/Alb ratio were risk factors for postoperative recurrence of esophageal cancer[OR(95%CI)=2.821(1.725-4.613),1.956(1.361-2.811)].Conclusion High CRP/Alb ratio is associated with esophageal cancer micrometastasis and postoperative recurrence.