改良格拉斯哥预后评分联合纤维蛋白原与前白蛋白比值对胸腔镜肺叶切除术治疗肺癌的预后评估价值

The value of mGPS score combined with FPR ratio in the prognostic evaluation of thoracoscopic lobectomy for lung cancer

目的分析改良格拉斯哥预后评分(mGPS)联合纤维蛋白原与前白蛋白比值(FPR)对胸腔镜肺叶切除术治疗肺癌的预后评估价值。方法2016年10月~2019年12月我院行胸腔镜肺叶切除术治疗的肺癌病人63例。术前检测并计算FPR比值,记录mGPS。采用受试者工作特征曲线(ROC)确定FPR最佳截断值,χ^(2)检验分析mGPS、FPR与肺癌临床病理特征关系,多因素Cox回归分析肺癌病人预后相关因素。结果将mGPS 0分纳入正常组(38例),1~2分纳入异常组(25例)。ROC曲线得出FPR最佳截断值为0.096,将病人分为高FPR组(FPR>0.096,19例)和低FPR组(FPR≤0.096,44例)。mGPS异常、高FPR病人TNM分期Ⅲ期比例更高(P<0.05)。mGPS正常组、低FPR组3年无病生存率高于mGPS异常组和高FPR组(78.95%vs 48.00%,75.00%vs 47.37%)(P<0.05)。18例mGPS联合FPR均异常(mGPS异常且高FPR)病人3年无病生存率(38.89%)低于二者非均异常肺癌病人(77.78%,P<0.05)。TNMⅢ期、mGPS异常、高FPR、mGPS联合FPR均异常均为肺癌病人预后独立危险因素(P<0.05)。结论术前mGPS异常、高FPR的胸腔镜肺叶切除术肺癌病人生存率显著降低,二者均异常者生存率更低,mGPS联合FPR有望作为评估肺癌病人预后的有效指标。

Objective To investigate the value of modified Glasgow prognostic score(mGPS)combined with Fibrinogen to pre-albumin ratio(FPR)in the prognostic evaluation of thoracoscopic lobectomy for lung cancer.Methods The clinical and follow-up data of 63 patients with lung cancer who underwent thoracoscopic lobectomy in Huanggang Central Hospital from October 2016 to December 2019 were retrospectively analyzed.FPR of patients before surgery was detected and calculated,and the mGPS was recorded.The receiver operating characteristic curve(ROC)was used to determine the optimal cut-off value of FPR,andχ^(2)test was used to analyze the relationship between mGPS,FPR and the clinicopathological characteristics of lung cancer,and single factor and multivariate Cox proportional hazard regression models were used to analyze the influence factors related to the prognosis of patients with lung cancer underwent thoracoscopic lobectomy.Results According to the mGPS,0 points were included in the normal group(38 cases),and 1~2 points were included in the abnormal group(25 cases).The best cutoff value of FPR by ROC curve was 0.096,and the patients were divided into the high FPR group(FPR>0.096,n=19)and low FPR group(FPR≤0.096,n=44).The proportion of TNM III stage in lung cancer patients with abnormal mGPS and high FPR was higher(P<0.05).The 3-year disease-free survival rate of the normal mGPS group and the low FPR group was higher than that of the abnormal mGPS group and the high FPR group(78.95%vs 48.00%,75.00%vs 47.37%)(P<0.05).The 3-year disease-free survival rate of 18 patients with abnormal mGPS combined with FPR(abnormal mGPS and high FPR)was 38.89%,which was significantly lower than that of the two non-uniform abnormal lung cancer patients(77.78%,P<0.05).TNM stageⅢ,abnormal mGPS,high FPR,and abnormal mGPS combined with FPR(abnormal mGPS and high FPR)were all independent risk factors of the prognosis of lung cancer patients after thoracoscopic lobectomy(P<0.05).Conclusion The survival rate of lung cancer patients undergoing thoracoscopic lobectomy with abnormal preoperative mGPS or high FPR is significantly reduced,and the survival rate of patients with both abnormalities is lower.The combination of mGPS and FPR is expected to be an effective indicator for evaluating the prognosis of lung cancer patients.