纤维蛋白原与白蛋白比值对Ⅰ-Ⅲ期结直肠癌患者预后的预测价值

Prognostic value of fibrinogen-to-albumin ratio in patients with stageⅠ-Ⅲcolorectal cancer

目的探讨术前外周血纤维蛋白原与白蛋白比值(FAR)对Ⅰ-Ⅲ期结直肠癌患者预后的预测价值。方法收集2015年1月1日至2017年12月31日402例于新疆医科大学第一附属医院行结直肠癌根治术患者的临床病理资料和随访资料;采用受试者工作特征(ROC)曲线确定术前FAR的最佳截断值,并分为高FAR组和低FAR组。分析结直肠癌患者术前不同FAR水平与临床病理特征之间的关系,采用Kaplan-Meier法确定不同FAR水平患者的生存率并绘制生存曲线,采用Log-rank检验比较生存资料,预后危险因素使用Cox比例风险模型分析。结果ROC曲线下面积为0.755,最佳截断值为0.091,约登指数为0.403。术前不同FAR水平结直肠癌患者的术前纤维蛋白原水平、术前白蛋白水平、肿瘤位置、肿瘤长径、神经和(或)脉管侵犯、T分期、N分期、TNM分期、术前癌胚抗原(CEA)水平及术前糖类抗原(CA19-9)水平在两组间的差异均有统计学意义(P均<0.05)。术前不同FAR水平的结直肠癌患者的总生存期(OS)差异有统计学意义(P<0.05)。在多因素Cox回归分析中,年龄≥60岁(HR=1.797,95%CI:1.167~2.768,P=0.008)、TNM分期为Ⅲ期(HR=2.837,95%CI:1.539~5.229,P=0.001)、CEA≥5 ng/mL(HR=1.690,95%CI:1.140~2.505,P=0.009)及术前FAR≥0.091(HR=4.228,95%CI:2.488~7.186,P<0.001)是结直肠癌患者OS的独立危险因素。结论术前外周血FAR对Ⅰ-Ⅲ期结直肠癌患者预后具有良好的预测价值,高FAR提示患者预后更差。

Objective To explore the predictive value of preoperative peripheral blood fibrinogen-to-albumin ratio(FAR)in patients withstageⅠ-Ⅲcolorectal cancer.Methods The clinicopathological data of 402 colorectal cancer patients undergoing radical surgery in the hospitalfrom January 1,2015 to December 31,2017 were collected.Ac-cording to the optimal cut-off point value of FAR determined by receiver operating characteristic(ROC)curve,402 colorectal cancer patients were divided into high FAR level group and low FAR level group.The correlation between the different preoperative peripheral blood FAR levels and the clinicopathological characteristics in patients with colorectal cancer were analyzed.The Kaplan-Meier method was used to calculate survival rates and draw survival curve.Log-rank test was used for survival analysis.The Cox proportional hazards model was used to analyze the risk factors for the prognosis of colorectal cancer patients.Results The area under ROC curve was 0.755,the optimal cut-off point was 0.091,andYouden index was 0.403.There were statistically significant differences in preoperative fibrinogen level,preoperative albumin level,tumor site,tumor long diameter,nerve and(or)vascular invasion,T stage,N stage,TNM stage,preoperative carcinoembryonic antigen(CEA)level and preoperative carbohydrate antigen 19-9(CA19-9)level between the colorectal cancer patients with different preoperative FAR levels(P<0.05).In the multivariate Cox regression analysis,age≥60 years(HR=1.797,95%CI:1.167-2.768,P=0.008),stageⅢof TNM staging(HR=2.837,95%CI:1.539-5.229,P=0.001),CEA≥5ng/mL(HR=1.690,95%CI:1.140-2.505,P=0.009)and FAR≥0.091(HR=4.228:95%CI:2.488-7.186,P<0.001)were independent risk factors of overall survival in colorectal cancer patients.Conclusion The preoperative peripheral blood FAR has a good predictive value for the prognosis of stageⅠ-Ⅲcolorectal cancer patients,and high FAR indicates a worse prognosis.