触珠蛋白和铁蛋白在结肠癌肝转移患者预后评估中的意义

Roles of haptoglobin and ferritin in the prognostic assessment of colon cancer patients with liver metastasis

目的探讨触珠蛋白和铁蛋白在结肠癌肝转移患者预后评估中的临床意义。方法选取确诊为结肠癌肝转移的患者101例。收集所有患者的临床资料和实验室检测结果,同时检测治疗前的血清触珠蛋白和铁蛋白水平。对所有患者进行随访,以全因死亡为随访终点。采用受试者工作特征(ROC)曲线评价各项指标判断预后的效能。采用Kaplan-Meier生存曲线评估患者的生存情况。采用Cox回归分析评估结肠癌肝转移患者全因死亡的独立危险因素。结果ROC曲线分析结果显示,触珠蛋白和铁蛋白单项检测和联合检测判断结肠癌肝转移患者预后的曲线下面积(AUC)分别为0.77、0.83、0.87。根据ROC曲线确定的触珠蛋白和铁蛋白的最佳临界值(触珠蛋白为1.37 g/L,铁蛋白为217.1μg/L)分别分组。触珠蛋白>1.37 g/L组C反应蛋白(CRP)、癌胚抗原(CEA)和天门冬氨酸氨基转移酶(AST)显著高于触珠蛋白≤1.37 g/L组(P<0.05),其他指标2个组之间差异均无统计学意义(P>0.05)。铁蛋白>217.1μg/L组年龄、CEA、丙氨酸氨基转移酶(ALT)、AST和总胆红素(TB)显著高于铁蛋白≤217.1μg/L组,白蛋白(Alb)低于铁蛋白≤217.1μg/L组(P<0.05),其他指标2个组之间差异均无统计学意义(P>0.05)。Kaplan-Meier生存曲线分析结果显示,触珠蛋白≤1.37 g/L组中位生存期(19个月)显著长于触珠蛋白>1.37 g/L组(10个月,P<0.001);铁蛋白≤217.1μg/L组中位生存期(21个月)显著长于铁蛋白>217.1μg/L组(10个月,P<0.001)。多因素Cox回归分析结果显示,美国东部肿瘤协作组(ECOG)评分、CRP、白蛋白、触珠蛋白和铁蛋白是结肠癌肝转移患者全因死亡的独立危险因素[风险比(HR)分别为1.99、2.12、1.38、1.76、1.70,95%可信区间(CI)分别为1.38~10.64、1.20~3.72、1.08~2.03、1.14~3.29、1.07~2.94]。结论检测触珠蛋白和铁蛋白水平有助于评估结肠癌肝转移患者预后。

Objective To investigate the roles of haptoglobin and ferritin in the prognostic assessment of colon cancer patients with liver metastasis.Methods A total of 101 colon cancer patients with liver metastasis were enrolled.The clinical and laboratory data were collected.Haptoglobin and ferritin levels were determined.The patients were followed-up with an endpoint of all-cause mortality.Receiver operating characteristic(ROC)curve was used to determine the efficiency of each indicator.Kaplan-Meier survival curve analysis was used to assess survival status.Cox proportional hazard model was used to determine the independent risk factors for all-cause mortality in colon cancer patients with liver metastasis.Results The areas under curves(AUC)of haptoglobin and ferritin was 0.77 and 0.83,respectively,which were increased to 0.87 when both indicators were used in combination.The optimal cut-off values of haptoglobin and ferritin were 1.37 g/L and 217.1μg/L,respectively.C-reactive protein(CRP),carcinoembryonic antigen(CEA)and aspartate aminotransferase(AST)in haptoglobin>1.37 g/L group were higher than those in haptoglobin≤1.37 g/L group(P<0.05),and the other indicators had no statistical significance(P>0.05).Age,CEA,alanine aminotransferase(ALT),AST and total bilirubin(TB)in ferritin>217.1μg/L group were higher than those in ferritin≤217.1μg/L group,albumin(Alb)was lower(P<0.05),and the other indicators had no statistical significance(P>0.05).Kaplan-Meier survival curve analysis showed that the median survival in patients with haptoglobin≤1.37 g/L(19 months)was longer than that with haptoglobin>1.37 g/L(10 months,P<0.001).The median survival in those with ferritin≤217.1μg/L(21 months)was longer than those with ferritin>217.1μg/L(10 months,P<0.001).Multivariate Cox regression model showed that the Eastern Cooperative Oncology Group(ECOG)score,CRP,albumin,haptoglobin and ferritin were independent risk factors for all-cause mortality in colon cancer patients with liver metastasis[hazard ratios(HR)were 1.99,2.12,1.38,1.76 and 1.70,95%confidence intervals(CI)were 1.38-10.64,1.20-3.72,1.08-2.03,1.14-3.29 and 1.07-2.94,respectively].Conclusions Haptoglobin and ferritin are helpful for the prognostic assessment of colon cancer patients with liver metastasis.