胃癌根治术后患者临床预后影响因素及与术前ALBI分级的相关性研究

The Prognostic Factors in Patients with Gastric Cancer Undergoing Radical Surgery and Relationship with Preoperative ALBI Classification

目的探讨胃癌根治术后患者临床预后影响因素及与术前ALBI分级的相关性。方法回顾性分析我院2014年1月-2017年12月收治行根治性胃癌手术142例患者的临床资料,根据ALBI分级进行分组,比较ALBI 1级和2级患者临床资料特征,分析不同ALBI分级、ALB及胆红素水平患者的生存情况,采用Cox比例风险模型评价行根治性胃癌手术患者预后独立影响因素。结果(1)ALBI 1级/2级患者年龄和性别比较差异无统计学意义(P>0.05);ALBI 1级患者肿瘤直径、低分化比例、TNM分期中Ⅲ-Ⅳ期比例及CEA水平均显著低于ALBI 2级患者(P<0.05);(2)ALBI 1级患者生存时间显著优于ALBI 2级生存时间(P<0.05);ALB水平<39.0g/L患者生存时间显著优于ALB水平≥39.0g/L(P<0.05);胆红素<17.1μmol/L与≥17.1μmol/L患者生存时间差异无统计学意义(P>0.05);(3)单因素分析结果显示,肿瘤直径、分化程度、ALBI分级、CEA水平及TNM分期与行根治性胃癌手术患者预后有关(P<0.05);多因素分析结果显示,分化程度、ALBI分级、CEA水平及TNM分期是行根治性胃癌手术患者预后独立影响因素(P<0.05)。结论ALBI分级与胃癌根治术后患者的预后相关;多因素分析提示ALBI评分可作为独立预测胃癌根治术后患者的预后指标;高ALBI评分提示患者预后不良。

Objective To investigate the prognostic factors in patients with gastric cancer undergoing radical surgery and relationship with preoperative ALBI classification.Methods Clinical data of 142 patients with gastric cancer undergoing radical surgery were retrospectively chosen in the period from January 2014 to December 2017 in our hospital and all patients were divided into different groups according to ALBI classification The clinical characteristics of patients with ALBI grade 1 and grade 2 were compared,the survival time of patients with different ALBI grade,ALB levels and bilirubin levels were analyzed and the independent prognostic factors of patients with gastric cancer undergoing radical surgery by Cox proportional risk model were evaluated.Results(1)There was no significant difference in age and gender between patients of ALBI grade for 1 and 2(P>0.05).The tumor diameter,the proportion of low degree differentiation,the proportion of TNM stage III-IV and CEA levels in patients with ALBI for grade 1 were significantly lower than patients with ALBI grade for 2(P<0.05).(2)The survival time of patients with ALBI for grade 1 were significantly longer than patients with ALBI for grade 2(P<0.05).There was no significant difference between the survival time between patients with bilirubin<17.1μmol/L and≥17.1μmol/L(P>0.05).(3)The results of univariate analysis showed that tumor diameter,differentiation degree,ALBI grade,CEA level and TNM stage were all related to the prognosis of gastric cancer patients undergoing radical surgery(P<0.05).The results of multivariate analysis showed that differentiation degree,ALBI grade,CEA level and TNM stage were the independent influencing factors in prognosis of gastric cancer patients undergoing radical surgery(P<0.05).Conclusion The differentiation degree,ALBI grade,CEA level and TNM stage are independent related to the clinical prognosis of patients with gastric cancer undergoing radical operation,and ALBI grade can be used as the simple index for prognosis prediction in clinical application.