纤维蛋白原与白蛋白比值联合CA19-9预测胃癌根治术患者预后的价值研究

Fibrinogen to albumin ratio combined with CA19-9 in predicting the prognosis of patients with radical gastrectomy for gastric cancer

目的探讨纤维蛋白原与白蛋白比值(FAR)联合糖类抗原19-9(CA19-9)预测胃癌根治术患者预后的价值。方法选取2017年6月至2019年6月湖州市中心医院普外科收治的行胃癌根治术治疗的患者184例,收集患者的临床资料,包括病理特征、术前FAR、中性粒细胞与淋巴细胞比值(NLR)、血小板与淋巴细胞比值(PLR)、CA19-9及其他肿瘤标志物水平等,采用ROC曲线分析各生化指标的AUC及最佳截断值并进行分组,结合患者随访情况进行生存分析,并分析影响胃癌根治术患者预后的独立危险因素。结果FAR联合CA19-9的评估患者预后的AUC最大,并根据其最佳截断值将患者分为3组:FAR联合CA19-90分组(FAR<0.075且CA19-9<21.04 U/ml)47例,FAR联合CA19-91分组(FAR≥0.075或CA19-9≥21.04 U/ml)61例,FAR联合CA19-92分组(FAR≥0.075且CA19-9≥21.04 U/ml)76例。3组患者年龄、是否合并高血压及糖尿病、肿瘤位置、分化程度、是否有神经及脉管侵犯比较差异均无统计学意义(均P>0.05),而性别、肿瘤大小、pTNM分期比较差异有统计学意义(均P<0.05)。生存分析显示,FAR联合CA19-90分组、1分组、2分组患者总生存率分别为83.0%、65.6%、36.8%,3组比较差异有统计学意义(P<0.05)。多因素分析显示,肿瘤分化程度低、pTNM分期晚及FAR联合CA19-9评分高均是影响胃癌根治术患者预后的独立危险因素(均P<0.05)。结论FAR联合CA19-9是根治性胃癌术后患者预后有效的预测指标,高FAR、高CA19-9的患者预后差。

Objective To explore the value of fibrinogen to albumin ratio(FAR)combined with carbohydrate antigen 19-9(CA19-9)in predicting the prognosis of patients undergoing radical gastric cancer resection.Methods The clinical data of 184 patients with gastric cancer who underwent radical gastretomy in Department of General Surgery of Huzhou Central Hospital from June 2017 to June 2019 were retrospectively analyzed.The preoperative FAR,neutrophil to lymphocyte ratio(NLR)and platelet to lymphocyte ratio(PLR)were calculated;and CA19-9 and other tumor markers were measured.The value of relevant indicators for predicting prognosis of patients were analyzed by ROC curve.Results The area under ROC curve(AUC)of FAR combined with CA19-9 was the largest among above indicators.The cut-off values of FAR and CA19-9 were defined as 0.075 and 21.04 U/ml,respectively.There were 47 cases with normal FAR(<0.075)and CA19-9(<21.04 U/ml)(group 0),61 cases with increased FAR(≥0.075)or CA19-9(≥21.04 U/ml)(group 1)and 76 cases with increased FAR(≥0.075)and CA19-9(≥21.04 U/ml)(group 2).There were significant differences in gender,tumor size,and pTNM stage(all P<0.05);while no significant differences in age,prevalence of hypertension and diabetes mellitus,tumor location,degree of differentiation,and nerve and vessel invasion among the three groups(all P>0.05).Survival analysis showed that the overall survival rates of groups 0,1,and 2 were 83.0%,65.6%,and 36.8%,respectively(P<0.05).Multivariate analysis showed that low tumor differentiation,advanced pTNM stage,and high FAR combined with high CA19-9 level were independent risk factors of poor prognosis in gastric cancer patients after radical gastrectomy(all P<0.05).Conclusion Gastric cancer patients with high FAR and high CA19-9 have poor prognosis;and FAR combined with CA19-9 may be used to predict the prognosis of patients after radical gastrectomy.