结直肠癌病人白蛋白、碱性磷酸酶水平对腹腔镜根治术后淋巴结转移的预测

Prediction of serum albumin and alkaline phosphatase levels in patients with colorectal cancer on lymph node metastasis after laparoscopic radical surgery

目的探讨结直肠癌(colorectal cancer,CRC)病人血清白蛋白(ALB)、碱性磷酸酶(ALP)水平预测腹腔镜根治术后淋巴结转移价值,寻找CRC病人术后淋巴结转移预测方法。方法本研究采用前瞻性分析方法,纳入2017年9月~2019年9月收治的CRC病人115例。全部病人均接受腹腔镜CRC根治术治疗,随访3年,末次随访时间截止至2022年9月。比较转移组和未转移组病人临床资料及血清ALB、ALP水平;采用点二列相关性检验、双变量Pearson相关系数和Logistic回归分析血清ALB、ALP与CRC病人术后淋巴结转移的相关性;绘制ROC曲线,分析血清ALB、ALP预测病人术后淋巴结转移的价值。结果完成研究的110例CRC病人中,有29例术后发生淋巴结转移,发生率26.36%。转移组血清癌胚抗原(CEA)、糖类抗原(CA)19-9和ALP水平、分化程度(低分化)占比均高于未发生组,血清ALB水平低于未发生组,差异有统计学意义(P<0.05)。血清CEA、CA19-9、ALP水平与CRC病人淋巴结呈正相关性(r=0.348、0.469、0.470,P<0.001),ALB水平与CRC病人淋巴结转移呈负相关性(r=-0.426,P<0.001)。血清ALB与ALP间呈负相关性(r=-0.250,P=0.009);血清CA199、CEA、ALB、ALP和分化程度与CRC病人术后淋巴结转移有关;血清ALB、ALP联合预测CRC病人术后淋巴结转移的AUC(0.839,95%CI:0.758~0.919)高于血清ALB、ALP单独(0.789,95%CI:0.701~0.876)、(0.748,95%CI:0.639~0.858),联合预测的价值最高。结论血清ALB、ALP预测CRC病人腹腔镜根治术后淋巴结转移具有一定的价值,且以联合预测的价值最高。

Objective To investigate the value of serum albumin(ALB)and alkaline phosphatase(ALP)levels in predicting lymph node metastasis in patients with colorectal cancer(CRC)after laparoscopic radical surgery,and to find a method to predict lymph node metastasis in patients with CRC.Methods The prospective analysis method was used in this study to include 115 CRC patients admitted to the hospital from September 2017 to September 2019.All patients were treated with laparoscopic radical surgery,and were followed up for 3 years.The last follow-up was until September 2022.The clinical data and related laboratory indicators of CRC patients were investigated,and the clinical data and serum ALB and ALP levels of patients in the metastatic group and non metastatic group were compared.The correlation between serum ALB,ALP and postoperative lymph node metastasis of CRC patients was tested by point binary correlation test,bivariate Pearson correlation coefficient and Logistic regression.ROC curve was drawn to analyze the value of serum ALB and ALP in predicting postoperative lymph node metastasis.Results Of the 110 patients with CRC,29 had lymph node metastasis after operation,with an incidence of 26.36%.The levels of serum carcinoembryonic antigen(CEA),carbohydrate antigen(CA)199 and ALP and the proportion of differentiation degree(low differentiation)in the developing group were higher than those in the non-developing group,and the level of serum ALB was lower than that in the non-developing group,the difference was statistically significant(P<0.05).Serum CEA,CA199 and ALP levels were positively correlated with lymph node metastasis in CRC patients(r=0.348,0.469,0.470,P<0.001),while ALB levels were negatively correlated with lymph node metastasis in CRC patients(r=-0.426,P<0.001).There was a negative correlation between serum ALB and ALP(r=-0.250,P=0.009).Serum CA199,CEA,ALB,ALP and differentiation degree were related to lymph node metastasis in CRC patients after operation.The AUC(0.839,95%CI:0.758-0.919)of serum ALB and ALP in predicting postoperative lymph node metastasis in CRC patients was higher than that of serum ALB and ALP alone(0.789,95%CI:0.701-0.876),(0.748,95%CI:0.639-0.858),and the value of combined prediction was the highest.Conclusion Serum ALB and ALP have a certain value in predicting lymph node metastasis in CRC patients after laparoscopic radical surgery,and the value of combined prediction is the highest.