术前C反应蛋白与白蛋白比值对非小细胞肺癌患者预后的预测价值

Prognostic Value of Preoperative C-reactive Protein to Albumin Ratio in Patients with Non-small Cell Lung Cancer

目的探讨术前C反应蛋白与白蛋白比值(C-reactive protein to albumin ratio,CAR)对非小细胞肺癌(non-small cell lung cancer,NSCLC)患者预后的预测价值。方法选取自2017年8月~2019年7月于南京医科大学附属苏州医院接受肺癌根治术的300例NSCLC患者的临床资料,通过受试者工作特征(receiver operating characteristic,ROC)曲线确定最佳临界值,分为高CAR组和低CAR组,分析不同CAR表达水平的NSCLC患者临床病理特征,采用Kaplan-Meier法绘制生存曲线并用Log-rank检验评估差异,COX比例风险模型分析影响NSCLC预后的因素。结果术前CAR预测NSCLC患者预后的ROC曲线下面积(area under the curve,AUC)为0.710,临界值为0.02。CAR与年龄、病理类型、T分期、是否淋巴结转移、临床分期、肿瘤直径、是否行术后化疗相关(P<0.05)。CAR低水平组患者总生存期(overall survival,OS)与无病生存期(disease-free survival,DFS)均长于CAR高水平组,差异有统计学意义(P<0.001)。COX多因素风险回归显示,CAR升高是NSCLC患者OS、DFS的独立危险因素(P<0.05)。结论术前CAR可作为非小细胞肺癌患者有效的预后指标,CAR升高提示预后不良。

Objective To explore the prognostic significance of preoperative C-reactive protein to albumin ratio(CAR)in non-small cell lung cancer(NSCLC)patients.Methods The clinical information of 300NSCLC patients who had radical lung cancer resection at the Affiliated Suzhou Hospital of Nanjing Medical University between August 2017 and July 2019 was selected.Receiver operating characteristic curve(ROC curve)was used to find the optimal cut-off value,and patients were divided into high and low CAR groups.The Kaplan-Meier method was used to plot the survival curves,and the Log-rank test was employed to assess any differences.The prognostic variables of NSCLC were examined using the COX proportional hazards model.Results The area under the ROC curve(AUC)of preoperative CAR in predicting the prognosis of NSCLC patients was 0.710,and the cut-off value was 0.02.Age,pathological type,T stage,lymph node metastases,clinical stage,tumor size,and postoperative chemotherapy were all related to CAR(P<0.05).Patients with low CAR levels had longer overall survivals(OS)and disease-free survivals(DFS),and these differences were statistically significant(P<0.001).Multivariate risk regressions revealed that higher CAR was an independent risk factor for OS and DFS in NSCLC patients(P<0.05).Conclusion Preoperative CAR is a useful prognostic marker for NSCLC patients,and increased CAR is associated with poor prognosis.