C反应蛋白与白蛋白比值对Ⅰb~Ⅱa期宫颈癌术后复发的预测价值

The Predictive Value of the Ratio of C-reactive Protein to Albumin for Postoperative Recurrence of StageⅠb~Ⅱa Cervical Cancer

目的探讨C反应蛋白与白蛋白比值(CAR)对Ⅰb~Ⅱa期宫颈癌术后复发的预测价值。方法选取2017年11月至2018年11月北部战区总医院收治的宫颈癌行手术治疗患者84例作为研究对象,依据患者随访期间的预后转归情况,分为预后良好组57例、预后不良组27例。收集所有患者术前24 h的临床病理资料,包括年龄、体重指数(BMI)、临床分期、肿瘤大小、病理类型、手术方式、是否辅助化疗、淋巴结转移情况、是否保留卵巢和实验室指标[血清C-反应蛋白(CRP)、白蛋白(ALB)、同型半胱氨酸(Hcy)、中性粒细胞数、单核细胞计数、淋巴细胞计数],并计算全身炎症指数(SIRI)、CAR。并对上述指标进行对比分析,单因素筛查有意义指标行多因素Logistic回归分析,对CAR采用受试者工作特征曲线(ROC)进行分析。结果预后良好组与预后不良组患者年龄、BMI、临床分期、是否辅助化疗、淋巴结转移情况、术后是否保留卵巢差异无统计学意义(P>0.05);预后良好组与预后不良组患者肿瘤大小、病理类型、CRP、ALB、Hcy、SIRI、CAR比较差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,SIRI、CAR是影响宫颈癌患者术后复发的重要因素(P<0.05)。术前24 h的CAR值对宫颈癌患者术后复发的判断价值的ROC下面积为0.858,NPR最佳界值为2.950,敏感度为0.815,特异度为0.930,约登指数为0.745。结论肿瘤直径≥4 cm、腺癌、高CRP、高Hcy、高SIRI、高CAR及低ALB均为宫颈癌术后复发的重要影响因素,对疾病的预后及复发有较好的预测价值。SIRI及CAR可作为预测宫颈癌患者术后复发的独立危险因素。CAR在预测宫颈癌患者术后复发方面具有较好的敏感性和特异性。

Objective To explore the predictive value of the ratio of C-reactive protein to albumin(CAR)for postoperative recurrence of stageⅠb~Ⅱa cervical cancer.Methods A total of 84 patients who underwent surgical treatment for cervical cancer admitted to the Northern Theater General Hospital from November 2017 to November 2018 were selected as the study objects.According to the prognosis of the patients during follow-up,they were divided into a good prognosis group(57 cases)and a poor prognosis group(27 cases).Clinicopathological data,which include age,body mass index(BMI),clinical stage,tumor size,pathological type,surgical method,adjuvant chemotherapy,lymph node metastasis,ovarian preservation and laboratory indicators[serum C-reactive protein(CRP),albumin(ALB),homocysteine(Hcy),neutrophil count,monocyte count,and lymphocyte count],of all patients 24 h before surgery were collected,the systemic inflammation index(SIRI)and CAR were calculated.Multivariate Logistic regression analysis was performed for meaningful indicators of single factor screening,and receiver operating characteristic curve(ROC)was used to analyze CAR.Results There were no significant differences in age,BMI,clinical stage,adjuvant chemotherapy,lymph node metastasis,and postoperative ovarian preservation between the good prognosis group and the poor prognosis group(P>0.05).There were significant differences in tumor size,pathological type,CRP,ALB,Hcy,SIRI and CAR between the good prognosis group and the poor prognosis group(P<0.05).Multivariate Logistic regression analysis showed that SIRI and CAR were important factors affecting postoperative recurrence of cervical cancer patients(P<0.05).The area under ROCcurve of CAR value 24 h before surgery was 0.858,the optimal threshold of NPR was 2.950,the sensitivity was 0.815,the specificity was 0.930,and the Yoden index was 0.745 in the judgment of postoperative recurrence of cervical cancer.Conclusion Tumor diameter≥4 cm,adenocarcinoma,high CRP,high Hcy,high SIRI,high CAR and low ALB are all important factors for postoperative recurrence of cervical cancer,and have good predictive value for the prognosis and recurrence of the disease.SIRI and CAR can be used as independent risk factors for predicting postoperative recurrence of cervical cancer.CAR has good sensitivity and specificity in predicting postoperative recurrence of cervical cancer.