术前FAR与胰头癌病理特征关系及预后影响因素分析

Relationship between Preoperative FAR and Pathological Features of Pancreatic Head Carcinoma and Prognosis Influencing Factors

目的分析术前纤维蛋白原与白蛋白比值(fibrinogen to albumin ratio,FAR)与胰头癌病理特征的关系以及预后影响因素。方法回顾性分析2016年1月~2018年12月于昆明医科大学第二附属医院接受根治性胰十二指肠切除术的92例胰头癌患者的临床资料,采用受试者工作特征(receiver operator characteristic,ROC)曲线确定术前FAR水平的最佳截断值,使用COX比例风险回归模型分析胰头癌患者的独立危险因素,并采用Kaplan-Meier法绘制生存曲线。结果COX比例风险回归模型单因素分析结果显示,胰头癌患者术前高FAR、高糖类抗原19-9(carbohydrate antigen 19-9,Ca19-9)、淋巴结转移、高TNM分期、低分化以及肿瘤直径≥4cm与胰头癌患者的不良预后有关;多因素分析结果显示,高Ca19-9、术前高FAR、高TNM分期以及低分化是胰头癌患者预后的独立危险因素。Kaplan-Meier生存分析显示,低FAR组患者第1、3年生存率分别为68.3%、37.5%,高FAR组患者第1、3年生存率分别为32.4%、3.1%;低FAR组患者平均生存时间和中位生存时间显著优于高FAR组(24.4个月vs 9.7个月,17.0个月vs 8.0个月),差异均有统计学意义(P<0.05)。结论术前FAR可有效预测胰头癌患者的预后,高Ca19-9、术前高FAR、高TNM分期以及低分化的患者预后效果更差,生存时间更短。

Objective To analyze the relationship between preoperative fibrinogen to albumin ratio(FAR)and pathological features of pancreatic head carcinoma and prognosis influencing factors.Methods The clinical data of 92 patients with pancreatic head carcinoma who underwent radical pancreaticoduodenectomy in the Second Affiliated Hospital of Kunming Medical University from January 2016 to December 2018 were retrospectively analyzed.Receiver operator characteristic(ROC)curve was used to determine the optimal cut-off value of preoperative FAR level.COX proportional risk regression model was used to analyze the independent risk factors of pancreatic head carcinoma,and Kaplan-Meier method was used to draw the survival curve.Results Univariate analysis of COX proportional risk regression model showed that preoperative high FAR,high carbohydrate antigen 19-9(Ca19-9),lymph node metastasis,high TNM stage,low differentiation and maximum tumor diameter≥4cm were associated with poor prognosis in patients with pancreatic head carcinoma.Multivariate analysis showed that high Ca19-9,preoperative high FAR,high TNM stage and low differentiation were independent risk factors for the prognosis of patients with pancreatic head carcinoma.Kaplan-Meier survival analysis showed that the survival rates of patients in the low FAR group were 68.3%and 37.5%in the first year and the third year,respectively;and those in the high FAR group were 32.4%and 3.1%,respectively.The mean survival time and median survival time of patients in the low FAR group were significantly better those in the high FAR group(24.4months vs 9.7months,17.0months vs 8.0months),and the differences were statistically significant(P<0.05).Conclusion Preoperative FAR can effectively predict the prognosis of patients with pancreatic head cancer.Patients with high Ca19-9,high preoperative FAR,high TNM stage and low differentiation have worse prognosis and shorter survival time.