系统免疫炎症指数、白蛋白、甲胎蛋白与老年胃腺癌肝转移病人预后的相关性研究

Relationship of systemic immune-inflammation index,albumin,alpha-fetoprotein with prognosis in elderly patients with liver metastasis from gastric adenocarcinoma

目的探讨系统免疫炎症指数(SII)、白蛋白(ALB)、甲胎蛋白(AFP)与老年胃腺癌肝转移病人预后的相关性。方法选取2019年10月至2022年10月94例住院治疗的老年胃腺癌肝转移病人,随访至2023年2月,收集病人临床资料、血常规(Hb、PLT、中性粒细胞、淋巴细胞计数)、肝肾功能[ALB、前白蛋白(PALB)]、凝血功能(D-二聚体)以及相关肿瘤标志物[AFP、癌胚抗原(CEA)、糖类抗原199(CA199)、糖类抗原125(CA125)]等资料,并计算SII。采用Kaplan-Meier生存曲线和Cox回归分析老年胃腺癌肝转移病人预后的相关因素。结果所有病人随访时间为4.4~33.5个月,中位随访时间为12.7个月。老年胃腺癌肝转移病人1年生存率为57.41%,2年生存率为6.38%。单因素Cox回归分析发现,年龄、婚姻状况、组织学分级、治疗方式、SII、ALB、PALB、AFP、CA199与老年胃腺癌肝转移预后相关(P<0.05);多因素Cox回归分析发现,化疗+局部治疗、低SII、高ALB、低AFP是老年胃腺癌肝转移预后的保护因素(P<0.05)。Kaplan-Meier生存曲线显示,化疗+局部治疗、低SII、高ALB、低AFP的病人生存时间明显较长(P均<0.05)。结论SII、ALB、AFP水平与老年胃腺癌肝转移病人预后相关,可能成为预测老年胃腺癌肝转移预后的良好指标。

Objective To explore the correlation of systemic immune inflammation index(SII),albumin(ALB)and alpha-fetoprotein(AFP)with the prognosis in the elderly patients with liver metastasis from gastric adenocarcinoma.Methods A total of 94 elderly inpatients with gastric adenocarcinoma and liver metastasis from October 2019 to October 2022 were enrolled in this study and followed up to February 2023.The clinical data of all patients were collected,and blood routine[hemoglobin(Hb),peripheral blood plate(PLT),neutrophil(NC),lymphocyte count(LY)],liver and kidney function[ALB,prealbumin(PALB)],coagulation function(D-dimer)and related tumor markers[AFP,carcinoembryonic antigen(CEA),carbohydrate antigen 199(CA199),carbohydrate antigen 125(CA125)]were detected and SII was caculated.Kaplan-Meier survival curve and Cox regression analysis were used to analyze the influencing factors of the prognosis in the elderly patients with liver metastasis from gastric adenocarcinoma.Results The follow-up time of all patients was 4.4-33.5 months,with a median follow-up time of 12.7 months.The 1-year and 2-year survival rates of the elderly patients with liver metastasis from gastric adenocarcinoma were 57.41%and 6.38%respectively.Univariate Cox regression analysis showed that age,marital status,histological grade,treatment style,the levels of SII,ALB,PALB,AFP and CA199 were correlated with the prognosis in the elderly patients with gastric adenocarcinoma and hepatic metastasis(P<0.05).Multivariate Cox regression analysis showed that chemotherapy combined with local treatment,low level of SII,high level of ALB and low level of AFP were protective factors of the prognosis in the elderly patients with gastric adenocarcinoma and liver metastasis(P<0.05).Kaplan-Meier survival curve showed that the median survival time of the patients with chemotherapy combined with local therapy,low SII,high ALB,and low AFP was significantly longer than that in the patients with other therapeutic interventions,high level of SII,low level of ALB and high level of AFP(all P<0.05),respectively.Conclusions The levels of SII,ALB and AFP are associated with the prognosis,and may be good prognostic indicators in the elderly patients with liver metastasis from gastric adenocarcinoma.