甲胎蛋白、纤维蛋白原与前白蛋白比值、癌胚抗原、D-二聚体对结肠癌术后复发的预测价值

Predictive value of preoperative serum alpha-fetoprotein,plasma fibrinogen to prealbumin ratio,carcinoembryonic antigen and D-dimer for recurrence of colon cancer patients after operation

目的分析术前血清甲胎蛋白(AFP)、血浆纤维蛋白原与前白蛋白比值(FPR)、癌胚抗原(CEA)及术后D-二聚体(D-D)水平对结肠癌患者手术后1年内复发的预测价值,并评价其效能。方法选取南京大学医学院附属苏州医院和南京中医药大学附属南京中医院2019年7月至2022年12月收治的120例结肠癌患者,按照其术后1年复发情况,将患者分别纳入复发组、未复发组。对比2组患者一般资料、病理特征及术前AFP、FPR、CEA和术后D-D检测结果,使用Logistic多因素回归模型归纳影响患者术后1年复发的相关因素。基于风险因素建立函数模型并绘制Nomogram图、建立预测模型;使用C指数评估模型区分度,使用决策曲线分析模型收益,使用X-lite评价不同风险患者无病生存时间(DFS)。结果120例患者均获得有效随访,中位随访时间17个月。随访期间共31例患者达到复发标准,复发率25.83%。多因素回归分析示,TNM分期Ⅲ~Ⅳ期、肿瘤侵及浆膜层,以及术前AFP≥10μg/L、FPR≥18、CEA≥9.7 ng/mL和术后D-D≥3.1 mg/L为影响结肠癌患者术后1年内复发的独立危险因素(P<0.05)。Nomogram模型C指数为0.868,区分度良好。决策曲线分析示,模型净收益良好,适合临床决策。按照总分将患者分为高风险组(>75分)、低风险组(≤75)分,高风险组DFS较低风险组明显更短(P<0.05)。结论较高的术前AFP、FPR、CEA和术后D-D水平与结肠癌患者术后1年内复发风险升高有关,结合上述指标及病理特征能够为患者复发预测提供可靠参考。

Objective To analyze the predictive value of preoperative serum alpha-fetoprotein(AFP),plasma fibrinogen to prealbumin ratio(FPR),carcinoembryonic antigen(CEA)and postoperative D-dimer(D-D)for the recurrence of colon cancer patients within one year after operation,and to evaluate their efficacy.Methods A total of 120 patients with colon cancer admitted to Suzhou Hospital,Affiliated Hospital of Medical School,Nanjing University and Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine from July 2019 to December 2022 were selected and divided into recurrence group and non-recurrence group according to their recurrence one year after operation.The general data,pathological features,preoperative AFP,FPR,CEA and postoperative D-D were compared between the two groups.Logistic multivariate regression model was used to summarize the related factors affecting the recurrence of patients one year after operation.A function model was established based on risk factors,a Nomogram diagram was drawn and a prediction model was established.C index was used to evaluate the model discrimination,decision curve was used to analyze the model income,and X-lite was used to evaluate the disease-free survival time(DFS)of patients with different risks.Results All 120 patients were followed up effectively,with a median follow-up time of 17 months.During the follow-up period,31 patients reached the recurrence standard,and the recurrence rate was 25.83%.Multivariate regression analysis showed that TNM stageⅢ-Ⅳ,tumor invading serosa,preoperative AFP≥10μg/L,FPR≥18,CEA≥9.7 ng/mL and postoperative D-D≥3.1 mg/L were all independent risk factors for recurrence of colon cancer patients within one year after operation(P<0.05).The C index of Nomogram model was 0.868,and the discrimination was good.The analysis of decision curve showed that the model had good net income and was suitable for clinical decision-making.Patients were divided into high-risk group(>75 points)and low-risk group(≤75 points)according to the total score.DFS in high-risk group was significantly shorter than that in low-risk group(P<0.05).Conclusion High preoperative AFP,FPR,CEA and postoperative D-D are related to the increased risk of recurrence in patients with colon cancer within one year after operation.Combining the above indexes and pathological features can provide reliable reference for recurrence prediction of patients.