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中华胸部外科电子杂志 ›› 2024, Vol. 11 ›› Issue (01) : 23 -30. doi: 10.3877/cma.j.issn.2095-8773.2024.01.03

论著

术前纤维蛋白原与前白蛋白比值对可切除食管鳞癌患者预后的影响
黄志宁1, 王高祥1, 崔世军1, 柳常青2, 孙效辉2, 徐美青2, 解明然3,()   
  1. 1. 230001 合肥,安徽医科大学附属省立医院胸外科
    2. 230001 合肥,中国科学技术大学附属第一医院胸外科;230001 合肥,中国科学技术大学生命医学与科学部
    3. 230001 合肥,安徽医科大学附属省立医院胸外科;230001 合肥,中国科学技术大学附属第一医院胸外科;230001 合肥,中国科学技术大学生命医学与科学部
  • 收稿日期:2023-10-14 修回日期:2024-01-10 接受日期:2024-02-04 出版日期:2024-02-28
  • 通信作者: 解明然
  • 基金资助:
    国家自然科学基金(81973643); 安徽省重点研究与开发项目基金(202004j07020017)

Effect of preoperative fibrinogen to prealbumin ratio on the prognosis of patients with resectable esophageal carcinoma

Zhining Huang1, Gaoxiang Wang1, Shijun Cui1, Changqing Liu2, Xiaohui Sun2, Meiqing Xu2, Mingran Xie3,()   

  1. 1. Department of Thoracic Surgery, Anhui Provincial Hospital Affiliated with Anhui Medical University, Hefei 230001, China
    2. Department of Thoracic Surgery, First Affiliated Hospital of University of Science and Technology of China, Hefei 230001, China; Department of Life Medicine and Science, University of Science and Technology of China, Hefei 230001, China
    3. Department of Thoracic Surgery, Anhui Provincial Hospital Affiliated with Anhui Medical University, Hefei 230001, China; Department of Thoracic Surgery, First Affiliated Hospital of University of Science and Technology of China, Hefei 230001, China; Department of Life Medicine and Science, University of Science and Technology of China, Hefei 230001, China
  • Received:2023-10-14 Revised:2024-01-10 Accepted:2024-02-04 Published:2024-02-28
  • Corresponding author: Mingran Xie
引用本文:

黄志宁, 王高祥, 崔世军, 柳常青, 孙效辉, 徐美青, 解明然. 术前纤维蛋白原与前白蛋白比值对可切除食管鳞癌患者预后的影响[J/OL]. 中华胸部外科电子杂志, 2024, 11(01): 23-30.

Zhining Huang, Gaoxiang Wang, Shijun Cui, Changqing Liu, Xiaohui Sun, Meiqing Xu, Mingran Xie. Effect of preoperative fibrinogen to prealbumin ratio on the prognosis of patients with resectable esophageal carcinoma[J/OL]. Chinese Journal of Thoracic Surgery(Electronic Edition), 2024, 11(01): 23-30.

目的

探讨术前纤维蛋白原与前白蛋白比值(FPR)在可切除食管鳞癌患者预后中的意义。

方法

回顾性分析255例行食管癌切除术患者的临床资料,通过受试者工作特征(ROC)曲线和约登指数得出FPR的临界值。根据临界值将患者分为高FPR组和低FPR组。采用Kaplan-Meier法描述生存曲线,采用Cox比例风险模型确定影响患者预后的危险因素。

结果

以5年生存为终点绘制FPR的ROC曲线,提示FPR是较为敏感的预测指标,当FPR值为16.24时,约登指数最大,敏感度为69.6%,特异性为70.1%。低FPR组累计5年生存率显著高于高FPR组(55.4%比20.3%)。多因素分析提示高FPR水平是食管癌患者术后生存率降低的危险因素。

结论

FPR水平与食管癌患者预后显著相关,应当对术前高FPR水平的患者实施早期干预。

Objective

To investigate the prognostic significance of fibrinogen to prealbumin ratio (FPR) in patients with resectable esophageal carcinoma.

Methods

The clinical data of 255 patients undergoing esophagectomy were analyzed retrospectively. The cut-off value of FPR was obtained by analyzing the receiver operating characteristic (ROC) curve. The patients were divided into high FPR group and low FPR group according to the cut-off value. Kaplan-Meier method was used to describe the survival curve, and Cox proportional hazards model was used to determine the prognostic risk factors.

Results

The ROC curve of FPR value was drawn using 5-year survival as the end point, suggesting that FPR was a sensitive predictor. When FPR value was 16.24, Youden index was the highest, with a sensitivity of 69.6% and a specificity of 70.1%. The cumulative 5-year survival rate in the low FPR group was significantly higher than that in the high FPR group (55.4% vs 20.3%). Multivariate analysis showed that high FPR level was a risk factor for poor postoperative survival in patients with esophageal cancer.

Conclusions

The level of FPR is significantly correlated with the prognosis of patients with esophageal cancer, so the patients with high level of FPR should be given early intervention.

表1 FPR与临床资料之间的关系
图1 FPR、FAR、NLR的ROC曲线。FPR:纤维蛋白原与前白蛋白的比值;FAR:纤维蛋白原与白蛋白比值;NLR:中性粒细胞与淋巴细胞比值
图2 FPR分组与5年生存率的关系。FPR:纤维蛋白原与前白蛋白的比值
图3 FAR与5年生存率的关系。FAR:纤维蛋白原与白蛋白比值
表2 影响生存率预后因素的单因素分析
项目 例数 平均生存时间(月) 5年生存率(%) P
性别       0.204
202 39.2(35.8~42.5) 38.60  
53 33.8(28.2~39.4) 24.50  
年龄       <0.001
<65岁 96 48.9(41.1~50.7) 53.10  
≥65岁 159 33.0(29.6~36.3) 25.20  
肿瘤部位       0.876
上段 20 36.8(27.5~46.0) 30.00  
中段 157 37.1(33.5~40.7) 35.00  
下段 78 39.4(34.0~44.8) 38.50  
吸烟史       0.826
183 37.8(34.5~41.1) 35.50  
72 38.0(32.2~43.7) 36.10  
饮酒史       0.342
185 36.6(33.3~39.9) 34.60  
70 40.9(35.4~46.4) 38.60  
分化程度       0.021
低分化 44 36.8(29.2~44.3) 38.60  
中分化 180 36.0(32.8~39.3) 31.10  
高分化 31 49.5(41.6~57.3) 58.10  
TNM分期       <0.001
Ⅰ期 39 57.0(51.0~63.0) 74.40  
Ⅱ期 126 45.0(41.3~48.6) 42.10  
Ⅲ期 81 20.8(17.6~23.9) 6.20  
Ⅳ期 9 6.7(3.7~9.6) 0  
淋巴结转移       <0.001
159 47.7(44.3~51.0) 50.30  
96 22.3(18.6~25.9) 11.50  
手术方式       0.091
Ivor Lewis 111 41.2(36.7~45.7) 40.50  
McKeown 144 35.6(31.8~39.3) 31.90  
FPR       <0.001
低FPR 112 47.4(43.0~51.9) 55.40  
高FPR 143 30.7(27.3~34.1) 20.30  
FAR       <0.001
低FAR 176 42.6(39.1~46.1) 46.60  
高FAR 79 26.8(22.7~30.9) 11.40  
NLR       0.004
低NLR 168 41.0(37.3~44.7) 41.70  
高NLR 87 32.6(28.1~37.1) 24.10  
PA       <0.001
低PA 123 30.8(27.1~34.6) 22.00  
高PA 132 44.7(40.6~48.7) 48.50  
FIB       <0.001
低FIB 199 40.3(37.1~43.6) 41.20  
高FIB 56 28.4(23.1~33.7) 16.10  
ALB       <0.001
低ALB 177 34.3(30.9~37.7) 28.20  
高ALB 78 46.3(35.3~41.1) 52.60  
表3 影响生存率预后因素的多因素分析
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