格拉斯哥预后评分可用作结肠癌预后的指标  

Glasgow prognostic score predicts postoperative outcome in patients of colon cancer

作　　者：郭鹏[1] 叶颖江[1] 尹慕军[1] 杨晓东[1] 张鑫[1] 王杉[1] 

机构地区：[1]北京大学人民医院胃肠外科,100044

出　　处：《中华普通外科杂志》2011年第7期557-561,共5页Chinese Journal of General Surgery

摘　　要：目的研究术前格拉斯哥预后评分（Glasgow prognostic score，GPS）对于可切除的结肠癌患者预后的判断价值。方法作为以炎症为基础的GPS评分系统仅包括C反应蛋白（C-reactive protein，CRP）和白蛋白水平。根据术前的检验结果计算GPS。对282例患者的临床资料进行分析；对CRP升高（〉10mg／L）和低蛋白血症（〈35g／L）两项均阳性者记作2分，1项异常的记作1分，无异常的记作0分。按GPS值的不同分为3组。采用多因素分析和生存曲线分析计算预后价值。结果Log—rank分析显示，高GPS评分的病例死亡率高（P〈0．01）。Kaplan．Meier分析提示，3组间生存时间差异明显：GPS2组（平均40．9个月；95％C／：31．5—50．3个月），GPS1组（平均49．6个月；95％CI：43．2—56．1个月），GPS0组（平均62．7个月；95％CI：58．8—66．7个月）。3组间无进展生存时间也存在明显差异：GPS2组（平均26．4个月；95％C／：18．5～34．3个月），GPS1组（平均34．7个月；95％C／：28．2—41．3个月），GPS0组（平均53．4个月；95％C／：48．8—58．1个月）。多因素分析显示，术后TNM分期（OR，0．210；95％C／，0．102—0．432；P〈0．01）术前的癌胚抗原（carcinoma embryonic antigen，CEA）（OR，0．356；95％6＇／，0．179～0．707；P=0．003），CA19-9（OR，0．260；95％C／，0．120～0．564；P〈0．01），CRP（OR，4．503；95％C／，1．590～12．751；P=0．005），GPS（OR，0．340；95％6＇／，0．181—0．920；P〈0．01）均与术后死亡相关。结论术前的GPS评分可以作为结肠癌患者术后预测的新指标。Objective To investigate the significance of preoperative Glasgow prognostic score （GPS） for postoperative prognosis in patients of resectable colon cancer. Recent studies have revealed that the GPS, an inflammation-based prognostic score that includes only C-reactive protein （CRP） and albumin, is a useful tool for predicting postoperative outcome in cancer patients. However, few studies have investigated the GPS in the field of colon surgery. Methods The GPS was calculated on the basis of admission data as follows： patients with an elevated level of both CRP （ 〉 10 mg/L） and hypoalbuminemia （Alb 〈 35 g/L） were allocated a score of 2, and patients showing 1 or none of these blood chemistry abnormalities were allocated a score of 1 or 0, respectively. Prognostic significance was analyzed by multivariate analyses. Overall survival and disease-free survival was estimated using the Kaplan-Meier method. Results A total of 282 patients were evaluated. Kaplan-Meier analysis and log-rank test revealed that a higher GPS predicted a higher risk of postoperative mortality and reccurence （ P 〈 0. 001 ）. multivariate analyses revealed that postoperative TNM was the most sensitive predictor of postoperative mortality （ OR, 0. 210 ; 95% CI, 0. 102 - 0. 432 ; P 〈 0.01 ） and CEA（ OR,0. 356 ;95% CI,0. 179 - 0. 707 ; P =0. 003 ）, CA19-9 （ OR,0. 260;95% CI,0. 120 - 0. 564;P 〈 0. 01 ）, CRP（ OR,4. 503 ;95% CI, 1. 590 - 12. 751 ;P =0. 005） ,GPS（ OR,0. 340;95% CI,0. 181 -0. 920;P 〈0. 01 ） were associated with postoperative mortality. Conclusions Preoperative GPS is considered to be a useful predictor of postoperative mortality in patients with colon cancer.

关 键 词：结肠肿瘤 格拉斯哥预后评分 C反应蛋白质 低蛋白血症 

分 类 号：R735.35[医药卫生—肿瘤]