术前血浆白蛋白与纤维蛋白原比值对食管鳞癌根治术后生存的预测价值  

Predictive value of preoperative albumin-to-fibrinogen ratio for postoperative survival of esophageal squamous cell carcinoma after radical esophagectomy

作　　者：樊宁波 陈冬妮 温浙盛[1] 林鹏[1] Fan Ningbo;Chen Dongni;Wen Zhesheng;Lin Peng(Department of Thoracic Surgery, Sun Yat-sen University Cancer Center/ Collaborative Innovation Center for Cancer Medicine/ State Key Laboratory of Oncology in South China, Guangzhou 510060, China)

机构地区：[1]中山大学肿瘤防治中心胸科/肿瘤医学合作创新中心/华南肿瘤学国家重点实验室,广州510060

出　　处：《中华消化外科杂志》2019年第6期563-569,共7页Chinese Journal of Digestive Surgery

基　　金：国家科技支撑计划(2015BAI12B00);中山大学临床医学研究5010计划(2007044).

摘　　要：目的探讨术前血浆白蛋白与纤维蛋白原比值(A/F)对食管鳞癌根治术后生存的预测价值。方法采用回顾性队列研究方法。收集2009年1月至2012年1月中山大学肿瘤防治中心收治的559例行根治性手术治疗的食管鳞癌患者的临床病理资料;男443例,女116例;平均年龄为59岁,年龄范围为53~66岁。559例患者中,394例A/F>11.14设为高A/F组,165例A/F≤11.14设为低A/F组。患者术前2周检测血浆白蛋白及纤维蛋白原水平。患者均行根治性食管鳞癌切除术。观察指标:(1)患者临床病理特征。(2)患者生存情况。(3)影响患者预后的危险因素分析。采用门诊或电话方式进行随访,术后前2年每3个月随访1次,2年后每6个月常规随访1次,了解患者术后生存情况。随访时间截至2018年11月。总体生存时间定义为患者手术日期至终点事件发生日期(死亡日期或末次有效随访日期)。总体无病生存时间定义为患者手术日期至终点事件发生日期(肿瘤复发、肿瘤相关死亡或末次有效随访日期)。偏态分布的计量资料以M(范围)表示。计数资料以百分比表示,组间比较采用χ2检验或Fisher确切概率法。等级资料比较采用Mann-Whitney U非参数检验。采用Kaplan-Meier法计算生存率和绘制生存曲线,采用Log-rank检验进行生存分析。采用COX比例风险模型进行单因素和多因素分析。结果(1)患者临床病理特征:559例患者中,高A/F组患者≤60岁、>60岁,肿瘤浸润深度T1期、T2期、T3期分别为246例、148例,60例、79例、255例;低A/F组患者上述指标分别为79例、86例,5例、32例、128例。两组患者年龄、肿瘤浸润深度比较,差异有统计学意义(χ^2=10.127,Z=-3.468,P<0.05)。(2)患者生存情况:559例患者均获得随访,随访时间为97个月(91~103个月)。高A/F组和低A/F组患者5年总体生存率分别为55.8%和38.8%,5年无病生存率分别为48.7%和35.8%。两组患者5年总体生存率和5年无病生Objective To investigate the predictive value of preoperative albumin-to-fibrinogen ratio (A/F) for postoperative survival of esophageal squamous cell carcinoma after radical esophagectomy. Methods The retrospective cohort study was conducted. The clinicopathological data of 559 patients with esophageal squamous cell carcinoma who underwent radical resection in the Sun Yat-sen University Cancer Center from January 2009 and January 2012 were collected. There were 443 males and 116 females, aged from 53 to 66 years, with an average age of 59 years. Of 559 patients, 394 with A/F > 11.14 were in high A/F group, and 165 with A/F ≤ 11.14 were in low A/F group. Levels of plasma albumin and fibrinogen were measured at two weeks before surgery, and patients underwent radical esophagectomy. Observation indicators:(1) clinicopathological characteristics of patients;(2) survival of patients;(3) risk factors analysis of prognosis of patients. Follow-up was conducted by outpatient examination and telephone interview to detect postoperative survival of patients up to November 2018. The overall survival time was from surgery date to date of endpoint events including death or the last follow-up, and the overall disease-free survival time was from surgery date to date of endpoint events including tumor recurrence, tumor-ralted death, or the last follow-up. Measurement data with skewed distribution were expressed by M (range). Count data were described as percentage, and comparison between groups was analyzed using chi-square test or Fisher exact probability. Comparison of ordinal data was analyzed by Mann-Whitney U non-parametric test. The survival rate and curve were calculated and drawn by Kaplan-Meier method and the Log-rank test was used for survival analysis. The univariate and multivariate analyses were done using COX proportional hazard model. Results (1) Clinicopathological characteristics of patients: of 559 patients, cases with age ≤60 years and > 60 years, cases in T1 stage, T2 stage, T3 stage(depth of tumor invasio

关 键 词：食管肿瘤 食管癌 食管鳞癌 白蛋白 纤维蛋白原 血浆白蛋白与纤维蛋白原比值 预测指标 预后 

分 类 号：R735.1[医药卫生—肿瘤]