食管鳞状细胞癌患者术前血清纤维蛋白原水平与病理特征及预后关系探讨  

Correlation between preoperative serum fibrinogen and pathological characteristics and prognosis in patients with esophageal squamous cell carcinoma

作　　者：王家林 田伟[2] 陈耀华[2] 豆亚伟[2] 戴云[2] 罗向晖[2] 王宏涛[2] 朱建飞[2] WANG Jialin;TIAN Wei;CHEN Yaohua(The First Department of Surgery,Shannxi Provincial Corps Hospital,Chinese People's Armed Police Forces,Xi'an 710054)

机构地区：[1]武警陕西省总队医院外一科,西安710054 [2]陕西省人民医院胸外科,西安710068

出　　处：《陕西医学杂志》2020年第5期630-634,共5页Shaanxi Medical Journal

基　　金：吴阶平医学基金资助项目(320.6750.17527).

摘　　要：目的:探讨食管鳞状细胞癌患者术前血清纤维蛋白原水平与病理特征之间的相关性,及其表达水平对食管鳞癌患者预后的影响。方法:应用Clause法对食管鳞癌患者术前空腹血清纤维蛋白原水平进行检测,血清纤维蛋白原水平≥4.0 g/L诊断为高纤维蛋白原血症。应用卡方检验比较纤维蛋白原水平与患者临床病理特征之间的关系,无病生存期与总生存期的分析采用Log-rank法和Cox风险回归模型。结果:合计366例患者纳入本研究,其中高纤维蛋白原血症患者116例(占31.7%),进一步分析显示:男性,年龄>65岁,病理T分期较晚、淋巴结转移是高纤维蛋白血症发生的高危因素。单因素生存分析显示,相较于血清纤维蛋白原<4.0 g/L患者,血清纤维蛋白原≥4.0 g/L患者拥有更差的预后,无病生存期(中位值,26.43月对比43.83月,P=0.002)和总生存期(中位值,30.77月对比54.53月,P=0.001)更短。多因素分析结果证明术前血清纤维蛋白原水平是影响食管鳞癌的术后复发(RR:1.44,P=0.006)及总生存(RR:1.49,P=0.004)的独立预后因子。结论:对于食管鳞癌患者,术前高血清纤维蛋白原血症患者预后较差,提示血清蛋白原水平可作为食管鳞癌预后预测的重要因子。Objective:To explore the correlation between the level of serum fibrinogen and the pathological characteristics of patients with esophageal squamous cell carcinoma(ESCC)before operation,and the influence of the expression level on the prognosis of patients with ESCC.Methods:The fasting serum fibrinogen level of patients with ESCC was detected by Clause method,and the serum fibrinogen level≥4.0 g/L was diagnosed as hyperfibrinogenemia.Chi square test was used to compare the relationship between the level of fibrinogen and the clinicopathological characteristics of patients.Log-rank method and Cox risk regression model were used to analyze the disease-free survival(DFS)and the total survival(OS).Results:A total of 366 patients with ESCC were included in the study,and 116 patients(31.7%)were diagnosed as hyperfibrinogenemia.Further analysis showed that male,age>65 years old,late stage of pathological T and lymph node metastasis were the high risk factors of hyperfibrinogenemia.Univariate analysis showed that patients with serum fibrinogen≥4.0 g/L had worse prognosis:DFS(median,26.43 months vs.43.83 months,P=0.002)and OS(median,30.77 months vs.54.53 months,P=0.001).Multivariate analysis demonstrated that preoperative serum fibrinogen level was an independent prognostic factor for postoperative recurrence(RR:1.44,P=0.006)and OS(RR:1.49,P=0.004).Conclusion:For patients with ESCC,the prognosis of patients with preoperative hyperfibrinogenemia is poor,which indicates that serum proteinogen level can be an important factor in predicting the prognosis of ESCC.

关 键 词：食管鳞癌 外科手术 纤维蛋白原 预后 病理特征 相关性 

分 类 号：R735.1[医药卫生—肿瘤]