C反应蛋白与白蛋白比值对老年食管鳞癌放疗患者预后的预测价值  

Prognostic significance of C-reactive protein to albumin ratio in elderly patients with esophageal squamous cell carcinoma undergoing radiotherapy

作　　者：赵彦[1] 祝淑钗[1] 沈文斌[1] 王旋 宋春洋[1] 苏景伟[1] 许金蕊 ZHAO Yan;ZHU Shuchai;SHEN Wenbin;WANG Xuan;SONG Chunyang;SU Jingwei;XU Jinrui(Department of Radiation Oncology,the Fourth Hospital of Hebei Medical University,Shijiazhuang 050011,China)

机构地区：[1]河北医科大学第四医院放疗科,石家庄050011

出　　处：《临床肿瘤学杂志》2021年第5期437-442,共6页Chinese Clinical Oncology

基　　金：河北省医学科学研究重点课题项目(20190725)。

摘　　要：目的探讨C反应蛋白与白蛋白比值(CAR)对接受根治性放疗的老年食管鳞癌患者生存的预测价值。方法回顾性分析136例接受根治性放疗且年龄≥60岁食管鳞癌患者的临床资料,计算患者放疗前CAR,根据受试者工作特征曲线(ROC)确定最佳临界值,分为高CAR组和低CAR组,比较两组的临床资料和总生存期(OS)的差异,采用Kaplan-Meier法计算生存率并行Log-rank检验,Cox风险比例回归模型进行多因素预后分析。结果ROC曲线确定CAR最佳临界值为0.073,分为高CAR组(≥0.073)和低CAR组(<0.073)。CAR与T分期、临床分期、中性粒细胞计数、前白蛋白、中性粒细胞与淋巴细胞比值(NLR)、血小板与淋巴细胞比值(PLR)和单核细胞与淋巴细胞比值(MLR)有关(P<0.05)。全组患者1、3、5年生存率分别为72.1%、31.5%、19.1%;高CAR组的1、3、5年生存率分别为66.3%、20.9%、11.4%,明显低于低CAR组的82.0%、49.4%、32.1%(P=0.001)。单因素分析显示,年龄、病变部位、临床分期、放疗方式、处方剂量、是否联合化疗、NLR、PLR、CAR与OS有关(P<0.05);多因素Cox回归分析显示,临床分期、病变部位和CAR水平是影响OS的独立因素。结论CAR是接受根治性放疗的老年食管鳞癌患者预后的影响因素,可作为预测生存的指标。Objective To investigate the predictive value of C-reactive protein to albumin ratio(CAR)in the prognosis of elderly patients with esophageal squamous cell carcinoma(ESCC)undergoing radiotherapy.Methods The clinicopathological and laboratory data of 136 patients aged over 60 years old with ESCC undergoing radiotherapy were retrospectively analyzed.CAR was calculated before radiotherapy.The time-dependent receiver operating characteristics(ROC)was used to determine the optimal cutoff value.Patients were divided into high CAR group and low CAR group.The clinicopathological data and overall survival(OS)rates were compared between two groups.Kaplan-Meier method was used to calculate the survival rate and Log-rank test was performed.Multivariate factors analysis was performed by Cox proportional hazard regression model.Results The optimal cutoff value of CAR was set at 0.073.Patients were divided into high CAR group(CAR≥0.073)and low CAR group(CAR<0.073).CAR was associated with T stage,clinical stage,neutrophil count,prealbumin,neutrophil-to-lymphocyte ratio(NLR),platelet-to-lymphocyte ratio(PLR)and monocyte-to-lymphocyte ratio(MLR)with statistical significance(P<0.05).The 1-,3-and 5-year overall survival rates were 72.1%,31.5%and 19.1%,respectively.The 1-,3-and 5-year survival rates in high CAR group were 66.3%,20.9%and 11.4%,respectively,which were significantly lower than 82.0%,49.4%and 32.1%in low CAR group(P=0.001).Univariate analysis showed that age,tumor location,clinical stage,irradiation method,radiotherapy dose,adjuvant chemotherapy,NLR,PLR and CAR were significantly associated with OS(P<0.05).The Cox multivariate analysis showed that clinical stage,tumor location and CAR were significant predictors for OS.Conclusion CAR is a significant and independent predictor for OS in elderly patients with ESCC undergoing radiotherapy.

关 键 词：食管鳞状细胞癌 C反应蛋白与白蛋白比值 放射治疗 预后 

分 类 号：R735.1[医药卫生—肿瘤]