基于辅助化疗前血清白蛋白水平的列线图预测胃癌患者术后复发及远期生存  

Nomograms Based on Serum Albumin Level Before Adjuvant Chemotherapy Predict Recurrence and Long-term Survival of Gastric Cancer Patients After Gastrectomy

作　　者：马泰[1] 徐辉 张澄 冯颖 谢敏敏 杨雅慧 张毅[1] 孙国平[1,2] MA Tai;XU Hui;ZHANG Cheng;FENG Ying;XIE Min-min;YANG Ya-hui;ZHANG Yi;SUN Guo-ping(The First Affiliated Hospital of Anhui Medical University,Hefei 230022,China;Anhui Provincial Cancer Institute/Anhui Provincial Office for Cancer Prevention and Control,Hefei 230022,China)

机构地区：[1]安徽医科大学第一附属医院,安徽合肥230022 [2]安徽省肿瘤防治所/安徽省肿瘤防治办公室,安徽合肥230022

出　　处：《中国肿瘤》2022年第1期75-80,共6页China Cancer

基　　金：安徽省重点研究与开发计划项目(1804b06020351);安徽医科大学第一附属医院临床研究项目(LCYJ2021YB015)。

摘　　要：[目的]对于胃癌根治术后接受辅助化疗的患者,构建基于化疗开始前血清白蛋白水平的预后预测模型。[方法]回顾性分析根治术后接受辅助化疗的胃癌患者的临床、病理资料以及生存数据;依据时间依赖性受试者工作特征曲线(ROC曲线)确定白蛋白水平的最佳截断值;采用多因素Cox回归分析校正混杂因素,探讨白蛋白水平对无病生存期(disease-free survival,DFS)和总生存期(overall survival,OS)的影响;绘制预测列线图并进行验证。[结果]共纳入121例患者,白蛋白对12个月OS影响的曲线下面积(area under curve, AUC)为0.69(95%CI:0.55~0.83),白蛋白最佳截断值为37.0 g/L。Cox回归分析结果提示化疗前血清白蛋白<37.0 g/L、低/差分化肿瘤和存在癌结节是增加患者复发及死亡风险的独立因素。基于3个参数构建的列线图预测DFS和OS的c-指数分别为0.671(95%CI:0.526~0.816)和0.649(95%CI:0.553~0.745),校准曲线基本沿45°线分布。[结论]对于接受辅助化疗的胃癌根治术后患者,基于化疗开始前血清白蛋白水平的列线图可用于预测复发、转移和生存结局。[Purpose]To construct a prognostic predicting model based on serum albumin level before adjuvant chemotherapy in gastric cancer patients after radical resection.[Methods]Clinical,pathological and survival data of patients with gastric cancer,who received gastrectomy followed by adjuvant chemotherapy,were retrospectively reviewed.Receiver operating characteristic(ROC)curve was generated to determine the optimal cut-off value of serum albumin level;multivariate Cox regression was used to explore the correlation of serum albumin level with overall survival(OS)and disease-free survival(DFS);prognostic nomograms were also depicted and validated.[Results]A total of 121 cases were included into analysis,area under curve(AUC)at 12 months was 0.69(95%CI:0.55~0.83),the optimal cut-off value of albumin was 37.0 g/L.Results of Cox regression showed that serum albumin<37.0 g/L,low/poor differentiated tumors and presence of tumor node(s)were independent risk factors of recurrence and death.Nomograms based on the three parameters were constructed,the c-index for predicting DFS and OS was0.671(95%CI:0.526~0.816)and 0.649(95%CI:0.553~0.745),respectively;the calibration curve was closed to the 45-degree line.[Conclusion]For gastric patients who received adjuvant chemotherapy after gastrectomy,the constructed nomograms based on serum albumin level before adjuvant chemotherapy may be used for prediction of recurrence and survival of patients.

关 键 词：胃癌 辅助化疗 白蛋白 生存预测 

分 类 号：R735.2[医药卫生—肿瘤]