治疗前白蛋白与纤维蛋白原比值对根治性放化疗宫颈癌患者预后的价值  

Impact of Pre-treatment Albumin-to-Fibrinogen Ratio on the Prognosis of Cervical Cancer Patients Undergoing Radical Chemoradiotherapy

作　　者：伍健 杜芝霖 秦远[2] 郎锦义[2] 

机构地区：[1]西南医科大学附属医院肿瘤科,四川泸州646000 [2]四川省肿痛临床医学研究中心,四川省肿瘤医院·研究所,四川省癌症防治中心,电子科技大学附属肿瘤医院放疗中心,放射肿瘤学四川省重点实验室,成都610041

出　　处：《肿瘤预防与治疗》2023年第7期564-575,共12页Journal of Cancer Control And Treatment

基　　金：四川省科技计划项目(编号:2020YJ0446)。

摘　　要：目的:探讨治疗前白蛋白与纤维蛋白原比值(albumin-to-fibrinogen ratio,AFR)在根治性放化疗宫颈癌患者预后中的价值。方法:收集2011年1月至2018年12月于四川省肿瘤医院行根治性放化疗的241名宫颈鳞癌患者的资料,评估AFR在不同FIGO分期和生存状态组别的差异,根据受试者ROC曲线确定AFR最佳截断值,根据最佳截断值将患者分为高AFR组和低AFR组,比较两组间总生存期(overall survival,OS)和无进展生存期(progression-free survival,PFS)。结果:AFR的水平在不同的FIGO分期存在显著差异,其水平随FIGO分期的增加而下降。高AFR组患者具有更长的PFS和OS(P <0.05)。在单个指标OS诊断ROC曲线中,血小板淋巴细胞比值(platelet-to-lymphocyte ratio,PLR)的AUC最大,为0.894。单个指标PFS诊断ROC曲线中,中性粒细胞与淋巴细胞比值(neutrophil-to-lymphocyte ratio,NLR)的AUC最大,为0.867,AFR的AUC分别为0.784、0.702。在联合指标OS及PFS诊断ROC曲线中,AFR-NLR的AUC最大,分别为0.901、0.876。根据最佳截断值计算结果将AFR分为高值组和低值组,分别与宫颈癌患者临床特征分组进行相关性分析,OS-AFR高值组与低值组相比,高值组的肿瘤分期相对较早,治疗前NLR、PLR、全身免疫炎症指数(systemic immune-inflammation index,SII)、全身性炎症反应指数(systemic inflammatory response index,SIRI)水平多处于各指标最佳截断值水平以下,在是否出现淋巴结转移及患者生存状态等组间的差异也具有统计学意义(P <0.05),但在肿瘤大小及是否出现宫旁侵犯等组间的差异不具有统计学意义。PFS-AFR高值组与低值组相比,高值组的肿瘤分期相对较早,治疗前NLR、PLR、SII、SIRI水平多处于各指标最佳截断值水平以下,在肿瘤大小及是否出现淋巴结转移、宫旁侵犯和肿瘤进展等组间的差异也具有统计学意义(P <0.05)。COX回归分析结果显示,治疗前AFR水平是影响患者OS与PFS的独立预后因素。治疗�Objective:To ascertain the significance of pre-treatment albumin-to-fibrinogen ratio(AFR)in cervical cancer patients receiving radical chemoradiotherapy.Methods:Data on 241 patients with squamous cervical cancer treated with radical radiotherapy at Sichuan Cancer Hospital from January 2011 to December 2018 were collected to assess the difference in AFR among different FIGO stage and survival groups,determine the optimal cut-off value of AFR according to the receiver operating characteristic(ROC)curve,assign the patients to high-and low-AFR groups based on the optimal cut-off value,and compare the overall survival(OS)and progression-free sur-vival(PFS)between high-and low-AFR groups.Results:AFR levels varied significantly among FICO stages,and fell as FIGO stage in-creased.The high-AFR group has longer PFS and OS(P<0.05).In the ROC curves of single indicators diagnosing OS,the area under the curve(AUC)of platelet-to-lymphocyte ratio(PLR)was the largest,with the value of O.894;while in the ROC curves of single indica-tors diagnosing PFS,the AUC of neutrophil-to-lymphocyte ratio(NLR)was the largest,with the value of 0.867;the AUC of AFR was 0.784 for diagnosing OS and O.702 for diagnosing PFS.In the ROC curves of combined indicators,the AUC of AFR combined with NLR was the largest,with the value of 0.901 for diagnosing OS and that of 0.876 for diagnosing PFS.According to the optimal cut-off value,the patients were assigned to the high-AFR group and the low-AFR group,and the correlation between the AFR levels and the clinical characteristics of cervical cancer patients was analyzed.Compared with the low OS-AFR group,the high OS-AFR group showed earlier FIGO stage;and the values of NLR,PLR,systemic immune-inflammation index(SII)and systemic inflammatory response index(SIRI)before treatment were below the optimal cut-off values;there were also statistically significant dfferences between groups in lymph node metastasis and survival(P<0.05),but there were no statistically significant differences between groups in tumor

关 键 词：纤维蛋白原 白蛋白 宫颈鳞癌 预后 

分 类 号：R737.33[医药卫生—肿瘤] R730.53[医药卫生—临床医学] R730.55R730.7