基于竞争风险模型探索术前间接胆红素/总胆红素比值在胃癌中的预后价值  

Preoperative indirect bilirubin to total bilirubin ratio:a novel rognostic factor for gastric cancer based on competing risk model

作　　者：马明哲 袁庶强[3] 闵筱辉[1,2] MA Ming-zhe;YUAN Shu-qiang;MIN Xiao-hui(Department of Gastroenterology,Sun Yat-sen Memorial Hospital,Sun Yat-sen University,Guangzhou 510120,China;Department of Gastroenterology,Shenshan Medical Center,Sun Yat-sen Memorial Hospital,Sun Yat-Sen University,Shanwei,Guangdong 516621,China;Department of Gastric Surgery,Sun Yat-sen University Cancer Center,Guangzhou 510060,China)

机构地区：[1]中山大学孙逸仙纪念医院消化内科,广州510120 [2]中山大学孙逸仙纪念医院深汕中心医院消化内科,广东汕尾516621 [3]中山大学肿瘤防治中心胃外科,广东广州510060

出　　处：《岭南现代临床外科》2024年第6期347-353,共7页Lingnan Modern Clinics in Surgery

基　　金：广东省自然科学基金(2016A030313316)。

摘　　要：背景胆红素,尤其是间接胆红素,除了作为一种代谢废物外,由于其内在的抗氧化特性在肿瘤发生发展中也有一定影响。胆红素与患者预后的关系在许多肿瘤中已有相应研究报道,但其在胃癌中的作用尚不明确。方法回顾性地收集2008~2023年在中山大学肿瘤防治中心和中山大学孙逸仙纪念医院深汕中心医院接受根治性或姑息性胃切除术的1245名胃癌患者,并使用Fine和Gray竞争风险模型评估临床病理因素和胆红素相关指标的预后意义。结果除了常规的间接胆红素、总胆红素外,建立了一个新的预后指标,间接胆红素与总胆红素比值(ITR),以预测接受根治性或姑息性手术的胃癌患者预后。结果显示ITR大于0.69的患者预后相对较好(HR=0.72,95%CI:0.61-0.84;P<0.01)。结论本研究表明术前ITR可作为胃癌患者新的预后标志物。Background Besides its adverse effect,bilirubin,especially indirect bilirubin,also serves as a potent antioxidant and could influence the formation and development of carcinoma.The correlation between bilirubin with clinical outcome has been widely validated in several malignancies,nevertheless,whether bilirubin is capable of being a prognosis indicator in gastric cancer remains disputable.Methods We retrospectively reviewed 1245 gastric cancer(GC)patients who received radical or palliative gastrec-tomy at Sun Yat-Sen University Cancer Center and Shenshan Medical Center,Sun Yat-Sen Memorial Hospital from 2008 to 2023.Fine and Gray competing risk model was conducted to evaluate prognostic significance of clinicopathological factors and bilirubin.Results We derived a novel index,Indirect Bilirubin to Total Bilirubin Ratio(ITR)and explored its role in predicting prognosis of GC patients with curative/palliative surgery by utilizing competing risk regression model.At first time,we found patients with ITR>0.69 had relatively better prognosis(HR,0.72;95%CI,0.61-0.84;P<0.001).Conclusion Our study indicated that preoperative ITR could act as an independent prognostic factor in GC.

关 键 词：胆红素 胃癌 预后 竞争风险模型 

分 类 号：R735.2[医药卫生—肿瘤]