南方医科大学学报

南方医科大学学报 ›› 2017, Vol. 37 ›› Issue (05): 622-.

• • 上一篇    下一篇

C反应蛋白/白蛋白比率预测结直肠癌病人预后关系

陈英英，张佳和，张湾，杨子科，罗荣城，康世均   

  • 出版日期:2017-05-20 发布日期:2017-05-20

C-reactive protein/albumin ratio as a novel inflammation-based prognostic index for predicting outcomes of patients with colorectal cancer

  • Online:2017-05-20 Published:2017-05-20

HTML

PDF

2658

摘要： 目的探讨初诊时C反应蛋白/白蛋白比率（CAR）与结直肠癌患者预后的关系，并与其他基于全身炎症反应的评分系统格 拉斯哥预后评分（GPS）和中性粒细胞/淋巴细胞比率（NLR）进行比较。方法收集2007年1月~2014年12月于南方医院确诊的 原发新发且临床病理因素资料完整的结直肠癌病人163例，并对其预后进行回顾性分析。各个病理因素的最佳界值用受试者 工作特征曲线分析；曲线下面积的测量和比较用De Long等确立的方法；分析初诊时CAR与临床病理因素的关系，分类变量组 间对比采用χ2检验，连续变量组间对比采用Mann-Whitney U检验；生存曲线比较采用Log-rank检验；单因素和多因素生存分析 采用Cox 比例风险回归模型。结果CAR的最佳界值是0.132，CAR低组（CAR<0.132）的中位生存时间为2157.0±395.3 天， CAR高组（CAR≥0.132）的中位生存时间为1661.0± 136.4天，组间比较P<0.001。CAR、NLR和GPS的受试者工作特征曲线下 面积分别为0.656、0.550和0.642，CAR相比NLR和GPS有更高的曲线下面积，对NLR和GPS评分后的病人采用CAR再次评 估，部分病人得到相反的预后预测结果。单因素生存分析中，年龄、C反应蛋白、白蛋白、CAR、NLR、GPS、血小板计数、TMN分 期、Dukes分期和化疗方式均与总生存时间相关（P<0.05）；多因素生存分析上述临床病理因素，显示TMN分期（Ⅰ~Ⅳ期，风险 比HR=1.689，95% CI：1.146-2.488，P=0.008）和Dukes 分期（A/B/C，风险比HR=2.447，95% CI：1.349-4.441，P=0.003）与总生存 时间相关。结论如以前报道的基于全身炎症反应的评分系统（GPS和NLR）一样，CAR也能有效预测结直肠癌病人的预后，且 CAR能弥补这两种评分系统的不足。

Abstract: Objective To evaluate the association of C-reactive protein/albumin ratio (CAR) with the prognosis of patients with colorectal cancer and compare the prognostic value of CAR with other inflammation-based prognostic scoring systems. Methods We retrospectively evaluated 163 newly diagnosed colorectal cancer patients in Nanfang Hospital between January, 2007 and December, 2014. All recommended cutoff values of the clinicopathological factors were defined using receiveroperating characteristic (ROC) curve analyses. We evaluated the prognostic value of CAR in comparison with Glasgow Prognostic Score (GPS) and neutrophil lymphocyte ratio (NLR) with the area under the ROC curve. Univariate and multivariate analyses using the Cox proportional hazards model were performed to identify the factors closely associated with overall survival of the patients. Kaplan-Meier analysis was used to compare overall survival curves between patients with a high CAR and those with a low CAR. Results The recommended cutoff value of CAR was 0.132. Kaplan-Meier analysis and log rank test demonstrated a significant difference in the overall survival between patients with a low CAR (<0.132) and those with a high CAR (≥0.132) (2157.0±395.3 vs 1661.0±136.4 days, P<0.001). The area under the ROC curve of CAR, NLR and GPS was 0.656, 0.550 and 0.642, respectively, indicating a better prognostic value of CAR. Univariate analyses showed that age, C-reactive protein, albumin, CAR, NLR, GPS, platelet, TMN stage, Dukes stage and chemotherapy regimens were associated with the overall survival of the patients (P<0.05). Multivariate analyses showed that TMN stage [HR= 1.689 (95%CI: 1.146-2.488), P=0.008] and Dukes stage [HR=2.447 (95% CI: 1.349-4.441), P=0.003] were associated with the overall survival of the patients. Conclusions Similar to the previously reported inflammation-based prognostic systems (GPS and NLR), CAR is useful for predicting the survival of patients with colorectal cancer and can be complementary to the two prognostic scoring systems.