术前白蛋白-球蛋白比值与食管鳞癌患者的预后

王靖雯; 林征; 刘双; 杨惠敏; 谢倩雯; 陈辉林; 陈元美; 胡志坚

doi:10.16462/j.cnki.zhjbkz.2019.10.016

术前白蛋白-球蛋白比值与食管鳞癌患者的预后

doi: 10.16462/j.cnki.zhjbkz.2019.10.016

1.
350122 福州, 福建医科大学公共卫生学院流行病与卫生统计学系, 福建省环境因素与肿瘤省级重点实验室
2.
362400 泉州, 安溪县医院肿瘤放疗科
3.
350014 福州, 福建医科大学教学医院, 福建省肿瘤医院胸外科

基金项目:

国家重点研发计划精准医学研究重点专项 2017YFC0907100

2018年福建省医学创新课题 2018-CX-38

详细信息

通讯作者:
胡志坚, E-mail: hzj99955888@126.com

中图分类号: R181
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- 被引次数: 0
出版历程
- 收稿日期: 2019-03-26
- 修回日期: 2019-06-18
- 刊出日期: 2019-10-10

Preoperative albumin-globulin ratio and prognosis of patients with esophageal squamous cell carcinoma

1.
Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fujian Provincial Key Laboratory of Environment Factors and Cancer, Fuzhou 350122, China
2.
Department of Tumor radiotherapy, Anxi County Hospital, Quanzhou 362400, China
3.
Department of Thoracic surgery, Fujian Provincial Tumor Hospital, Teaching Hospital of Fujian Medical University, Fuzhou 350014, China

Funds:

National Key Research and Development Program of China 2017YFC0907100

Medical Innovation Project of Fujian Province 2018-CX-38

More Information

Corresponding author: HU Zhi-jian, E-mail: hzj99955888@126.com

摘要

摘要: 目的探讨术前白球蛋白比（albumin/globulin ratio，AGR）与食管鳞癌（esophageal squamous cell carcinoma，ESCC）患者预后的关系，建立ESCC手术患者生存时间的预测列线图，为ESCC患者的预后预测提供参考依据。方法收集2014年2月-2017年9月在福建省肿瘤医院收治的390例接受过手术治疗的ESCC患者的临床资料。利用接受者操作特征曲线（receiver operating characteristic curves，ROC）确定术前AGR的最佳临界值，χ²检验分析AGR与一般临床特征间的相关性，Cox比例风险回归模型分析AGR与ESCC患者预后的关系，进而构建ESCC术后患者预后预测列线图模型。结果按术前AGR最佳临界值1.16将患者分为高AGR和低AGR两组，高AGR组1年和3年生存率均高于低AGR组（均有P < 0.05）。多因素分析结果显示：T分期、N分期、AGR是影响ESCC患者预后的因素（均有P < 0.05），其中T₃-T₄ vs T₁-T₂（HR=1.87，95% CI：1.04~3.35），N₊ vs N₀（HR=1.89，95% CI：1.13~3.17），高AGR组vs低AGR组（HR=0.57，95% CI：0.36~0.90）。预测ESCC术后患者预后的列线图一致性指数为0.68（95% CI：0.62~0.73，P < 0.001）。结论术前AGR水平是影响ESCC术后患者预后的因素，高AGR组ESCC患者的预后优于低AGR组，列线图有助于临床医生对ESCC术后患者的预后进行个体化预测。
- 食管鳞癌 /
- 预后 /
- 白球蛋白比 /
- 列线图
Abstract: Objective To investigate the relationship between albumin/globulin ratio (AGR) and postoperative survival among patients with esophageal squamous cell carcinoma(ESCC) undergoing radical oesophagectomy, to establish an effective prognostic nomogram for ESCC and to provide a reference for prognosis prediction of ESCC. Methods From February 2014 to September 2017, 390 ESCC patients who underwent surgery were retrospectively enrolled from the tumor hospital in Fujian Province. The receiver operating characteristic curves(ROC) were applied to establish optimal cutoff points. Chi-square test was used to estimate the relationship between the AGR and the clinical features. Cox proportional hazards model was used to estimate the HR and 95% CI for the associations between AGR and Prognosis of ESCC patients. A nomogram model was established to predict the outcome of ESCC patients. Results The ROC demonstrated the best cutoff value for AGR was 1.16. A total of 356 patients were recruited in the final analysis, who were divided into the high AGR group (≥ 1.16) and the low AGR group (< 1.16) by the best cutoff value. Both 1-year and 3-year survival rates in the high AGR group were higher than those detected in the low AGR group(all P < 0.05). Multivariate analysis showed that the T stage, N stage, and AGR were independent prognostic factors of overall survival(all P < 0.05). The HR of T stage was 1.87 (T₃-T₄ vs T₁-T₂, 95% CI: 1.04-3.35); The HR of N stage was1.89 (N₊ vs N₀, 95% CI: 1.13-3.17); The HR of AGR was 0.57(the high AGR group vs the low AGR group, 95%CI: 0.36-0.90). The concordance index(C-index) of the nomogram to predict overall survival was 0.68 (95% CI: 0.62-0.73, P < 0. 001). Conclusions The AGR was an independent prognosis factor for operated ESCC patients. The prognosis of ESCC in the high AGR group was better than that in the low AGR group and the prognostic nomogram provides individualized risk estimate of survival in ESCC patients after surgery.
- ESCC /
- Prognosis /
- AGR /
- Nomogram

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图 1 使用ROC曲线确定AGR分组截断值

Figure 1. The ROC curve was used to determine the cutoff value of AGR

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图 2 ESCC术后患者总生存时间列线图

Figure 2. A survival nomogram of ESCC patients after surgery

下载: 全尺寸图片幻灯片

表 1 术前AGR与ESCC患者一般特征的关系[n(%)]

Table 1. Relationship between preoperative AGR and baseline clinical features of ESCC patients[n(%)]

变量	合计	AGR		χ²值	P值
变量	合计	< 1.16	≥1.16	χ²值	P值
性别				4.597	0.032
女	94	37	(33.9)	57	(23.1)
男	262	72	(66.1)	190	(76.9)
年龄(岁)				12.768	< 0.001
≥60	208	79	(72.5)	129	(52.2)
< 60	148	30	(27.5)	118	(47.8)
肿瘤部位				4.233	0.237
胸上段	42	9	(8.3)	33	(13.4)
胸中段	172	56	(51.9)	116	(47.2)
胸下段	140	43	(39.8)	97	(39.4)
T分期				8.260	0.004
T₁~T₂	121	25	(23.6)	96	(39.5)
T₃~T₄	228	81	(76.4)	147	(60.5)
N分期				3.100	0.078
N₀	178	47	(43.5)	131	(53.7)
N₊	174	61	(56.5)	113	(46.3)
分化程度				3.098	0.078
高分化	19	6	(5.6)	13	(5.3)
中分化	282	85	(79.4)	197	(81.1)
低分化/未分化	49	16	(15.0)	33	(13.6)
治疗方式				0.960	0.810
单纯手术	207	63	(57.8)	144	(58.3)
手术+放疗	5	1	(0.9)	4	(1.6)
手术+化疗	109	36	(33.3)	73	(29.6)
手术+放化疗	35	9	(8.3)	26	(10.5)

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表 2 不同人群高、低AGR分组生存分析

Table 2. Survival analysis of high and low AGR groups in different populations

对象	1年生存率(95% CI)	3年生存率(95% CI)	χ²值	P值
总人群			8.887	0.003
低AGR组	85.64%(78.68%~92.60%)	43.95%(30.92%~56.99%)
高AGR组	90.23%(86.26%~94.20%)	63.21%(53.93%~72.50%)
T₁-T₂期人群			0.220	0.639
低AGR组	95.65%(95.57%~95.74%)	69.69%(69.46%~69.92%)
高AGR组	94.99%(94.94%~95.03%)	64.80%(64.61%~64.99%)
T₃-T₄期人群			7.085	0.008
低AGR组	81.87%(81.78%~81.96%)	41.24%(41.10%~41.38%)
高AGR组	88.05%(87.99%~88.11%)	57.36%(57.23%~57.49%)
N₀期人群			2.425	0.119
低AGR组	89.80%(89.71%~89.90%)	63.37%(63.19%~63.55%)
高AGR组	94.91%(94.87%~94.95%)	72.15%(72.02%~72.29%)
N₊期人群			2.497	0.114
低AGR组	84.00%(83.90%~84.09%)	38.13%(37.97%~38.28%)
高AGR组	83.24%(83.16%~83.32%)	45.15%(45.00%~45.31%)

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表 3 影响ESCC患者预后的单因素与多因素Cox回归分析

Table 3. Univariate and multivariate Cox regression analysis of prognosis in patients with ESCC

变量	单因素		多因素模型1		多因素模型2		多因素模型3
变量	P值	HR(95% CI) 值	P值	HR(95% CI) 值	P值	HR(95% CI) 值	P值	HR(95% CI) 值
性别	0.288		0.145		0.292		0.281
女		1.00		1.00		1.00		1.00
男		1.30(0.80~2.12)		1.50(0.87~2.59)		1.34(0.78~2.29)		1.36(0.78~2.35)
年龄(岁)	0.300		0.605		0.506		0.464
≥60		1.00		1.00		1.00		1.00
< 60		0.8(0.53~1.22)		0.89(0.56~1.41)		0.85(0.54~1.36)		0.84(0.53~1.34)
肿瘤部位
胸上段		1.00		1.00		1.00		1.00
胸中段	0.512	0.81(0.44~1.51)	0.257	0.69(0.37~1.31)	0.283	0.70(0.37~1.34)	0.311	0.72(0.38~1.36)
胸下段	0.561	0.83(0.44~1.57)	0.283	0.70(0.36~1.35)	0.322	0.71(0.37~1.39)	0.330	0.72(0.39~1.40)
T分期	0.001		0.036		0.024		0.025
T₁-T₂		1.00		1.00		1.00		1.00
T₃-T₄		2.48(1.48~4.16)		1.87(1.04~3.35)		1.96(1.10~3.53)		1.96(1.09~3.54)
N分期	＜0.001		0.016		0.007		0.007
N₀		1.00		1.00		1.00		1.00
N₊		2.53(1.63~3.92)		1.89(1.13~3.17)		2.03(1.21~3.42)		2.04(1.21~3.43)
分化程度
高分化		1.00		1.00		1.00		1.00
中分化	0.167	2.26(0.71~7.16)	0.322	1.85(0.55~6.20)	0.404	1.67(0.50~5.62)	0.397	1.69(0.55~5.65)
低分化/未分化	0.284	2.03(0.56~7.39)	0.761	1.24(0.31~5.04)	0.801	1.20(0.30~4.87)	0.798	1.20(0.30~4.87)
治疗方式
单纯手术		1.00		1.00		1.00		1.00
手术+放疗	0.421	1.79(0.43~7.40)	0.693	1.34(0.32~5.63)	0.867	1.13(0.27~4.73)	0.850	1.15(0.27~4.87)
手术+化疗	0.324	1.26(0.79~2.01)	0.353	0.77(0.45~1.33)	0.228	0.72(0.42~1.23)	0.244	0.72(0.42~1.25)
手术+放化疗	0.139	1.59(0.86~2.94)	0.535	1.23(0.64~2.39)	0.794	1.09(0.57~2.10)	0.769	1.10(0.57~2.12)
AGR	0.003		0.017
< 1.16		1.00		1.00
≥1.16		0.54(0.35~0.81)		0.57(0.36~0.90)
白蛋白(g/L)	0.252				0.609
< 41.5		1.00				1.00
≥41.5		0.70(0.38~1.29)				0.84(0.44~1.63)
球蛋白(g/L)	0.552						0.923
< 31.5		1.00						1.00
≥31.5		1.15(0.73~1.82)						1.03(0.61~1.73)

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