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中华普通外科学文献(电子版)

中华普通外科学文献(电子版) ›› 2020, Vol. 14 ›› Issue (04) : 266 -270. doi: 10.3877/cma.j.issn.1674-0793.2020.04.007

所属专题： 专题评论； 文献；

论著

术前纤维蛋白原与白蛋白比值联合全身炎症反应指数对可切除胃癌患者预后的评估价值
严征远1, 张恒1,†(), 尹光平1   
  1. 1. 211200　南京，东南大学附属中大医院溧水分院普外科
  • 收稿日期:2020-01-04 出版日期:2020-08-01
  • 通信作者: 张恒
  • 基金资助:
    江苏省卫生计生委医学科研课题面上项目(H201782)

Prognostic value of preoperative fibrinogen to albumin ratio combined with systemic inflammation response index in patients with resectable gastric cancer

Zhengyuan Yan1, Heng Zhang1,†(), Guangping Yin1   

  1. 1. Department of General Surgery, Lishui Branch, Zhongda Hospital of Southeast University, Nanjing 211200, China
  • Received:2020-01-04 Published:2020-08-01
  • Corresponding author: Heng Zhang
  • About author:
    Corresponding author: Zhang Heng, Email:
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引用本文：

严征远, 张恒, 尹光平. 术前纤维蛋白原与白蛋白比值联合全身炎症反应指数对可切除胃癌患者预后的评估价值[J/OL]. 中华普通外科学文献(电子版), 2020, 14(04): 266-270.

Zhengyuan Yan, Heng Zhang, Guangping Yin. Prognostic value of preoperative fibrinogen to albumin ratio combined with systemic inflammation response index in patients with resectable gastric cancer[J/OL]. Chinese Archives of General Surgery(Electronic Edition), 2020, 14(04): 266-270.

目的

评估术前纤维蛋白原与白蛋白比值（FAR）联合全身炎症反应指数（SIRI）对可切除胃癌（rGC）患者预后的评估价值，分层探讨FAR-SIRI作为胃癌患者预后指标的作用价值。

方法

选择2014年1月至2016年12月在东南大学附属中大医院溧水分院行胃癌根治术治疗的rGC患者105例，术前计算FAR和SIRI，绘制受试者工作特征（ROC）曲线确定FAR、SIRI界值和分组，结合随访生存情况分析FAR-SIRI与rGC患者临床病理因素及预后的关系。

结果

FAR、SIRI预测界值分别为0.083、0.740。患者分为三组：FAR-SIRI 2分组29例（FAR≥0.08且SIRI≥0.74），FAR-SIRI 1分组14例（FAR<0.08，且SIRI≥0.74），FAR-SIRI 0分组62例（SIRI<0.74）。FAR-SIRI与性别、年龄、肿瘤直径、TNM分期、CEA水平及组织分化程度有关（均P<0.05）。Cox比例风险回归分析显示，年龄≥60岁（HR=1.957，95% CI：1.015~3.773，P=0.045）、TNM分期（P=0.047、0.003）、组织分化程度差（HR=0.363，95% CI：0.172~0.764，P=0.008）及FAR-SIRI 2分（HR=2.576，95% CI：1.313~5.051，P=0.006）是影响rGC患者预后的独立危险因素。

结论

FAR-SIRI可作为rGC患者预后的有效预测指标，指导个体化治疗，高FAR-SIRI提示患者预后不良。

关键词: 胃肿瘤, 全身炎症反应指数, 纤维蛋白原与白蛋白比值, 预后
Objective

To investigate the prognostic value of preoperative fibrinogen to albumin ratio (FAR) combined with systemic inflammation resonance index (SIRI) in patients with resectable gastric cancer (rGC).

Methods

From January 2014 to December 2016, 105 patients with rGC underwent radical gastrectomy were included, followed up to December 31, 2019 or patient’s death. The cut-off values for FAR and SIRI were determined by ROC curve. The clinicopathological characteristics of three different groups were compared, and the prognostic factors of rGC patients were analyzed.

Results

According to the cut-off values of FAR and SIRI, patients were divided into three groups: FAR-SIRI 2 score group (FAR≥0.08, and SIRI≥0.74), FAR-SIRI 1 score group (FAR<0.08, and SIRI≥0.74), FAR-SIRI 0 score group (SIRI<0.74). FAR-SIRI was related to sex, age, tumor diameter, TNM stage, carcinoembryonic antigen and tissue differentiation (all P<0.05). Cox regression multivariate analysis showed that age≥60 yearsold (HR=1.957, 95% CI: 1.015-3.773, P=0.045), TNM stage (P=0.047, 0.003), poor degree of tissue differentiation (HR=0.363, 95% CI: 0.172-0.764, P=0.008) and FAR-SIRI 2 score (HR=2.576, 95% CI:1.313-5.051, P=0.006) were independent risk factors that affected the prognosis of rGC patients.

Conclusions

FAR-SIRI can be used as an effective predictor for prognosis in rGC patients, and can guide individualized treatment. High FAR-SIRI indicates that patients have a poor prognosis.

Key words: Stomach neoplasms, Systemic inflammatory response index, Fibrinogen to albumin ratio, Prognosis
图1 相关生化指标判断可切除胃癌患者预后的ROC曲线　A~G分别为中性粒细胞、单核细胞、淋巴细胞、纤维蛋白原、白蛋白、术前纤维蛋白原与白蛋白比值（FAR）、全身炎症反应指数（SIRI）、CEA
表1 相关生化指标判断rGC患者预后的ROC分析结果
项目 临界值 AUC(95% CI) 敏感度(%) 特异度(%) 约登指数 P值
中性粒细胞(×109/L) 3.28 0.660(0.561~0.750) 75.00 60.00 0.35 0.003
单核细胞(×109/L) 0.34 0.693(0.596~0.780) 70.00 69.23 0.39 <0.001
淋巴细胞(×109/L) 1.56 0.662(0.563~0.751) 72.50 66.15 0.39 0.003
纤维蛋白原(g/L) 3.09 0.644(0.545~0.735) 67.50 61.54 0.29 0.009
白蛋白(g/L) 38.40 0.629(0.529~0.721) 60.00 69.23 0.29 0.020
FAR 0.08 0.734(0.639~0.815) 62.50 90.77 0.53 <0.001
SIRI 0.74 0.785(0.694~0.859) 72.50 93.85 0.66 <0.001
FAR-SIRI - 0.919(0.849~0.963) 90.00 89.23 0.79 <0.001
CEA(μg/L) 4.30 0.765(0.673~0.843) 80.00 58.46 0.38 <0.001
表2 FAR-SIRI与可切除胃癌患者临床病理特征的关系[例(%)]
项目 FAR-SIRI 0分组 FAR-SIRI 1分组 FAR-SIRI 2分组 χ2值 P值
例数 62 14 29 ? ?
性别 ? ? ? 6.267 0.044
? 男 33(53.2) 10(71.4) 23(79.3) ? ?
? 女 29(46.8) 4(28.6) 6(20.7) ? ?
年龄(岁) ? ? ? 12.741 0.002
? <60 35(56.5) 5(35.7) 5(17.2) ? ?
? ≥60 27(43.5) 9(64.3) 24(82.8) ? ?
肿瘤直径(cm) ? ? ? 10.152 0.006
? <3 37(59.7) 6(42.9) 7(24.1) ? ?
? ≥3 25(40.3) 8(57.1) 22(75.9) ? ?
TNM分期 ? ? ? 11.459 0.022
? Ⅰ 24(38.7) 2(14.3) 5(17.2) ? ?
? Ⅱ 20(32.3) 6(42.9) 6(20.7) ? ?
? Ⅲ 18(29.0) 6(42.9) 18(62.1) ? ?
分化程度 ? ? ? 8.166 0.017
? 差 32(51.6) 9(64.3) 24(82.8) ? ?
? 中-好 30(48.4) 5(35.7) 5(17.2) ? ?
CEA(μg/L) ? ? ? 6.470 0.039
? <4.3 34 5 8 ? ?
? ≥4.3 28 9 21 ? ?
表3 rGC患者预后影响因素的单因素和多因素Cox回归分析
影响因素 单因素分析 多因素分析
β Wald χ2 HR(95% CI) P β Wald χ2 HR(95% CI) P
性别(女 vs男) 0.803 5.859 2.233(1.165~4.279) 0.015 0.485 2.323 1.624(0.871~3.030) 0.127
年龄(<60岁 vs ≥60岁) 0.936 6.839 2.551(1.264~5.145) 0.009 0.671 4.020 1.957(1.015~3.773) 0.045
肿瘤直径(<3 cm vs ≥3 cm) 0.334 1.076 1.397(0.743~2.627) 0.300 - - ? ?
TNM分期(Ⅰ vs Ⅱ) 1.619 6.369 5.048(1.436~17.750) 0.012 0.986 3.944 2.680(1.013~7.091) 0.047
TNM分期(Ⅰvs Ⅲ) 2.256 12.965 9.545(2.796~32.590) <0.001 1.251 8.944 3.495(1.539~7.935) 0.003
分化程度(差 vs中-好) -1.622 11.474 0.197(0.077~0.505) 0.001 -1.013 7.116 0.363(0.172~0.764) 0.008
FAR-SIRI (0 vs 1) 0.888 4.112 2.431(1.030~5.738) 0.043 0.628 2.250 1.874(0.825~4.259) 0.134
FAR-SIRI (0 vs 2) 1.270 13.831 3.561(1.823~6.954) <0.001 0.946 7.581 2.576(1.313~5.051) 0.006
CEA(<4.3 μg/L vs ≥4. 3 μg/L) 0.488 1.992 1.629(0.827~3.210) 0.158 ? ? ? ?
图2 rGC患者生存分析曲线
[1]
Torre LA, Bray F, Siegel RL, et al. Global cancer statistics, 2012[J]. CA Cancer J Clin, 2015, 65(2): 87-108.
[2]
Li S, Lan X, Gao H, et al. Systemic inflammation response index (SIRI), cancer stem cells and survival of localised gastric adenocarcinoma after curative resection[J]. J Cancer Res Clin Oncol, 2017, 143(12): 2455-2468.
[3]
Chen Y, Jin M, Shao Y, et al. Prognostic value of the systemic inflammation response index in patients with adenocarcinoma of the oesophagogastric junction: A propensity score-matched analysis[J]. Dis Markers, 2019, 2019: 4659048.
[4]
Li S, Xu H, Wang W, et al. The systemic inflammation response index predicts survival and recurrence in patients with resectable pancreatic ductal adenocarcinoma[J]. Cancer Manag Res, 2019, 11: 3327-3337.
[5]
Li SQ, You XH, Sun F, et al. Albumin to fibrinogen ratio and fibrinogen to pre-albumin ratio are economical, simple and promising prognostic factors for solid malignancy[J]. J Thorac Dis, 2019, 11(Suppl 15): S2036-S2038.
[6]
Qi Q, Zhuang L, Shen Y, et al. A novel systemic inflammation response index (SIRI) for predicting the survival of patients with pancreatic cancer after chemotherapy[J]. Cancer, 2016, 122(14): 2158-2167.
[7]
Li S, Lan X, Gao H, et al. Systemic inflammation response index (SIRI), cancer stem cells and survival of localised gastric adenocarcinoma after curative resection[J]. J Cancer Res Clin Oncol, 2017, 143(12): 2455-2468.
[8]
Virizuela JA, Camblor-Álvarez M, Luengo-Pérez LM, et al. Nutritional support and parenteral nutrition in cancer patients: an expert consensus report[J]. Clin Transl Oncol, 2018, 20(5): 619-629.
[9]
Wu M, Pan Y, Jia Z, et al. Preoperative plasma fibrinogen and serum albumin score is an independent prognostic factor for resectable stage -Ⅲ gastric cancer[J]. Dis Markers, 2019, 2019: 9060845.
[10]
Lieto E, Galizia G, Auricchio A, et al. Preoperative neutrophil to lymphocyte ratio and lymphocyte to monocyte ratio are prognostic factors in gastric cancers undergoing surgery[J]. J Gastrointest Surg, 2017, 21(11): 1764-1774.
[11]
Zhang Y, Lu JJ, Du YP, et al. Prognostic value of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in gastric cancer[J]. Medicine (Baltimore), 2018, 97(12): e0144.
[12]
曹能琦，曹晓刚，孙宝林, 等. 食管胃结合部腺癌炎性反应和营养状态变化及对预后的影响[J/CD]. 中华普通外科学文献（电子版）, 2019, 13(2): 137-142.
[13]
Arigami T, Uenosono Y, Matsushita D, et al. Combined fibrinogen concentration and neutrophil-lymphocyte ratio as a prognostic marker of gastric cancer[J]. Oncol Lett, 2016, 11(2): 1537-1544.
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