摘要
目的探讨辅助化疗前后C反应蛋白与白蛋白比值(C-reactive protein to albumin ratio,CAR)对结、直肠癌预后的评估价值。方法选取2013年2月至2014年3月于西南医科大学附属医院胃肠外科行结、直肠癌根治术联合术后辅助化疗的248例患者的临床资料进行回顾性分析。术后2年内每3个月随访1次,3年以后每半年1次,随访截止日期为2019年3月。分析患者化疗前、化疗后及化疗前后连续监测的CAR受试者工作曲线(receiver operating characteristic,ROC)及Cox风险评估。通过ROC曲线分别获得辅助化疗前后CAR最佳截断点,根据最佳截断点分为化疗前高CAR组和化疗前低CAR组,以及化疗后高CAR组和化疗后低CAR组。比较化疗前后CAR与临床病理特征及生存情况的关系。结果辅助化疗前CAR(0.23±0.05)与化疗后CAR(0.31±0.07)之间为正相关(r=0.382,P<0.001)。联合分析辅助化疗前后CAR的ROC曲线面积为0.808,灵敏度及特异度分别为79.3%和78.5%,预后预测价值大于单独分析化疗前CAR(曲线下面积为0.776,灵敏度及特异度分别为78.1%和66.2%,Z=1.675,P<0.001)与化疗后CAR(曲线下面积为0.699,灵敏度及特异度分别为76.5%和53.8%,Z=3.361,P<0.001)。Cox风险评估模型单因素分析以及多因素联合分析提示,化疗前(HR=2.853,95%CI2.021~4.029,P<0.001)后(HR=2.165,95%CI1.890~2.565,P<0.001)CAR均高是影响结、直肠癌预后的独立危险因素。结论联合检测辅助化疗前后CAR对于结、直肠癌预后具有评估价值。
Objective To evaluate the prognostic value of C-reactive protein(CRP)to albumin ratio(CAR)before and after adjuvant chemotherapy for colorectal cancer.Methods From February 2013 to March 2014,the clinical data of 248 patients underwent radical resection of colorectal cancer combined with postoperative adjuvant chemotherapy in Department of Gastroenterology Surgery of the Affiliated Hospital of Southwest Medical University were retrospectively analyzed.The patients were followed up every 3 months within 2 years,once every six months after three years,and the deadline for follow-up was March 2019.Receiver operating characteristic(ROC)and Cox risk assessment were analyzed before,after and after chemotherapy.The optimal cut-off points of CAR before and after adjuvant chemotherapy were obtained by ROC curve.According to the optimal cut-off point,the patients were divided into high CAR group before chemotherapy and low CAR group before chemotherapy,high CAR group after chemotherapy and low CAR group after chemotherapy.The relationship between CAR and clinicopathological features and survival was compared before and after chemotherapy.Results There was a positive correlation between CAR before adjuvant chemotherapy(0.23±0.05)and after chemotherapy(0.31±0.07)(r 0.382,P<0.001).Combined analysis of car before and after adjuvant chemotherapy the ROC curve area of CAR was 0.808,the sensitivity and specificity were 79.3%and 78.5%,respectively,which was higher than those of CAR before chemotherapy alone(the area under the curve was 0.776,the sensitivity and specificity were 78.1%and 66.2%,respectively,z=1.675,P<0.001)and CAR after chemotherapy(the area under the curve was 0.699,the sensitivity and specificity were 76.5%and 53.8%,Z=3.361,P<0.001).Cox risk assessment model single factor analysis and multivariate analysis showed that high CAR before chemotherapy(HR=2.853,95%CI 2.021-4.029,P<0.001)and and after chemotherapy(HR=2.165,95%CI 1.890-2.565,P<0.001)were independent risk factors for colorectal cancer prognosis.Conclusio
作者
付翼
黎鑫
周业江
Fu Yi;Li Xin;Zhou Yejiang(Department of Gastrointestinal Surgery,the Affiliated Hospital of Southwest Medical University,Luzhou 646000,China)
出处
《中国综合临床》
2020年第4期371-375,共5页
Clinical Medicine of China
关键词
结直肠癌
辅助化疗
C反应蛋白与白蛋白比值
预后
Colorectal cancer
Adjuvant chemotherapy
C-reactive protein/albumin ratio
Prognosis
