摘要
目的 探讨血浆纤维蛋白原(fibrinogen, FIB)、全身炎症反应指数(Systemic inflammatory response index, SIRI)对非转移性肾透明细胞癌(Non-metastatic renal cell carcinoma, nmRCC)患者的预后判断价值。方法 选择2018年1月-2022年12月苏州大学附属第二医院收治的146例nmRCC患者为研究对象,采用受试者工作特征曲线(Receiver operating characteristic,ROC)曲线确定FIB、SIRI诊断高Fuhrman分级(Ⅲ~Ⅳ级)的最佳截断值,并根据最佳截断值将患者分为高、低FIB组和高、低SIRI组。比较不同FIB、SIRI水平患者临床病理参数与生存预后的差异。用多因素Cox风险模型分析影响患者总体生存时间(Overall survival, OS)、肿瘤特异生存时间(Cancer specific survival, CSS)、无复发生存时间(Disease free survival, DFS)的独立危险因素。ROC曲线分析FIB、SIRI单独及联合检测对患者预后不良的预测效能。结果 患者FIB、SIRI水平越高,肿瘤直径越大,TNM分期及Fuhrman分级越高(P<0.05)。与低FIB组相比,高FIB组患者的总体生存率显著较低(χ^(2)=8.385,P=0.003);与低SIRI组相比,高SIRI组患者的总体生存率显著较低(χ^(2)=10.029,P<0.001)。Cox多因素分析显示,FIB水平、SIRI水平、肿瘤直径、Fuhrman分级、TNM分期均是影响患者OS、CSS、DFS的独立性危险因素(P<0.05)。ROC曲线分析显示,FIB、SIRI预测肾透明细胞癌患者预后不良的曲线下面积(Area under curve,AUC)分别为0.735、0.799,敏感性分别为62.6%、67.4%,特异性分别为659%、72.3%,二者联合检测的AUC为0.852,敏感性为71.2%,特异性为76.6%。结论 高FIB与高SIRI是nmRCC患者不良生存预后的危险因素,二者联合检测对患者预后不良的预测效能更高。
Objective To explore the prognostic value of plasma fibrinogen(FIB)and systemic inflammatory response index(SIRI)in non-metastatic renal cell carcinoma(nmRCC).Methods A total of 146 patients with nmRCC admitted to the hospital of soochow university from January 2018 to December 2022 were selected,the receiver operating characteristic(ROC)curve was used to determine the optimal cut-off value of FIB and SIRI in diagnosis of high Fuhrman grade(Ⅲ-Ⅳ),according to the optimal cut-off val-ue,the patients were divided into high FIB group,low FIB group and high SIRI group.The differences of clinical pathological parameters and survival prognosis among the patients with different FIB and SIRI lev-els were compared.A multivariate Cox risk model was used to analyze the independent risk factors that af-fect overall survival(OS),cancer specific survival(CSS)and disease free survival(DFS)of the patients.ROC curve was used to analyze the predictive efficacy of FIB and SIRI alone and in patients with poor prog-nosis.Results The higher the levels of FIB and SIRI,the larger the tumor diameter of the patients,and the higher the TNM staging and Fuhrman grading(P<0.05).Compared with low FIB group,the overall survival rate of the patients in high FIB group was significantly lower.Compared with low SIRI group(χ^(2)=8.385,P=0.003),the overall survival rate of the patients in high SIRI group was significantly lower(χ^(2)=10.029,P<0.001).FIB level,SIRI level,tumor size,Fuhrman grade and TNM stage were all in-dependent risk factors that affect OS,CSS and DFS of the patients(P<0.05).ROC curve analysis showed that the AUC of FIB and SIRI predicting poor prognosis in renal clear cell carcinoma patients was 0.735 and 0.799,respectively.When the 2 were combined,the AUC was 0.852,with sensitivity of 71.2%and specificity of 76.6%.Conclusion High FIB and high SIRI are risk factors of poor survival prognosis in nmRCC patients,and their combined detection can help determine poor survival progno-sis in patients.
作者
孔淑敏
KONG Shumin(Department of Nephrology,the Second Affiliated Hospital of Soochow University,Suzhou Jiangsu 215004,China)
出处
《新疆医科大学学报》
CAS
2024年第3期378-382,共5页
Journal of Xinjiang Medical University
基金
苏州市科技发展计划项目(SKY2023178)
江苏省科学技术研究计划项目(BK20200027)。
关键词
肾透明细胞癌
纤维蛋白原
全身炎症反应指数
预后
renal clear cell carcinoma
fibrinogen
systemic inflammatory response index
prognosis
