血清纤维蛋白原及白蛋白/球蛋白比值水平与胃癌患者生存预后的关系

马勇; 陈善勤; 傅军; 杭群

doi:10.16766/j.cnki.issn.1674-4152.003021

血清纤维蛋白原及白蛋白/球蛋白比值水平与胃癌患者生存预后的关系

doi: 10.16766/j.cnki.issn.1674-4152.003021

蚌埠医学院第一附属医院胃肠外科, 安徽蚌埠 233004

基金项目:

安徽省高校自然科学研究项目 KJ2021A0765

详细信息

通讯作者:
杭群，E-mail: 2905419552@qq.com

中图分类号: R735.2 R730.7
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- 文章访问数: 95
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- 被引次数: 0
出版历程
- 收稿日期: 2022-09-20
- 网络出版日期: 2023-08-26

Relationship between serum fibrinogen and albumin/globulin ratio levels and survival prognosis of patients with gastric cancer

Department of Gastrointestinal Surgery, the First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233004, China

摘要

摘要: 目的研究发现术前血清纤维蛋白原(FIB)及白蛋白/球蛋白比值(AGR)与恶性肿瘤的预后相关，目前关于血清FIB及AGR与胃癌患者生存预后的研究较少，本研究探讨术前血清FIB及AGR与胃癌患者生存预后的关系。方法共纳入2013年1月—2016年12月于蚌埠医学院第一附属医院行胃癌根治术的222例患者，回顾性研究胃癌患者术前血清FIB、AGR水平及临床病理特征。通过绘制ROC曲线获取FIB和AGR的最佳截断值，根据截断值将患者分为高FIB组和低FIB组、高AGR组和低AGR组。依次分析血清FIB、AGR分组与胃癌患者临床病理特征的关系, 并使用Kaplan-Meier生存曲线进行生存分析，Cox比例风险模型研究影响胃癌患者预后的独立危险因素。结果 FIB和AGR的最佳截断值分别为3.33 g/L和1.46。术前血清FIB与胃癌患者的体重指数、分化程度、肿瘤大小、T分期、N分期、TNM分期、CEA、CA19-9有关。术前血清AGR与胃癌患者的年龄、体重指数、分化程度、肿瘤大小、T分期、N分期、TNM分期、CEA、CA19-9有关。生存分析提示低FIB组的OS率和平均OS时间显著高于高FIB组(57.6% vs. 14.4%，74.8个月vs. 32.9个月，P＜0.001)。高AGR组的OS率和平均OS时间也显著高于低AGR组(56.8% vs.18.6%，73.7个月vs.38.5个月，P＜0.001)。多因素分析显示低分化程度、肿瘤大小(≥5 cm)、N分期、高FIB和低AGR是影响胃癌患者预后的独立危险因素。结论术前血清FIB及AGR可作为预测胃癌患者生存预后的重要的血液指标。
- 胃癌 /
- 纤维蛋白原 /
- 白蛋白/球蛋白比值 /
- 炎症水平 /
- 预后
Abstract: Objective Studies have found that preoperative serum fibrinogen (FIB) and albumin/globulin ratio (AGR) are correlated with the prognosis of malignant tumors. Currently, there are few studies on the relationship between serum FIB and AGR and the survival prognosis of patients with gastric cancer. This study explores the relationship between preoperative serum FIB and AGR and the survival prognosis of patients with gastric cancer. Methods A total of 222 patients who underwent radical gastritis in the First Affiliated Hospital of Bengbu Medical College from January 2013 to December 2016 were included. The preoperative serum FIB and AGR levels and clinic pathological characteristics of patients with gastric cancer were analyzed retrospectively. The optimal truncation values of FIB and AGR were obtained by drawing ROC curves. According to the truncation values, patients were divided into high FIB group and low FIB group, high AGR group and low AGR group. The relationship between serum FIB, AGR grouping and clinicopathological features of patients with gastric cancer was analyzed successively. Kaplan-Meier survival curve was used for survival analysis, and Cox proportional risk model was used to study independent risk factors affecting prognosis of patients with gastric cancer. Results The optimal truncation values of FIB and AGR were 3.33 g/L and 1.46, respectively. Preoperative serum FIB was correlated with body mass index, differentiation degree, tumor size, T stage, N stage, TNM stage, CEA and CA19-9. Preoperative serum AGR was correlated with age, body mass index, degree of differentiation, tumor size, T stage, N stage, TNM stage, CEA and CA19-9. Survival analysis suggested that the OS rate and mean OS time in the low FIB group were significantly higher than those in the high FIB group (57.6% vs. 14.4%, 74.8 months vs. 32.9 months, P < 0.001). The OS rate and mean OS time in the high AGR group were also significantly higher than those in the low AGR group (56.8% vs.18.6%, 73.7 months vs.38.5 months, P < 0.001). Multivariate analysis showed that low differentiation degree, tumor size (≥5 cm), N stage, high FIB and low AGR were independent risk factors affecting the prognosis of patients with gastric cancer. Conclusion Preoperative serum FIB and AGR can be used as important blood indexes to predict the survival and prognosis of patients with gastric cancer.
- Gastric cancer /
- Fibrinogen /
- Albumin/globulin ratio /
- Inflammation levels /
- Prognosis

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图 1 胃癌患者术后Kaplan-Meier生存曲线

注：A为纤维蛋白原；B为白蛋白/球蛋白比值。

Figure 1. Kaplan-Meier survival curve of patients with gastric cancer

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表 1 FIB、AGR判断GC患者预后的价值

Table 1. The prognostic value of FIB and AGR in GC patients

项目	最佳截段值	AUC(95% CI)	灵敏度(%)	特异度(%)
FIB	3.33	0.706(0.639~0.773)	56.5	85.7
AGR	1.46	0.721(0.653~0.788)	60.9	79.8
注：FIB为纤维蛋白原；AGR为白蛋白/球蛋白比值；AUC为各自的ROC曲线下面积。

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表 2 患者的临床病理特征与FIB及AGR的关系

Table 2. Relationship between clinicopathological features of patients and FIB and AGR

因素	总例数	FIB		χ²值	P值	AGR		χ²值	P值
因素	总例数	＜3.33 g/L	≥3.33 g/L	χ²值	P值	＜1.46	≥1.46	χ²值	P值
性别				0.946	0.331			＜0.001	0.983
男性	165	95	70			75	90
女性	57	37	20			26	31
年龄(岁)				3.529	0.060			4.674	0.031
＜60	83	56	27			30	53
≥60	139	76	63			71	68
体重指数				8.156	0.004			5.643	0.018
＜18.5	18	5	13			13	5
≥18.5	204	127	77			88	116
分化程度				5.184	0.023			7.991	0.005
高、中分化	124	82	42			46	78
低分化	98	50	48			55	43
肿瘤部位				5.777	0.056			5.569	0.062
贲门	94	50	44			48	46
胃体	48	26	22			25	23
幽门	80	56	24			28	52
肿瘤大小				21.140	＜0.001			21.917	＜0.001
＜5 cm	132	95	37			43	89
≥5 cm	90	37	53			58	32
T分期				21.578	＜0.001			12.343	＜0.001
T1~T2	53	46	7			13	40
T3~T4	169	86	83			88	81
N分期				32.926	＜0.001			21.146	＜0.001
N0~N1	123	94	29			39	84
N2~N3	99	38	61			62	37
TNM分期				44.056	＜0.001			21.349	＜0.001
Ⅰ~Ⅱ期	99	83	16			28	71
Ⅲ期	123	49	74			73	50
CEA(μg/L)				10.647	0.001			6.982	0.008
＜5	164	108	56			66	98
≥5	58	24	34			35	23
CA19-9(U/mL)				5.402	0.020			4.766	0.029
＜37	175	111	64			73	102
≥37	47	21	26			28	19
注：FIB为纤维蛋白原；AGR为白蛋白/球蛋白比值；CEA为癌胚抗原；CA19-9为糖类抗原19-9。

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表 3 变量赋值方法

Table 3. Variable assignment method

变量	赋值方法
体重指数	≥18.5=0，＜18.5=1
分化程度	高、中分化=0，低分化=1
肿瘤大小	＜5 cm=0，≥5 cm=1
T分期	T1~T2=0，T3~T4=1
N分期	N0~N1=0，N2~N3=1
TNM分期	Ⅰ~Ⅱ期=0，Ⅲ期=1
CA19-9	＜37 U/mL=0，≥37 U/mL=1
FIB	＜3.33 g/L=0，≥3.33 g/L=1
AGR	≥1.46=0，＜1.46=1

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表 4 影响胃癌术后生存预后的单因素分析

Table 4. Univariate analysis of survival and prognosis of gastric cancer after operation

变量	B	SE	Waldχ²	P值	HR(95% CI)
体重指数(＜18.5)	0.742	0.275	7.277	0.007	2.099(1.225~3.598)
分化程度(低分化)	0.904	0.174	27.114	＜0.001	2.469(1.757~3.470)
肿瘤大小(≥5 cm)	0.985	0.173	32.315	＜0.001	2.677(1.906~3.759)
T分期(T3~T4)	1.571	0.293	28.809	＜0.001	4.809(2.710~8.534)
N分期(N2~N3)	1.498	0.182	67.936	＜0.001	4.472(3.132~6.386)
TNM分期(Ⅲ期)	1.522	0.201	57.395	＜0.001	4.579(3.089~6.788)
CA19-9(≥37 U/mL))	0.644	0.190	11.489	0.001	1.905(1.312~2.765)
FIB(≥3.33 g/L)	1.313	0.176	55.830	＜0.001	3.718(2.634~5.246)
AGR(＜1.46)	1.100	0.176	39.247	＜0.001	3.003(2.219~4.236)

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表 5 影响胃癌术后生存预后的多因素分析

Table 5. Multivariate analysis of influencing survival and prognosis of gastric cancer after operation

变量	B	SE	Waldχ²	P值	HR(95% CI)
分化程度(低分化)	0.616	0.180	11.744	0.001	1.851(1.301~2.631)
肿瘤大小(≥5 cm)	0.428	0.187	5.244	0.022	1.534(1.064~2.213)
N分期(N2~N3)	0.832	0.254	10.691	0.001	2.297(1.395~3.782)
FIB(≥3.33 g/L)	0.711	0.200	12.681	＜0.001	2.035(1.376~3.010)
AGR(＜1.46)	0.399	0.189	4.454	0.035	1.490(1.029~2.158)

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