Relationship between serum fibrinogen and albumin/globulin ratio levels and survival prognosis of patients with gastric cancer
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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。 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. -
Key words:
- 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
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 ＜3.33 g/L ≥3.33 g/L ＜1.46 ≥1.46 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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