术前白蛋白-球蛋白比值与食管鳞癌患者的预后

目的  探讨术前白球蛋白比（albumin/globulin ratio，AGR）与食管鳞癌（esophageal squamous cell carcinoma，ESCC）患者预后的关系，建立ESCC手术患者生存时间的预测列线图，为ESCC患者的预后预测提供参考依据。 方法  收集2014年2月-2017年9月在福建省肿瘤医院收治的390例接受过手术治疗的ESCC患者的临床资料。利用接受者操作特征曲线（receiver operating characteristic curves，ROC）确定术前AGR的最佳临界值，χ²检验分析AGR与一般临床特征间的相关性，Cox比例风险回归模型分析AGR与ESCC患者预后的关系，进而构建ESCC术后患者预后预测列线图模型。 结果  按术前AGR最佳临界值1.16将患者分为高AGR和低AGR两组，高AGR组1年和3年生存率均高于低AGR组（均有P < 0.05）。多因素分析结果显示：T分期、N分期、AGR是影响ESCC患者预后的因素（均有P < 0.05），其中T₃-T₄ vs T₁-T₂（HR=1.87，95% CI：1.04~3.35），N₊ vs N₀（HR=1.89，95% CI：1.13~3.17），高AGR组vs低AGR组（HR=0.57，95% CI：0.36~0.90）。预测ESCC术后患者预后的列线图一致性指数为0.68（95% CI：0.62~0.73，P < 0.001）。 结论  术前AGR水平是影响ESCC术后患者预后的因素，高AGR组ESCC患者的预后优于低AGR组，列线图有助于临床医生对ESCC术后患者的预后进行个体化预测。

Preoperative albumin-globulin ratio and prognosis of patients with esophageal squamous cell carcinoma

  Objective  To investigate the relationship between albumin/globulin ratio (AGR) and postoperative survival among patients with esophageal squamous cell carcinoma(ESCC) undergoing radical oesophagectomy, to establish an effective prognostic nomogram for ESCC and to provide a reference for prognosis prediction of ESCC.  Methods  From February 2014 to September 2017, 390 ESCC patients who underwent surgery were retrospectively enrolled from the tumor hospital in Fujian Province. The receiver operating characteristic curves(ROC) were applied to establish optimal cutoff points. Chi-square test was used to estimate the relationship between the AGR and the clinical features. Cox proportional hazards model was used to estimate the HR and 95% CI for the associations between AGR and Prognosis of ESCC patients. A nomogram model was established to predict the outcome of ESCC patients.  Results  The ROC demonstrated the best cutoff value for AGR was 1.16. A total of 356 patients were recruited in the final analysis, who were divided into the high AGR group (≥ 1.16) and the low AGR group (< 1.16) by the best cutoff value. Both 1-year and 3-year survival rates in the high AGR group were higher than those detected in the low AGR group(all P < 0.05). Multivariate analysis showed that the T stage, N stage, and AGR were independent prognostic factors of overall survival(all P < 0.05). The HR of T stage was 1.87 (T₃-T₄ vs T₁-T₂, 95% CI: 1.04-3.35); The HR of N stage was1.89 (N₊ vs N₀, 95% CI: 1.13-3.17); The HR of AGR was 0.57(the high AGR group vs the low AGR group, 95%CI: 0.36-0.90). The concordance index(C-index) of the nomogram to predict overall survival was 0.68 (95% CI: 0.62-0.73, P < 0. 001).  Conclusions  The AGR was an independent prognosis factor for operated ESCC patients. The prognosis of ESCC in the high AGR group was better than that in the low AGR group and the prognostic nomogram provides individualized risk estimate of survival in ESCC patients after surgery.