术前白蛋白与碱性磷酸酶比值在胃癌根治术后患者预后中的预测价值

 目的 探讨术前白蛋白与碱性磷酸酶比值（albumin to alkaline phosphatase ratio，AAPR）在可切除胃癌患者预后中的预测价值。方法 回顾性招募2014年6月至2019年11月在本院接受胃切除术的357例胃癌患者为研究对象，随访截至2020年12月。采用最大选择秩统计量计算患者AAPR的最佳截断值并据此分为高AAPR组和低AAPR组。采用Kaplan-Meier法和Cox比例风险模型分析AAPR与无病生存期（disease-free survival，DFS）和总生存期（overall survival，OS）的相关性。结合AAPR与TNM分期构建AAPR-TNM系统，通过似然比检验（LRT）、AIC、C-index比较TNM分期系统和AAPR-TNM系统对DFS和OS的预测能力。结果 AAPR最佳截断值为0.412，其中高AAPR组患者的3年DFS率和OS率均高于低AAPR组（78.5% vs 38.1%，log-rank χ²=49.652，P<0.001； 87.2% vs 51.1%，log-rank χ²=33.532，P<0.001）。校正潜在的混杂因素后，高AAPR是DFS（HR=0.25，95%CI：0.15~0.42）和OS（HR=0.24，95%CI：0.13~0.39）的保护因素。AAPR-TNM系统较TNM分期系统具有更大的LRT χ2值，更小的AIC以及更高的C-index（均P<0.001）。结论 术前AAPR水平低的胃癌患者根治性切除术后预后较差，且AAPR结合TNM分期在术后预后中较TNM分期系统具有更好的预测能力。

Predictive value of preoperative albumin to alkaline phosphatase ratio in the prognosis of patients after radical gastrectomy

Objective To investigate the predictive value of preoperative albumin to alkaline phosphatase ratio (AAPR) in prognosis of patients after radical gastrectomy. Methods A total of 357 gastric cancer patients who underwent gastrectomy in Chongming Branch of Xinhua Hospital Affiliated to Medical College of Shanghai Jiao Tong University from June 2014 to November 2019 were retrospectively recruited as the research objects, and the follow-up was until December 2020. The optimal cut-off value of AAPR was calculated by the maximum selection rank statistics and the patients were divided into the high AAPR group and the low AAPR group. The Kaplan-Meier method and the Cox proportional hazards model were used to analyze the relationship between AAPR and disease-free survival (DFS) and overall survival (OS). The AAPR-TNM system was constructed by combining AAPR and TNM stage, and the predictive abilities of TNM staging system and AAPR-TNM system on DFS and OS were compared by the likelihood ratio test (LRT), AIC and C-index. Results The optimal cut-off value of AAPR was 0.412. 3-year DFS rate and OS rate of patients in the high AAPR group were higher than those in the low AAPR group (78.5% vs 38.1%, log-rank χ²=49.652, P<0.001; 87.2% vs 51.1%, log-rank χ²=33.532, P<0.001). After adjusting for potential confounding factors, high AAPR was a protective factor for DFS (HR=0.25, 95%CI: 0.15-0.42) and OS (HR=0.24, 95%CI: 0.13-0.39). Compared with the TNM staging system, the AAPR-TNM system had a larger LRT χ² value, a smaller AIC and a higher C-index (all P<0.001). Conclusions The prognosis of gastric cancer patients with low preoperative AAPR level is poor after radical gastrectomy, and AAPR combined with TNM stage has better predictive ability than TNM staging system in postoperative prognosis.