术前血清白蛋白水平正常的老年胃癌患者术后白蛋白变化与并发症的相关性分析

目的:探讨术前血清白蛋白水平正常的老年胃癌患者术后血清白蛋白变化(ΔALB)与术后并发症之间的相关性。方法:回顾性分析2014年1月至2018年12月连云港市市立东方医院经根治性手术治疗(R0切除,D2或D2+淋巴结清扫)的老年(年龄>65岁)胃癌患者的实验室指标、术后并发症情况。采用单因素和多因素分析以鉴定预测术后并发症的临床因素。计算ΔALB,绘制受试者工作特征曲线(ROC);测量ΔALB的截止值并得出诊断精度。ΔALB定义为:(术前白蛋白水平-术后第1天白蛋白水平)/术前白蛋白水平×100%。结果:本研究共纳入符合条件患者214例,并发症发生率为25.7%。通过Logistic回归分析,ΔALB、C-反应蛋白水平CRP(POD3)]与联合脏器切除是术前ALB水平正常患者术后短期并发症的独立危险因素。根据并发症情况,计算ΔALB、CRP(POD3)与联合脏器切除的ROC曲线下面积(AUC)分别为0.719、0.609与0.614。ΔALB的截止值为17.1%,灵敏度为0.564,特异度为0.805;以17.1%作为分界值,将患者分为低ΔALB组(152例)和高ΔALB组(62例)。对于不同级别并发症及总体并发症发生率,高ΔALB组均大于低ΔALB组(均P<0.05)。通过Kaplan-Meier生存分析,与低ΔALB的患者相比,高ΔALB的患者短期内出现并发症的风险更高(P<0.001)。结论:对于术前血清白蛋白正常的老年胃癌患者,ΔALB是术后短期并发症的独立预测因素,ΔALB超过17.1%时,术后并发症风险增加。

Correlation between postoperative albumin changes and complications in elderly gastric cancer patients with normal preoperative serum albumin level

  Objective  To assess the correlation between postoperative albumin changes (ΔALB) and complications in elderly gastric cancer patients with normal serum albumin levels before surgery.  Methods  In this study, laboratory indices and postoperative complications of elderly (aged >65 years) gastric cancer patients undergoing radical surgery (R0 resection, D2/D2+ dissection) from January 2014 to December 2018 in Lianyungang Oriental Hospital were retrospectively analyzed. Univariate and multivariate analyses were performed to identify clinical factors that predicted postoperative complications. ΔALB was calculated, and the receiver operating characteristic (ROC) curve was drawn. The cut-off ΔALB value and diagnostic accuracy were determined. The patients were assigned into high and low ΔALB groups based on the optimal cutoff value, and the complications of the two groups were compared. ΔALB was defined as follows:preoperative albumin level-day 1 after operation (POD1)]/preoperative albumin level×100%.  Results  This study included 214 eligible patients, and the complication rate was 25.7%. Using Logistic regression analysis, ΔALB, C-reactive protein (CRP) levels (POD3), and combined organ resection were identified to be independent risk factors for short-term complications after surgery in patients with normal serum albumin levels. With respect to complications, the area under the ROC curve values of ΔALB, CRP levels (POD3), and combined organ resection were 0.719, 0.609, and 0.614, respectively. The cutoff value of ΔALB was 17.1%, with a sensitivity of 0.564 and specificity of 0.805. Using 17.1% as the cutoff value, 152 cases were assigned to the low ΔALB group and 62 were assigned to the high ΔALB group. The high ΔALB group had higher levels of overall complication rates than the low ΔALB group (all P < 0.05). Survival analysis was performed using the Kaplan-Meier method. Patients with high ΔALB had at a higher risk of short-term complications than patients with low ΔALB (P < 0.001).  Conclusions  For elderly gastric cancer patients with normal serum albumin levels before surgery, ΔALB is an independent predictor of short-term complications after surgery. When ΔALB exceeded 17.1%, the risk of postoperative complications increased.