C反应蛋白与前白蛋白比值在评估胃癌病人预后中的临床价值

目的观察胃癌病人术前血清中C反应蛋白（CRP）与前白蛋白（PA）水平比值（CRP/PA）对预后的影响。方法随访并记录经过根治性手术治疗的胃癌病人的生存期和实验室指标,计算所有病人的CRP/PA和C反应蛋白/白蛋白（CRP/ALB）值,分别绘制两者的受试者工作特征曲线（ROC）,比较曲线下面积。计算Youden指数,得出CRP/PA的最佳界值。以最佳界值为标准,将病人分为高CRP/PA（HCP）组和低CRP/PA（LCP）组,分析2组病人的临床病理特征、术后并发症及预后。结果根据5年生存作为终点绘制CRP/PA与CRP/ALB的ROC曲线,AUC分别为0.704及0.656。当CRP/PA值为18.8×10-3时,Youden指数最大,灵敏度为0.828,特异度为0.562。年龄、贫血、肿瘤直径、浸润深度、淋巴结转移、TNM分期均与CRP/PA值水平有关（P < 0.05~P < 0.01）。214例病人并发症的发生率为28.9%,HCP组并发症发生率为37.64%,高于LCP组发率23.26%（P < 0.05）。214例胃癌病人中有125人死亡,所有病人5年累积生存率为35.5%。病人的中位生存时间是43个月。HCP组和LCP组病人的5年累积生存率分别是29.4%和46.3%,LCP组病人5年生存率高于HCP组的病人（P < 0.05）。Cox比例风险模型分析发现,CRP/PA水平（HR=3.117）、TNM分期（HR=4.053）是胃癌病人术后的独立预后因素（P < 0.01）。结论CRP/PA水平、TNM分期是影响胃癌病人预后的独立因素。处于CRP/PA高值水平的病人术后并发症发生率会增加,预后差。

Clinical value of the ratio of C reactive protein to prealbumin in evaluating the prognosis of gastric cancer patients

ObjectiveTo observe the effects of the ratio of preoperative serum C reactive protein to prealbumin(CRP/PA) on the prognosis of gastric cancer patients.MethodsThe survival and laboratory indicators in gastric cancer patients treated with radical operation were followed up and recorded.The ratio CRP to ALB and CRP/PA in all patients were calculated, the receiver operating characteristic curves(ROC)were plotted, and the area under the curve(AUC) was compared.The Youden index was calculated to obtain the optimal cutoff value of CRP/PA.The patients were divided into the high CRP/PA(HCP) group and low CRP/PA(LCP) group according to the optimal cutoff value.The clinical and pathological features, postoperative complications and prognosis in two groups were analyzed.ResultsThe ROC curves of the CRP/PA and CRP/ALB were plotted based on the 5-year survival as the end point, and the AUC of which were 0.704 and 0.656, respectively.When the CRP/PA value was 18.8×10-3, the Youden index was the largest, the sensitivity was 0.828, and the specificity was 0.562.The age, anemia, tumor diameter, infiltration depth, lymph node metastasis and TNM stage were related to the level of CRP/PA(P < 0.05 to P < 0.01).The incidence rate of complication in 214 patients was 28.9%, and which in HCP group(37.64%)was higher than that in LCP group(23.26%)(P < 0.05).Among the 214 patients with gastric cancer, 125 cases died, the 5-year cumulative survival rate of all patients was 35.5%, and the median survival time was 43 months.The 5-year cumulative survival rate in HCP group and LCP group was 29.4% and 46.3%, respectively.The 5-year survival rate in HCP group was higher than that in LCP group(P < 0.05).The results of Cox proportional hazards model showed that the level of CRP/PA and TNM stage were the independent prognostic factors for postoperative gastric cancer patients(P < 0.01).ConclusionsThe CRP/PA level and TNM stage are the independent factors affecting the prognosis of gastric cancer patients.The incidence rate of postoperative complications in patients with high CRP/PA level increases, and the prognosis of patients is poor.