术前的白蛋白与碱性磷酸酶比值联合全身炎症反应指数与根治性切除胃癌患者的临床病理特征相关

Correlation between preoperative albumin and alkaline phosphatase ratio combined with

关键词:  白蛋白与碱性磷酸酶比值  全身炎症反应指数  胃癌  预后

Key words:  albumin to alkaline phosphatase ratio  systemic inflammatory response index  gastric cancer  prognosis

摘要:

目的 探讨术前白蛋白与碱性磷酸酶比值（AAPR）联合全身炎症反应指数（SIRI）与根治性切除胃癌 患者临床病理特征及预后的相关性。方法 该研究为回顾性研究，收集2018年8月至2020年12月广东医科大学 附属医院胃肠外科收治的行胃癌根治术治疗患者241例的临床资料，计算出AAPR、SIRI数值。通过ROC曲线确定 AAPR和SIRI的最佳截断点。结合两个指标构建AAPR-SIRI评分，通过χ2 检验分析AAPR-SIRI评分与胃癌的病理 特征关系；以Kaplan-Meier法描绘生存曲线；用Cox比例风险回归模型进行单因素和多因素分析。结果 （1）肿瘤直 径、TNM分期、有无神经侵犯、有无脉管癌栓、生存时间在AAPR-SIRI评分0、1、2分组的组间差异有统计学意义（P < 0.05），高分组患者可能肿瘤直径更大、TNM 分期更晚、神经脉管更易侵犯、生存时间更短；（2）生存分析显示， AAPR-SIRI 0、1、2分组的 3 a生存率分别为 81.08%、57.47%和 41.25%，3组间的差异有统计学意义（P < 0.05），较高 的AAPR-SIRI评分与较低的生存率有关；（3）多因素Cox分析结果显示：AAPR-SIRI评分、Lauren分型、TNM、含印 戒细胞癌均是影响胃癌患者预后的独立危险因素（均P < 0.05）。结论 （1）AAPR-SIRI评分与胃癌患者肿瘤直径大 小、病理分期、神经脉管侵犯等临床病理特征存在相关性；（2）术前 AAPR与 SIRI联合应用有助于评估胃癌患者的 预后。

Abstract:

Objective To investigate the correlation between preoperative albumin to alkaline phosphatase ratio (AAPR）combined with systemic inflammatory response index (SIRI) and the clinicopathological characteristics and prognosis of patients with radically resected gastric cancer. Methods A total of 241 patients admitted to the Department of Gastrointestinal Surgery of the Affiliated Hospital of Guangdong Medical University for radical gastric cancer treatment during the period of August 2018 to December 2020 were selected. The clinical data of the patients were collected, and the values of the AAPR and the SIRI were calculated. The optimal cut-off points for AAPR and SIRI were determined by ROC curves. The AAPR-SIRI score was constructed by combining the two indexes, and the relationship between the AAPR-SIRI score and the pathological characteristics of gastric cancer was analyzed by the χ2 test; the survival curve was depicted by the Kaplan-Meier method; and unifactorial and multifactorial analyses were carried out by the Cox proportional hazards regression model. Results (1) The AAPR-SIRI scores of the 0, 1, and 2 groups showed statistically significant differences in tumor diameter, TNM stage, presence or absence of nerve invasion, presence or absence of choroidal cancer embolism, and survival time when compared between groups (P<0.05). The patients with high scores may have larger tumor diameters, later TNM stages, easier invasion of nerves and vessels, and shorter survival times. (2) Survival analysis showed that the three-year survival rates of AAPR-SIRI subgroups 0, 1, and 2 were 81.08%, 57.47%, and 41.25%, respectively, and the differences among the three groups were statistically significant (P<0.05), with higher AAPR-SIRI scores associated with lower survival rates. (3) The results of multifactorial Cox analysis showed that AAPR-SIRI score, Lauren staging, TNM, and indwelling ring cell-containing carcinoma were independent risk factors affecting the prognosis of patients with gastric cancer (all P<0.05). Conclusion (1) There is a correlation between AAPR-SIRI score and clinicopathological features such as tumor diameter size, pathological stage, and neurovascular invasion in patients with gastric cancer. (2) AAPR-SIRI score, Lauren staging, TNM staging, and the presence of indolent cell carcinoma are independent risk factors for prognosis in patients with gastric cancer.