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术前纤维蛋白原与前白蛋白比值对肾癌根治术后预后的影响
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Abstract:
目的：探讨术前纤维蛋白原(fibrinogen, FIB)与前白蛋白(prealbumin, PA)比值(Fibrinogen to prealbumin ratio, FPR)对预测评估肾癌患者术后生存状况的临床应用价值。方法：回顾性队列分析医院2015年1月~2016年12月收治的肾癌手术患者的相关临床资料。通过ROC曲线分析确定术前FPR的最佳分界值。分析高FPR组和低FPR组的术前基线资料；采用COX分析影响患者存活状态的独立风险因素。通过Kaplan-Meier法计算生存率。采用log rank检验分析组间生存差异。最后建立列线图以预测患者的5年生存率。结果：本研究共收集251例肾癌患者，ROC曲线显示FPR最佳分界值为0.009，分为高FPR组和低FPR组，与肿瘤大小、手术方式、病理类型、淋巴结转移、TNM级别、FM分级密切相关(P < 0.05)。COX回归分析显示FPR > 0.009为影响患者存活的独立风险因素。列线图可以用来预测患者术后5年的生存率。结论：高FPR是影响肾癌预后不良的独立危险因素，对预测患者术后生存状况有积极的作用。
Objective: To investigate the clinical application value of preoperative fibrinogen (FIB) to prealbu-min (PA) ratio (Fibrinogen to prealbumin ratio, FPR) in predicting and evaluating postoperative survival of patients with renal cancer. Methods: A retrospective analysis was performed on the rel-evant clinical data of patients with renal cancer surgery admitted to the hospital from January 2015 to December 2016. The optimal cut-off value of preoperative FPR was determined by ROC curve analysis. The preoperative baseline data of the high FPR group and the low FPR group were ana-lyzed; COX was used to analyze the independent risk factors affecting the survival status of patients. Survival rate was calculated by the Kaplan-Meier method. Differences in survival between groups were analyzed using the log-rank test. Finally, a nomogram was established to predict the 5-year survival rate of the patients. Results: A total of 251 patients with renal cancer were collected in this study. The ROC curve showed that the best cutoff value of FPR was 0.009. They were divided into high FPR group and low FPR group. Tumor size, surgical method, pathological type, lymph node metastasis, TNM grade and FM grade were closely related (P < 0.05). COX regression analysis showed that FPR > 0.009 was an independent risk factor affecting patient survival. A nomogram can be used to predict a patient’s 5-year survival rate after surgery. Conclusion: High FPR is an inde-pendent risk factor for poor prognosis of renal cancer, and has a positive effect on predicting post-operative survival of patients.
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