1 徐州医科大学研究生学院肿瘤学系，江苏 徐州 221002
2 徐州医科大学附属医院肿瘤放射治疗科，江苏 徐州 221002
目的：探讨术前血浆白蛋白与纤维蛋白原比值(albumin to fibrinogen ratio，AFR)及纤维蛋白原与前白蛋白比值(fibrinogen to prealbumin ratio，FPR)对结直肠癌患者生存的预后评价。方法：回顾性分析2012年6月至2014年6月徐州医科大学附属医院行根治性手术切除的286例结直肠癌患者的临床病例资料。通过受试者工作特征(receiver operating characteristic，ROC)曲线确定AFR和FPR的最佳分界值，并通过卡方检验分析AFR和FPR与患者临床病理特征的关系，Kaplan-Meier法进行生存分析，运用log-rank法进行差异性检验，Cox比例风险模型进行多因素回归分析。结果：根据ROC曲线下面积，AFR，FPR对结直肠癌患者预后的预测价值均较好(P<0.05)。术前AFR和FPR均与年龄、大体类型、临床分期、浸润深度、淋巴结转移有密切关系(P<0.05)，与性别、肿瘤部位、肿瘤大小、组织学分级、神经侵犯无明显关联(P>0.05)。低FPR水平患者的总生存期(overall survival，OS)明显高于高FPR水平患者(P<0.05)；高AFR水平患者的OS明显高于低AFR水平患者(P<0.05)。单因素分析显示：临床分期、浸润深度、淋巴结转移、术后放化疗、AFR、FPR、纤维蛋白原浓度、血浆白蛋白、前白蛋白水平是影响结直肠癌患者OS的危险因素(P<0.05)；多因素分析结果表明：临床分期、浸润深度、淋巴结转移、术后放化疗、pAlb、FPR是影响结直肠癌患者术后OS的独立危险因素。 结论：术前FPR对结直肠癌患者预后有较好的预测能力，有望成为评估结直肠癌患者预后的必要指标之一。关键词： 结直肠癌；纤维蛋白原；白蛋白；前白蛋白；血浆白蛋白与纤维蛋白原比值；纤维蛋白原与前白蛋白比值；预后
Prognostic evaluation of preoperative AFR and FPR in patients with colorectal cancer
CorrespondingAuthor:WANG Xia Email: firstname.lastname@example.org
Foundation: This work was supported by the Xuzhou Science and Technology Project, China (KC14SH111).
Objective: To investigate the prognostic evaluation of preoperative albumin to fibrinogen ratio (AFR) and fibrinogen to prealbumin ratio (FPR) on the survival of colorectal cancer patients. Methods: The clinical data of 286 patients with colorectal cancer who underwent radical resection in the Affiliated Hospital of Xuzhou Medical University from June 2012 to June 2014 were retrospectively analyzed. The best dividing line between AFR and FPR was determined by ROC curve. The relationship between AFR and FPR and clinicopathological characteristics was analyzed by chi-square test. Survival analysis was performed by Kaplan-Meier method. Difference test was performed by Log-rank method. Cox proportional risk model was used for multivariate regression analysis. Results: According to the area under ROC curve, AFR and FPR have better predictive value for the prognosis of colorectal cancer patients (P<0.05). Preoperative AFR and FPR were closely related to age, gross type, clinical stage, depth of invasion and lymph node metastasis (P<0.05), but not to sex, location, size, histological grade and nerve invasion (P>0.05). The overall survival (OS) of patients with low level of FPR was significantly higher than those with high level of FPR (P<0.05); OS of patients with high level of AFR was significantly higher than that of patients with low level of AFR (P<0.05). Univariate analysis showed that clinical stage, depth of invasion, lymph node metastasis, post-operative radiotherapy and chemotherapy, AFR, FPR, fibrinogen concentration, plasma albumin and prealbumin levels were risk factors for OS in patients with colorectal cancer (P<0.05); multivariate analysis showed that clinical stage, depth of invasion, lymph node metastasis were risk factors for OS in patients with colorectal cancer (P<0.05). Postoperative radiotherapy and chemotherapy, pAlb and FPR were independent risk factors for OS in patients with colorectal cancer. Conclusion: Preoperative Fib to prealbumin ratio (FPR) has a good predictive ability for the prognosis of patients with colorectal cancer, and it is expected to become one of the necessary indicators for evaluating the prognosis of patients with colorectal cancer.Keywords： colorectal cancer; fibrinogen; albumin; prealbumin; AFR; FPR; prognosis