文章摘要

术前纤维蛋白原与食管鳞状细胞癌患者预后的关系

作者: 1郑燕, 1,2李印, 1,2秦建军, 1刘先本, 1张瑞祥, 1王总飞, 1,2陈先凯, 1邢文群
1 郑州大学附属肿瘤医院/河南省肿瘤医院胸外科,郑州 450000
2 国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院胸外科,北京 100021
通讯: 邢文群 Email: 1294200325@qq.com
DOI: 10.3978/j.issn.2095-6959.2020.09.007
基金: 河南省高等学校重点科研项目计划(17A320048);吴阶平医学基金会临床科研专项资助基金(320.6799.15062,320.2730.1892);河南省医学科技攻关计划项目(2018020497);河南省青年人才托举工程(2019HYTP018)。

摘要

目的:评估血浆纤维蛋白原(fibrinogen,FIB)对预测可手术食管鳞状细胞癌患者预后的价值。方法:回顾性分析郑州大学附属肿瘤医院/河南省肿瘤医院2015年6月至2016年4月334例接受手术治疗的食管鳞状细胞癌患者,以FIB指标的最佳截点值2.90 g/L为界,血浆FIB≥2.90 g/L为高FIB组,血浆FIB<2.90 g/L为低FIB组。分析FIB水平与患者临床病理特征的关系,应用Kaplan-Meier生存分析及Cox比例风险回归模型分析术前FIB水平对患者总生存期(overall survival,OS)的影响。结果:食管鳞状细胞癌患者低FIB组163例(48.8%),高FIB组171例(51.2%)。食管鳞状细胞癌患者T分期与FIB水平相关(W=10 817,P=0.015)。高FIB组患者平均生存期为26.60个月,低FIB组患者平均生存期为29.17个月,低FIB组的平均生存期显著优于高FIB组,差异有统计学意义(χ²=6.5497,P=0.011)。单因素分析显示血浆FIB水平(HR=1.994,95%CI:1.163~3.418,P=0.012),T分期(HR=2.213,95%CI:1.196~4.097,P=0.011),N分期(HR=3.883,95%CI:2.278~6.621,P<0.001),TNM分期(HR=0.248,95%CI:0.139~0.443,P<0.001)与OS密切相关。在α=0.1的水平,血浆FIB为食管鳞状细胞癌的独立预后因素(HR=1.680,95%CI:1.062~2.805,P=0.062),对比低FIB组,高FIB组患者的死亡风险高68%。结论:术前血浆纤维蛋白为食管鳞状细胞癌的不良生存预后因子。
关键词: 食管肿瘤;预后;纤维蛋白

Association of preoperative plasma levels of fibrinogen and the prognosis of patients with esophageal squamous cell carcinoma

Authors: 1ZHENG Yan, 1,2LI Yin, 1,2QIN Jianjun, 1LIU Xianben, 1ZHANG Ruixiang, 1WANG Zongfei, 1,2CHEN Xiankai, 1XING Wenqun
1 Department of Thoracic Surgery, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou 450000, China
2 Department of Thoracic Surgery, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China

CorrespondingAuthor: XING Wenqun Email: 1294200325@qq.com

Foundation: This work was supported by the Key Projects of Henan Province Ministry of Education (17A320048), the Clinical Research Fund of Wu Jieping Medical Foundation (320.6799.15062, 320.2730.1892), the Medical Science and Technology Research Project of Henan Province (grant number 2018020497), the Henan youth talent project (2019HYTP018), China.

Abstract

Objective: To evaluate the prognostic value of plasma fibrinogen (FIB) in operable esophageal squamous cell carcinoma (ESCC). Methods: In this project, there were 334 consecutive patients who underwent esophagectomy between June 2015 and April 2016 in our cancer center. The impact of fibrinogen on overall survival (OS) was analyzed by using the Kaplan-Meier method and Cox proportional hazard models. The correlation of patient characteristics and fibrinogen were explored by using Mann-Whitney U test, Chi-square test. Results: The patients with high level of plasma fibrinogen were significantly related with late T (W=10 817, P=0.015) stage. The average survival time of patients with high level of plasma fibrinogen was 26.60 months, while the average survival time of patients with low plasma fibrinogen was 29.17 months. The average survival time of patients in the low plasma fibrinogen group was significantly better than that in the high plasma fibrinogen group. The difference was statistically significant (χ²=6.5497, P=0.011). Patients with hyperfibrinogenemia showed poor OS (HR=1.994, 95%CI: 1.163 to 3.418, P=0.012). In univariate analysis, except plasma fibrinogen, pathological T stage (HR=2.213, 95%CI: 1.196 to 4.097, P=0.011), pathological N stage (HR=3.883, 95%CI: 2.278 to 6.621, P<0.001) and pathological TNM stage (HR=0.248, 95%CI: 0.139 to 0.443, P<0.001) significantly associated with OS. In multivariate analysis, the level of α=0.1, plasma fibrin was an independent prognostic factor for ESCC (HR=1.680, 95%CI: 1.062 to 2.805, P=0.062). Conclusion: This project indicated that preoperative plasma fibrinogen was a poor prognostic factor for overall survival in ESCC.
Keywords: esophageal neoplasms; prognosis; fibrinogen