| 陈 云,张永杰.治疗前胆碱酯酶联合纤维蛋白原/前白蛋白比值对转移性结直肠癌患者预后价值研究[J].肿瘤学杂志,2022,28(6):490-497. |
| 治疗前胆碱酯酶联合纤维蛋白原/前白蛋白比值对转移性结直肠癌患者预后价值研究 |
| Prognostic Value of Pre-treatment Cholinesterase and Fibrinogen-to-prealbumin Ratio (CHE-FPR) in Patients with Metastatic Colorectal Cancer |
| 投稿时间：2021-11-16 |
| DOI：10.11735/j.issn.1671-170X.2022.06.B009 |
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| 中文关键词: 结直肠肿瘤 血清胆碱酯酶 纤维蛋白原/前白蛋白比值 预后 列线图预测模型 |
| 英文关键词:colorectal neoplasms cholinesterase fibrinogen-to-prealbumin ratio prognosis nomogram |
| 基金项目:淮安市科技技术局市自然科学研究计划（HAB201818） |
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| 中文摘要: |
| 摘 要：［目的］ 探讨治疗前血清胆碱酯酶（cholinesterase，CHE）联合纤维蛋白原/前白蛋白比值（fibrinogen-to-prealbumin ratio，FPR）对转移性结直肠癌（metastatic colorectal cancer，mCRC）患者的预后价值，建立mCRC患者的预后列线图预测模型并进行验证。［方法］ 回顾性分析161例mCRC患者的临床病理学资料。应用Cox回归模型分析临床基线特征和实验室检测指标在全体、左侧和右侧mCRC患者预后中的作用，确定独立预后因素；建立列线图预测模型。［结果］ 161例mCRC患者中，CHE、FPR的最佳截断值分别为4 140 U/L和23.6。生存分析显示，CHE≥4 140 U/L组和CHE＜4 140 U/L组中位生存期分别为23.0个月和10.1个月（χ2=40.429，P＜0.001）；FPR＜23.6组和FPR≥23.6组中位生存期分别为27.0个月和12.0个月（χ2=59.338，P＜0.001）；CHE-FPR评分为0、1和2分组中位生存期为别为29.6个月、14.6个月和7.2个月(1 vs 0：χ2=80.984，2 vs 0：χ2=161.671，P均＜0.001）。单因素和多因素Cox回归分析显示，ECOG 评分（HR=1.923，95%CI：0.989~3.739，P=0.05)、临床治疗方案（HR=0.663，95%CI：0.403~1.092，P=0.01）、CHE（HR=0.187，95%CI：0.041~0.850，P=0.03）、FPR（HR=1.956，95%CI：1.014~3.775，P=0.04）和CHE-FPR（HR=7.906，95%CI：4.636~13.481，P＜0.001）是mCRC的独立预后因素，构建列线图预测模型，包含CHE-FPR评分指标的预后列线图预测模型的一致性指数（C-index）为0.754；而不包含CHE-FPR评分指标的预后列线图预测模型的C-index则为0.606。［结论］ 治疗前CHE-FPR评分是mCRC患者有效的独立预后指标，可较准确个体化地预测不同治疗方式、不同原发肿瘤部位mCRC患者的预后，并可以辅助临床医生进行治疗决策。 |
| 英文摘要: |
| Abstract： ［Objective］ To investigate the prognostic value of pretreatment serum cholinesterase(CHE) and fibrinogen-to-prealbumin ratio(FPR) in patients with metastatic colorectal cancer(mCRC)， and to establish and validate a prognostic nomogram based on CHE-FPR. ［Methods］ The clinical and pathological data of 161 mCRC patients were reviewed retrospectively. The factors related to the prognosis of mCRC patients were analyzed by Cox regression model. A prognostic nomogram model was established and validated. ［Results］ Among 161 patients with mCRC， the best cut-off values of CHE and FPR were 4 140 U/L and 23.6. Survival analysis showed that the median survival time of CHE≥4 140 U/L was 23.0 months， CHE＜4 140 U/L was 10.1 months(χ2=40.429， P＜0.001). The median survival time of FPR＜23.6 was 27.0 months， FPR≥23.6 was 12.0 months(χ2=59.338， P＜0.001). The median survival time in mCRC patients with CHE-FPR score 0 was greater than those with CHE-FPR score 1(29.6 vs 14.6 months， χ2=80.984， P＜0.001) and 2(29.6 months vs 7.2 months， χ2=161.671， P＜0.001). Univariate and multivariate Cox regression analysis showed that ECOG PS score(HR=1.923， 95%CI： 0.989~3.739， P=0.05)， clinical therapeutic regimen(HR=0.663， 95%CI：0.403~1.092， P=0.01)， CHE(HR=0.187， 95%CI：0.041~0.850，P=0.03)， FPR(HR=1.956， 95%CI： 1.014~3.775， P=0.04)， CHE-FPR score(HR=7.906， 95%CI：4.636~13.481，P＜0.001) were independent prognostic factors for mCRC. A nomogram prediction model was constructed based on above indicators. The C-index of prognostic nomogram with CHE-FPR score was 0.754. On the contrary， C-index of the nomogram without CHE-FPR score was only 0.606. ［Conclusion］ The pre-treatment CHE-FPR score is an effective independent prognostic factor for patients with mCRC. It can be used to predict the prognosis of mCRC patients with different clinical therapeutic regimens and primary tumor locations. |
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