术前全身炎症反应指数联合纤维蛋白原与白蛋白比值对肾癌预后的价值

Prognostic value of preoperative systemic inflammatory response index combined with fibrinogen-to-albumin ratio for kidney cancer

摘要

目的 研究外周血中全身炎症反应指数（systemic inflammatory response index，SIRI）及纤维蛋白原与白蛋白比值（fibrinogen albumin ratio，FAR）对肾恶性肿瘤患者临床及病理特征的影响，将两者及其联合重新分组，探索与肾癌预后的价值。 方法 选取2013年1月至2018年11月在重庆医科大学附属第一医院泌尿外科进行肾癌部分切除及根治性肾切除手术治疗且病理确诊为肾恶性肿瘤的患者临床资料及随访数据。利用回顾性分析方法分析最终纳入的200例患者的临床数据。利用SPSS 26.0统计软件对纳入患者的临床资料进行分析，利用受试者工作特征（eceiver operating characteristic，ROC）曲线确定术前外周血中SIRI及FAR的最佳截点值，分别为1.30；0.10。较高肿瘤分期、高截点评分、高SIRI、高FAR与预后OS显著相关（P<0.05），是影响肾癌术后患者预后的危险因素；而高血压，糖尿病，性别，体质指数等与OS无关（P>0.05）；采用Kaplan-Meier分析绘制生存曲线，进行Cox回归单多因素分析。 结果 肾癌患者是否是肾透明细胞癌，较高肿瘤分期，截点评分、SIRI、FAR与预后OS显著相关（P<0.05），是影响肾癌术后患者预后的危险因素；而高血压，糖尿病，性别，体质指数等与OS无关（P>0.05），进行Cox回归多因素分析，统计分析结果显示，在FAR、SIRI、截点评分中，只有FAR是肾癌患者OS的独立危险因素［P=0.003，HR-8.461（2.104~34.028）］。 结论 高纤维蛋白原与白蛋白比值是肾癌预后不良的危险因素，与全身炎症反应指数相比价值更高。

Abstract

Objective To investigate the effects of systemic inflammatory response index（SIRI） and fibrinogen-to-albumin ratio（FAR） in peripheral blood on the clinical and pathological features of patients with malignant renal tumors，and to regroup the two indicators and their combinations to explore their value in prognosis prediction of patients with renal cancer. Methods Clinical data and follow-up data were collected from patients with partial renal cancer resection and radical nephrectomy who were pathologically diagnosed with malignant kidney tumors at the Department of Urology，The First Affiliated Hospital of Chongqing Medical University between January 2013 and November 2018. Clinical data of the finally included 200 patients were analyzed using a retrospective analysis method. The clinical data of the included patients were analyzed using SPSS 26.0 statistical software. The optimal cut-off values of SIRI and FAR in preoperative peripheral blood were determined using the receiver operating characteristic curve，which were 1.30 and 0.10，respectively. High tumor stage，high cut-off score，high SIRI，and high FAR were significantly associated with overall survival（P<0.05），which were risk factors affecting the prognosis of patients with renal cancer. Hypertension，diabetes，sex，and body mass index were not related to overall survival（P>0.05）. Kaplan-Meier survival analysis as well as univariate and multivariate Cox regression analyses were performed. Results Clear cell carcinoma，high tumor stage，cut-off score，SIRI，and FAR were significantly associated with overall survival（P<0.05），which were risk factors affecting the prognosis of patients with renal cancer after surgery. While hypertension，diabetes，sex，and body mass index were not related to overall survival（P>0.05）. Cox regression multivariate analysis showed that among FAR，SIRI，and cut-off score，only FAR was an independent risk factor for overall survival in kidney cancer patients（P=0.003，hazard ratio=8.461，95%CI=2.104-34.028）. Conclusion High FAR is a risk factor for poor prognosis of patients with kidney cancer and FAR is more valuable than SIRI.

关键词

全身炎症反应指数 / 纤维蛋白原与白蛋白比值 / 肾癌 / 预后

Key words

systemic inflammatory response index / fibrinogen-to-albumin ratio / kidney cancer / prognosis