基于列线图模型对进展期胃窦癌术前低蛋白高危患者的识别

Identification of high risk patients with preoperative low albumin for advanced gastric antrum cancer based on nomogram model

摘要:

目的 探讨胃窦癌根治术前低白蛋白血症发生的高危因素以及对预后的影响。方法 选择2008年6月至2015年6月福建省肿瘤医院收治的行手术治疗胃窦癌患者共497例，按术前血清白蛋白水平分为低白蛋白组（<35 g/L，194例）与正常白蛋白组（≥35 g/L，303例），分析根治术前低白蛋白血症发生的高危因素及对预后的影响。结果 影响根治术前低白蛋白血症的单因素研究发现，在年龄、肿瘤大小、分化程度、肿瘤T分期、TNM分期上，低白蛋白组与正常白蛋白组存在统计学差异（P<0.05）；多因素研究发现，年龄、肿瘤大小、肿瘤TNM分期是术前低白蛋白血症发生的独立危险因素，并据此建立列线图风险预测模型；低白蛋白组1年、3年、5年生存率分别为96.3%、85.7%、78.7%，正常白蛋白组1年、3年、5年生存率分别为94.1%、76.0%、62.9%，差异有统计学意义（P<0.001）。胃窦癌患者预后单因素及多因素分析结果显示，年龄、T分期、TNM分期、术前白蛋白是患者的独立预后因素（P<0.05）。结论 对于胃窦癌患者，年龄、肿瘤大小及肿瘤TNM分期是术前低白蛋白血症发生的独立危险因素，术前低白蛋白血症是胃窦癌患者不良预后的提示，对该类患者应加强识别及干预措施。

Abstract:

Objective To explore the high risk factors of hypoalbuminemia before radical gastrectomy，and influence on prognosis.Methods From June 2008 to June 2015，a total of 497 patients with gastric antrum cancer treated by surgery in Fujian Cancer Hospital were included in the study，then they were divided into low albumin group（< 35 g/L，194 cases）and normal albumin group（≥35 g/L，303 cases）according to the preoperative serum albumin level. The high risk factors of hypoalbuminemia before radical operation and its impact on prognosis were analyzed.Results The univariate study found that there were significant differences in age，tumor size，differentiation degree and tumor stage between hypoalbuminemia group and normal albuminemia group. The multivariate study found that age，tumor size，TNM stage were independent risk factors for preoperative hypoalbuminemia. The nomogram risk prediction model was established. The 1-year，3-year and 5-year survival rates of low albumin group were 96.3%，85.7% and 78.7% respectively. The 1-year，3-year and 5-year survival rates of normal albumin group were 94.1%，76.0% and 62.9% respectively（P<0.001）. The results of univariate and multivariate analysis showed that age，T stage，TNM stage and preoperative albumin were independent prognostic factors for patients（P<0.05）.Conclusion For patients with gastric antrum cancer，age，tumor size and TNM stage are independent risk factors of preoperative hypoalbuminemia. That is an indication of poor prognosis of patients with gastric antrum cancer. For these patients，identification and intervention measures should be strengthened.