Joliat Gaëtan-Romain, Labgaa Ismail, Demartines Nicolas, Halkic Nermin
Gaëtan-Romain Joliat, Ismail Labgaa, Nicolas Demartines, Nermin Halkic, Department of Visceral Surgery, University Hospital CHUV, 1011 Lausanne, Switzerland.
World J Gastroenterol. 2017 Feb 7;23(5):853-858. doi: 10.3748/wjg.v23.i5.853.
To identify a preoperative blood marker predictive of alveolar echinococcosis (AE) recurrence after hepatectomy.
All consecutive patients who underwent operation for liver AE at the Lausanne University Hospital (CHUV) between January 1992 and December 2015 were included in this retrospective study. Preoperative laboratory values of leukocytes, mean corpuscular volume (MCV), red blood cell distribution width (RDW), thrombocytes, C-reactive protein (CRP) and albumin were collected and analyzed. Univariate and multivariate Cox regression analyses were performed to determine the risk factors for AE recurrence after liver resection. A receiver operating characteristic (ROC) curve was used to define the best discrimination threshold of the blood marker. Moreover, recurrence-free survival curves were calculated using the Kaplan-Meier method.
The cohort included 68 adult patients (37 females) with median age of 61 years [interquartile range (IQR): 46-71]. Eight of the patients (12%) presented a recurrence over a median follow-up time of 76 mo (IQR: 34-128). Median time to recurrence was 10 mo (IQR: 6-11). Median preoperative leukocyte, MCV, RDW, thrombocyte and CRP levels were similar between recurrent and non-recurrent cases. Median preoperative albumin level was 43 g/L (IQR: 41-45) for non-recurrent cases and 36 g/L (IQR: 33-42) for recurrent cases ( = 0.005). The area under the ROC curve for preoperative albumin level to predict recurrence was 0.840 (95%CI: 0.642-1, = 0.002). The cut-off albumin level value was 37.5 g/L for sensitivity of 94.5% and specificity of 75%. In multivariate analysis, preoperative albumin and surgical resection margins were independent predictors of AE recurrence (HR = 0.099, = 0.007 and HR = 0.182, = 0.045 respectively).
Low preoperative albumin level was associated with AE recurrence in the present cohort. Thus, preoperative albumin may be a useful biomarker to guide follow-up.
确定一种术前血液标志物，用于预测肝切除术后肺泡型包虫病（AE）的复发。
本回顾性研究纳入了1992年1月至2015年12月期间在洛桑大学医院（CHUV）接受肝AE手术的所有连续患者。收集并分析术前白细胞、平均红细胞体积（MCV）、红细胞分布宽度（RDW）、血小板、C反应蛋白（CRP）和白蛋白的实验室值。进行单因素和多因素Cox回归分析，以确定肝切除术后AE复发的危险因素。采用受试者工作特征（ROC）曲线确定血液标志物的最佳鉴别阈值。此外，使用Kaplan-Meier方法计算无复发生存曲线。
该队列包括68例成年患者（37例女性），中位年龄61岁[四分位间距（IQR）：46 - 71岁]。8例患者（12%）在中位随访时间76个月（IQR：34 - 128个月）出现复发。复发的中位时间为10个月（IQR：6 - 11个月）。复发组和未复发组术前白细胞、MCV、RDW、血小板和CRP水平的中位数相似。未复发组术前白蛋白水平中位数为43 g/L（IQR：41 - 45），复发组为36 g/L（IQR：33 - 42）（P = 0.005）。术前白蛋白水平预测复发的ROC曲线下面积为0.840（95%CI：0.642 - 1，P = 0.002）。白蛋白水平的截断值为37.5 g/L，敏感性为94.5%，特异性为75%。在多因素分析中，术前白蛋白和手术切缘是AE复发的独立预测因素（HR分别为0.099，P = 0.007和HR为0.182，P = 0.045）。
在本队列中，术前白蛋白水平低与AE复发相关。因此，术前白蛋白可能是指导随访的有用生物标志物。
