Hachiya Hiroyuki, Ishizuka Mitsuru, Takagi Kazutoshi, Iwasaki Yoshimi, Shibuya Norisuke, Nishi Yusuke, Aoki Taku, Kubota Keiichi
Second Department of Surgery Dokkyo Medical University Tochigi Japan.
Ann Gastroenterol Surg. 2018 Aug 29;2(6):434-441. doi: 10.1002/ags3.12201. eCollection 2018 Nov.
A previous study has revealed that the albumin/globulin ratio (GAR) before treatment is a predictor of cancer-specific survival in patients with colorectal cancer (CRC). The aim of the present study was to investigate the clinical significance of GAR for prediction of postoperative survival in patients with CRC.
Nine hundred and forty-one patients who had undergone elective CRC surgery were enrolled. Uni- and multivariate analysis models were performed to detect the clinical characteristics that were most closely associated with overall survival (OS). All recommended cutoff values were defined using receiver operating characteristic curve (ROC) analyses. Kaplan-Meier analysis was used to compare the OS curves between the high GAR (GAR > 0.83) and low GAR (GAR ≤ 0.83) groups.
Multivariate analysis using eight clinical characteristics selected by univariate analyses showed that the GAR was associated with OS (>0.83/≤0.83) (hazard ratio [HR], 1.979; 95% CI, 1.321-2.966; = 0.001) along with carcinoembryonic antigen (CEA; >8.7/≤8.7, ng/mL; HR, 2.319; 95% CI, 1.569-3.428; < 0.001), carbohydrate antigen 19-9 (CA19-9; >18.5/≤18.5, U/mL; HR, 1.727; 95% CI, 1.178-2.532; = 0.005), and the neutrophil-to-lymphocyte ratio (NLR; >2.9/≤2.9; HR, 2.132; 95% CI, 1.454-3.126; < 0.001), and the area under the ROC (AUROC) curve revealed that the GAR had the largest AUROC among these four clinical characteristics (GAR 0.711 > CEA 0.698 > CA19-9 0.676 > NLR 0.635). A significant difference in OS was observed between patients with low GAR and those with high GAR ( < 0.001).
Globulin-to-albumin ratio is a useful predictor of postoperative survival in patients with CRC.
先前的一项研究表明，治疗前的白蛋白/球蛋白比值（GAR）是结直肠癌（CRC）患者癌症特异性生存的预测指标。本研究的目的是探讨GAR对预测CRC患者术后生存的临床意义。
纳入941例行择期CRC手术的患者。采用单因素和多因素分析模型来检测与总生存（OS）最密切相关的临床特征。所有推荐的临界值均使用受试者工作特征曲线（ROC）分析来定义。采用Kaplan-Meier分析比较高GAR（GAR>0.83）组和低GAR（GAR≤0.83）组的OS曲线。
对单因素分析选择的8个临床特征进行多因素分析显示，GAR与OS相关（>0.83/≤0.83）（风险比[HR]，1.979；95%可信区间，1.321-2.966；P=0.001），同时癌胚抗原（CEA；>8.7/≤8.7，ng/mL；HR，2.319；95%可信区间，1.569-3.428；P<0.001）、糖类抗原19-9（CA19-9；>18.5/≤18.5，U/mL；HR，1.727；95%可信区间，1.178-2.532；P=0.005）以及中性粒细胞与淋巴细胞比值（NLR；>2.9/≤2.9；HR，2.132；95%可信区间，1.454-3.126；P<0.001）也与OS相关，并且ROC曲线下面积（AUROC）显示，在这四个临床特征中GAR的AUROC最大（GAR 0.711>CEA 0.698>CA19-9 0.676>NLR 0.635）。低GAR患者和高GAR患者的OS存在显著差异（P<0.001）。
球蛋白与白蛋白比值是CRC患者术后生存的有用预测指标。
