Sawayama Hiroshi, Miyamoto Yuji, Hiyoshi Yukiharu, Shimokawa Mototsugu, Kato Rikako, Akiyama Takahiko, Sakamoto Yuki, Daitoku Nobuya, Yoshida Naoya, Baba Hideo
Department of Gastroenterological Surgery Graduate School of Medical Sciences Kumamoto University Kumamoto Japan.
Department of Biostatistics Graduate School of Medicine Yamaguchi University Yamaguchi Japan.
Ann Gastroenterol Surg. 2021 Jan 25;5(2):243-251. doi: 10.1002/ags3.12411. eCollection 2021 Mar.
This study investigated whether preoperative serum transferrin, a rapid-turnover protein, was associated with prognosis after colorectal cancer (CRC) resection.
We evaluated preoperative transferrin, which was calculated as iron and unsaturated iron-binding capacity, in 501 patients who underwent surgery for Stage I-III CRC. Transferrin level was directly proportional to total iron-binding capacity (TIBC), and TIBC < 250 μg/dl was defined as low transferrin. The associations between transferrin and prognosis were evaluated in univariate and multivariate Cox proportional hazards analyses.
Fifty-eight of 501 patients (11.5%) had low transferrin. In these patients, low transferrin was significantly associated with high age, female gender, low body mass index (<18.5), high white blood cell count, low total protein, low albumin, high C-reactive protein, low hemoglobin, and low neutrophil/lymphocyte ratio. In the univariate analysis, low transferrin was associated with shorter relapse-free survival (RFS) (hazard ratio [HR] 2.180, 95% confidence interval [CI] 1.417-3.354, < .001), overall survival (OS) (HR 2.930, 95% CI 1.784-4.811, < .001), and cancer-specific survival (CSS) (HR 2.122, 95% CI 1.053-4.275, = .035). In multivariate analysis, high age ( < .001), Glasgow Prognostic Score ( = .009), and low transferrin (HR 2.336, 95% CI 1.173-4.654, = .011) were independently associated with shorter OS, and depth of invasion pT4 ( = .015), presence of lymph node metastasis ( = .001), low hemoglobin ( = .034), and low transferrin (HR 2.638, 95% CI 1.113-5.043, = .025) were independently associated with shorter CSS.
Preoperative serum transferrin in Stage I-III CRC patients was identified as a novel prognostic marker by univariate and multivariate analyses.
本研究调查术前血清转铁蛋白（一种快速周转蛋白）是否与结直肠癌（CRC）切除术后的预后相关。
我们评估了501例接受I - III期CRC手术患者的术前转铁蛋白，其通过铁和不饱和铁结合能力计算得出。转铁蛋白水平与总铁结合能力（TIBC）成正比，TIBC < 250μg/dl被定义为低转铁蛋白。在单因素和多因素Cox比例风险分析中评估转铁蛋白与预后的关联。
501例患者中有58例（11.5%）转铁蛋白水平低。在这些患者中，低转铁蛋白与高龄、女性、低体重指数（<18.5）、高白细胞计数、低总蛋白、低白蛋白、高C反应蛋白、低血红蛋白以及低中性粒细胞/淋巴细胞比值显著相关。在单因素分析中，低转铁蛋白与无复发生存期（RFS）缩短相关（风险比[HR] 2.180，95%置信区间[CI] 1.417 - 3.354，P <.001）、总生存期（OS）缩短相关（HR 2.930，95% CI 1.784 - 4.811，P <.001）以及癌症特异性生存期（CSS）缩短相关（HR 2.122，95% CI 1.053 - 4.275，P =.035）。在多因素分析中，高龄（P <.001）、格拉斯哥预后评分（P =.009）以及低转铁蛋白（HR 2.336，95% CI 1.173 - 4.654，P =.011）与较短的OS独立相关，而侵袭深度pT4（P =.015）、淋巴结转移的存在（P =.001）、低血红蛋白（P =.034）以及低转铁蛋白（HR 2.638，95% CI 1.113 - 5.043，P =.025）与较短的CSS独立相关。
通过单因素和多因素分析，I - III期CRC患者术前血清转铁蛋白被确定为一种新的预后标志物。
