Wang Yan, Xiong Feng, Yang Jian, Xia Tingting, Jia Zhenyu, Shen Jiaqing, Xu Chunfang, Feng Jun, Lu Yongda
Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Suzhou, China.
Department of Oncology, The First Affiliated Hospital of Soochow University, Suzhou, China.
J Gastrointest Oncol. 2021 Aug;12(4):1338-1350. doi: 10.21037/jgo-21-430.
The albumin-to-alkaline phosphatase ratio (AAPR) is an innovative prognostic index for various cancer patients, the clinical significance of the AAPR in patients with GC is unknown.
We retrospectively reviewed 227 resectable GC patients in our center. The Kaplan-Meier method and the Cox proportional hazards model were used to analyze the disease-free survival (DFS) and overall survival (OS). The Likelihood Ratio Test (LRT) and Akaike information criterion (AIC) were used to compare the prognostic abilities of the TNM and AAPR-TNM staging systems in DFS and OS prediction.
The AAPR was significantly decreased in GC patients, and the optimal cut-off value for resectable and benign gastric disease was 0.437 as determined by the receiver operating characteristic (ROC) curve. The correlation analysis revealed that decreased AAPR in GC was associated with T stage (P=0.004) and TNM stage (P=0.013). Decreased preoperative AAPR correlated with both unfavorable disease-free survival (DFS) and overall survival (OS). Cox regression analysis showed that the TNM stage (DFS: P=0.001, OS: P=0.002) and differential levels of AAPR (DFS: P<0.001, OS: P<0.001) were independent risk factors of DFS and OS. ROC analysis showed that the AAPR-TNM system was more superior than the TNM staging system for DFS (z=1.91, P=0.028) and OS (z=1.937, P=0.026) prediction. The likelihood ratio test (LRT) analysis indicated that the AAPR-TNM system had a significantly larger χ for both DFS (35.58 34.51, P<0.001) and OS (32.92 30.07, P<0.001), and a lower Akaike information criterion (AIC) value both for DFS (1,032 1,065, P<0.001) and OS (869 898, P<0.001) compared to the TNM system.
The AAPR level significantly decreased in patients with GC, and impacted the prognosis of patients.
白蛋白与碱性磷酸酶比值（AAPR）是各类癌症患者的一种创新型预后指标，其在胃癌（GC）患者中的临床意义尚不清楚。
我们回顾性分析了本中心227例可切除的GC患者。采用Kaplan-Meier法和Cox比例风险模型分析无病生存期（DFS）和总生存期（OS）。使用似然比检验（LRT）和赤池信息准则（AIC）比较TNM分期系统和AAPR-TNM分期系统在DFS和OS预测方面的预后能力。
GC患者的AAPR显著降低，根据受试者工作特征（ROC）曲线确定，可切除的良性胃病的最佳截断值为0.437。相关性分析显示，GC患者AAPR降低与T分期（P=0.004）和TNM分期（P=0.013）相关。术前AAPR降低与不良的无病生存期（DFS）和总生存期（OS）均相关。Cox回归分析表明，TNM分期（DFS：P=0.001，OS：P=0.002）和AAPR差异水平（DFS：P<0.001，OS：P<0.001）是DFS和OS的独立危险因素。ROC分析显示，AAPR-TNM系统在DFS（z=1.91，P=0.028）和OS（z=1.937，P=0.026）预测方面比TNM分期系统更优越。似然比检验（LRT）分析表明，AAPR-TNM系统在DFS（35.58对34.51，P<0.001）和OS（32.92对30.07，P<0.001）方面的χ值均显著更大，且在DFS（1,032对1,065，P<0.001）和OS（869对898，P<0.001）方面的赤池信息准则（AIC）值均低于TNM系统。
GC患者的AAPR水平显著降低，并影响患者的预后。
