Sato Ryuichiro, Oikawa Masaya, Kakita Tetsuya, Okada Takaho, Abe Tomoya, Yazawa Takashi, Tsuchiya Haruyuki, Akazawa Naoya, Yoshimachi Shingo, Okano Haruka, Ito Kei, Tsuchiya Takashi
Department of Gastroenterological Surgery, Sendai City Medical Center Sendai Open Hospital, Sendai, Japan.
Department of Surgery, Japanese Red Cross Sendai Hospital, Sendai, Japan.
J Anus Rectum Colon. 2021 Oct 28;5(4):366-375. doi: 10.23922/jarc.2021-016. eCollection 2021.
It has been increasingly recognized that the progression of cancer is dependent not only on the tumor characteristics but also on the nutritious and inflammatory condition of the host. We investigated the relationship between the globulin-to-albumin ratio (GAR) and long-term outcomes in obstructive colorectal cancer (OCRC) patients who were inserted self-expandable metallic stent as a bridge to curative surgery.
A total of 75 pathological stage II and III OCRC patients between 2013 and 2020 were retrospectively evaluated. The associations of the preoperative GAR with clinicopathological factors and patient survival were examined.
Receiver operating characteristic curve analysis demonstrated that the optimal cutoff value was 0.88. The GAR ≥ 0.88 status was significantly associated with the absence of lymph node metastasis (P = 0.011), longer postoperative hospital stay (17 days vs 15 days, P = 0.042), and not receiving adjuvant chemotherapy (P = 0.011). Relapse-free survival and cancer-specific survival were significantly shorter in the GAR ≥ 0.88 group (P = 0.007 and P = 0.023, respectively). Multivariate analyses revealed that the GAR ≥ 0.88 was independently associated with relapse-free survival [hazard ratio (HR) = 4.17, 95% confidence interval (CI) 1.32-13.14, P = 0.015)]. Moreover, CA19-9 ≥ 37 (HR = 6.56, 95% CI 2.12-20.27, p = 0.001) and not receiving adjuvant chemotherapy (HR = 4.41, 95% CI 1.28-15.26, p = 0.019) were independent poor prognostic factors for relapse-free survival.
The results demonstrated that the GAR was a significant prognostic factor for OCRC patients.
人们越来越认识到癌症的进展不仅取决于肿瘤特征，还取决于宿主的营养和炎症状况。我们研究了球蛋白与白蛋白比值（GAR）与接受自膨式金属支架置入作为根治性手术桥梁的梗阻性结直肠癌（OCRC）患者长期预后之间的关系。
回顾性评估2013年至2020年间共75例病理分期为II期和III期的OCRC患者。研究术前GAR与临床病理因素及患者生存率之间的关联。
受试者工作特征曲线分析表明最佳临界值为0.88。GAR≥0.88状态与无淋巴结转移显著相关（P = 0.011）、术后住院时间较长（17天对15天，P = 0.042）以及未接受辅助化疗（P = 0.011）。GAR≥0.88组的无复发生存期和癌症特异性生存期显著缩短（分别为P = 0.007和P = 0.023）。多因素分析显示GAR≥0.88与无复发生存期独立相关[风险比（HR）= 4.17，95%置信区间（CI）1.32 - 13.14，P = 0.015]。此外，CA19 - 9≥37（HR = 6.56，95% CI 2.12 - 20.27，p = 0.001）和未接受辅助化疗（HR = 4.41，95% CI 1.28 - 15.26，p = 0.019）是无复发生存期的独立不良预后因素。
结果表明GAR是OCRC患者的一个重要预后因素。
