Lv Quan, Rao Si-Qi, Xiang Zheng
Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
Chongqing Key Laboratory of Department of General Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
Updates Surg. 2025 Jan 10. doi: 10.1007/s13304-025-02061-z.
The purpose of this study was to identify whether the preoperative hemoglobin to albumin ratio (HAR) could predict the prognosis of patients who underwent colorectal cancer (CRC) radical resection. This study enrolled 4018 consecutive CRC patients, calculating HAR as the hemoglobin count divided by albumin count. Patients were divided into the high and low HAR groups based on a cut-off value (0.36). Baseline information and short-term outcomes were compared between the two groups. Logistic and Cox regression analyses were conducted to determine whether HAR was an independent risk factor for CRC. A total of 4018 patients were divided into the high HAR group (3295) and the low HAR group (723). It was found that the high HAR group had more females (P < 0.01), less BMI (P = 0.027), less smoking (P < 0.01), less drinking (P < 0.01), less T2DM (P = 0.027), lower albumin (P < 0.01), higher hemoglobin (P < 0.01) and more rectal cancer (P = 0.026). We found that HAR was an independent risk factor for overall complications (P = 0.012, OR = 1.279, 95% CI 1.055-1.550). Moreover, we found that HAR was an independent risk factor for overall survival (OS) (P = 0.012, HR = 1.300, 95% CI 1.059-1.597) and disease-free survival (DFS) (P = 0.030, HR = 1.231, 95% CI 1.021-1.484). We found that the low HAR group had worse OS in stage III (P = 0.012) CRC than the high HAR group. In terms of DFS, the low HAR group also had worse DFS in stage III (P = 0.01) CRC than the high HAR group. HAR was an independent predictive factor for the prognosis of CRC. Therefore, surgeons should pay attention to hemoglobin and albumin values before surgery.
本研究的目的是确定术前血红蛋白与白蛋白比值（HAR）是否能够预测接受结直肠癌（CRC）根治性切除术患者的预后。本研究纳入了4018例连续的CRC患者，计算HAR为血红蛋白计数除以白蛋白计数。根据临界值（0.36）将患者分为高HAR组和低HAR组。比较两组之间的基线信息和短期结局。进行逻辑回归和Cox回归分析以确定HAR是否为CRC的独立危险因素。总共4018例患者被分为高HAR组（3295例）和低HAR组（723例）。结果发现，高HAR组女性更多（P＜0.01），体重指数更低（P = 0.027），吸烟更少（P＜0.01），饮酒更少（P＜0.01），2型糖尿病更少（P = 0.027），白蛋白更低（P＜0.01），血红蛋白更高（P＜0.01），直肠癌更多（P = 0.026）。我们发现HAR是总体并发症的独立危险因素（P = 0.012，比值比= 1.279，95%可信区间1.055 - 1.550）。此外，我们发现HAR是总生存期（OS）的独立危险因素（P = 0.012，风险比= 1.300，95%可信区间1.059 - 1.597）和无病生存期（DFS）的独立危险因素（P = 0.030，风险比= 1.231，95%可信区间1.021 - 1.484）。我们发现，在III期CRC中，低HAR组的OS比高HAR组更差（P = 0.012）。就DFS而言，在III期CRC中，低HAR组的DFS也比高HAR组更差（P = 0.01）。HAR是CRC预后的独立预测因素。因此，外科医生在手术前应关注血红蛋白和白蛋白值。
