Predictive Value of C-reactive Protein/Albumin Ratio on Prognosis of Patients with Primary Hepatocellular Carcinoma
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摘要:目的
探讨C反应蛋白（CRP）与白蛋白（Alb）比值对原发性肝癌患者预后的判断价值。
方法纳入首次行手术治疗的原发性肝癌患者178例，计算术前CRP/Alb，运用受试者工作特征曲线、生存分析和Cox多元回归分析评价CRP/Alb与预后的关系。
结果CRP/Alb比值的最佳界点为0.46，敏感度为70.45%，特异度为73.97%。与低CRP/Alb组相比，高CRP/Alb组的CRP水平较高、Alb水平较低、Child-Pugh分级较高、肿瘤最长径较大、血管浸润比例较多，差异均有统计学意义（P＜0.001）。Kaplan-Meier曲线显示高CRP/Alb组的生存率较低（26.8% vs. 56.8%, P＜0.001）。Cox多元回归分析显示CRP/Alb、Child-Pugh分级、血管浸润是预后的独立危险因素。
结论术前CRP/Alb比值升高提示原发性肝癌患者预后不良，是影响患者预后的独立危险因素。
Abstract:ObjectiveTo assess the prognostic value of C-reactive protein/albumin (CRP/Alb) ratio on patients with primary hepatocellular carcinoma (HCC).
MethodsA total of 178 cases with HCC were enrolled. The pre-operative CRP/Alb ratio was calculated. The receiver operating characteristic curve, survival analysis and multivariate analysis were performed to identify the effect of CRP/Alb ratio on the prognosis of HCC patients.
ResultsThe best cutoff level for CRP/Alb ratio was 0.46, sensitivity was 70.45%, and specificity was 73.97%. Compared with the low CRP/Alb group, the high CRP/Alb group showed higher CRP levels, lower Alb level, higher Child-Pugh grade, larger tumor maximum diameter and larger proportion of vascular invasion, with statistical significance (P<0.001). The Kaplan-Meier curve displayed that lower survival rate in the high CRP/Alb group than that in low CRP/Alb group (26.8% vs. 56.8%, P<0.001). The Cox multivariate analysis showed that CRP/Alb, Child-Pugh grade and vascular invasion were independent risk factors for the prognosis.
ConclusionThe elevated CRP/Alb ratio at baseline indicates poor prognosis of patients with HCC, and may be an important independent prognostic factor for the prognosis.
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Key words:
- Hepatocellular carcinoma /
- C-reactive protein /
- Albumin /
- Prognosis
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图 1 CRP/Alb比值评估原发性肝癌患者生存情况的受试者工作特征曲线
Figure 1 Receiver operating characteristic curves of CRP/Alb ratio on assessing overall survival of HCC patients
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图 2 两组患者生存分析的Kaplan-Meier曲线
Figure 2 Kaplan-Meier curve of survival analysis of two groups
表 1 低CRP/Alb组与高CRP/Alb组患者的临床特征比较
Table 1 Comparison of clinical characteristics between low CRP/Alb group and high CRP/Alb group
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表 2 HCC患者预后影响因素的Cox回归分析
Table 2 Risk factors of prognosis of HCC patients analyzed by Cox multivariate model
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[1] Xiu P, Dong XF, Li XP, et al. Clusterin: Review of research progress and looking ahead to direction in hepatocellular carcinoma[J]. World J Gastroenterol, 2015, 21(27): 8262-70. [1] Xiu P, Dong XF, Li XP, et al. Clusterin: Review of research progress and looking ahead to direction in hepatocellular carcinoma[J]. World J Gastroenterol, 2015, 21(27): 8262-70. doi: 10.3748/wjg.v21.i27.8262
[2] Hsu CS, Chao YC, Lin HH, et al. Systematic Review: Impact of Interferon-based Therapy on HCV-related Hepatocellular Carcinoma[J]. Sci Rep, 2015, 5: 9954. [2] Hsu CS, Chao YC, Lin HH, et al. Systematic Review: Impact of Interferon-based Therapy on HCV-related Hepatocellular Carcinoma[J]. Sci Rep, 2015, 5: 9954. doi: 10.1038/srep09954
[3] Shalapour S, Karin M. Immunity, inflammation, and cancer: an eternal fight between good and evil[J]. J Clin Invest, 2015, 125(9): 3347-55. doi: 10.1172/JCI80007
[3] Shalapour S, Karin M. Immunity, inflammation, and cancer: an eternal fight between good and evil[J]. J Clin Invest, 2015, 125(9): 33 47-55. [4] Mischinger J, Comperat E, Schwentner C, et al. Inflammation and Cancer: What Can We Therapeutically Expect from Checkpoint Inhibitors?[J]. Curr Urol Rep, 2015, 16(9): 532. http://cn.bing.com/academic/profile?id=764607786&encoded=0&v=paper_preview&mkt=zh-cn
[4] Mischinger J, Comperat E, Schwentner C, et al. Inflammation and Cancer: What Can We Therapeutically Expect from Checkpoint Inhibitors?[J]. Curr Urol Rep, 2015, 16(9): 532. [5] Parisi I, O’Beirne J, Tsochatzis E. Inflammation-based scores and hepatocellular carcinoma[J]. Liver Transpl, 2014, 20(12): 15 29-30. [5] Parisi I, O’Beirne J, Tsochatzis E. Inflammation-based scores and hepatocellular carcinoma[J]. Liver Transpl, 2014, 20(12): 1529-30. http://cn.bing.com/academic/profile?id=1493656056&encoded=0&v=paper_preview&mkt=zh-cn
[6] Kim MH, Ahn JY, Song JE, et al. The C-Reactive Protein/Albumin Ratio as an Independent Predictor of Mortality in Patients with Severe Sepsis or Septic Shock Treated with Early Goal-Directed Therapy[J]. PLoS One, 2015, 10(7): e132109. http://cn.bing.com/academic/profile?id=786080931&encoded=0&v=paper_preview&mkt=zh-cn
[6] Kim MH, Ahn JY, Song JE, et al. The C-Reactive Protein/Albumin Ratio as an Independent Predictor of Mortality in Patients with Severe Sepsis or Septic Shock Treated with Early Goal-Directed Therapy[J]. PLoS One, 2015, 10(7): e132109. [7] Patel A, Laffan MA, Waheed U, et al. Randomised trials of human albumin for adults with sepsis: systematic review and metaanalysis with trial sequential analysis of all-cause mortality[J]. BMJ, 2014, 349: g4561. [7] Patel A, Laffan MA, Waheed U, et al. Randomised trials of human albumin for adults with sepsis: systematic review and meta-analysis with trial sequential analysis of all-cause mortality[J]. BMJ, 2014, 349: g4561. doi: 10.1136/bmj.g4561
[8] Chinese Society of Liver Cancer. The standard of clinical diagnosis and staging of primary liver cancer[J]. Zhonghua Gan Zang Bing Za Zhi, 2011, 9(6): 324. [中国抗癌协会肝癌专业委员会. 原发性肝癌的临床诊断与分期标准[J]. 中华肝脏病杂志, 2001, 9(6): 324.] [8] 中国抗癌协会肝癌专业委员会. 原发性肝癌的临床诊断与分期标准[J]. 中华肝脏病杂志, 2001, 9(6): 324. http://www.cnki.com.cn/Article/CJFDTOTAL-ZHGZ200106000.htm Chinese Society of Liver Cancer. The standard of clinical diagnosis and staging of primary liver cancer[J]. Zhonghua Gan Zang Bing Za Zhi, 2011, 9(6): 324. http://www.cnki.com.cn/Article/CJFDTOTAL-ZHGZ200106000.htm
[9] Balkwill FR, Mantovani A. Cancer-related inflammation: common themes and therapeutic opportunities[J]. Semin Cancer Biol, 2012, 22 (1): 33-40. [9] Balkwill FR, Mantovani A. Cancer-related inflammation: common themes and therapeutic opportunities[J]. Semin Cancer Biol, 2012, 22(1): 33-40. doi: 10.1016/j.semcancer.2011.12.005
[10] Allavena P, Germano G, Marchesi F, et al. Chemokines in cancer related inflammation[J]. Exp Cell Res, 2011, 317(5): 664-73. doi: 10.1016/j.yexcr.2010.11.013
[10] Allavena P, Germano G, Marchesi F, et al. Chemokines in cancer related inflammation[J]. Exp Cell Res, 2011, 317(5): 664-73. [11] 高翔, 左桂兰, 郭林. 血清C反应蛋白在恶性肿瘤中的临床应用[J]. 诊断学理论与实践, 2004, 3(1): 39-40. http://www.cnki.com.cn/Article/CJFDTOTAL-ZDLS200401015.htm Gao X, Zuo G, Guo L. Clinical application of serum C-reactive protein in patients with malignant tumor[J]. Zhen Duan Xue Li Lun Yu Shi Jian, 2004, 3(1): 39-40. http://www.cnki.com.cn/Article/CJFDTOTAL-ZDLS200401015.htm
[11] Gao X, Zuo G, Guo L. Clinical application of serum C-reactive protein in patients with malignant tumor[J]. Zhen Duan Xue Li Lun Yu Shi Jian, 2004, 3(1): 39-40. [高翔, 左桂兰, 郭林. 血清 C反应蛋白在恶性肿瘤中的临床应用[J]. 诊断学理论与实践, 20 04, 3(1): 39-40.] [12] Chan DS, Bandera EV, Greenwood DC, et al. Circulating C-reactive protein and breast cancer risk- systematic literature review and meta-analysis of prospective cohort studies[J]. Cancer Epidemiol Biomarkers Prev, 2015, 24(10): 1439-49. doi: 10.1158/1055-9965.EPI-15-0324
[12] Chan DS, Bandera EV, Greenwood DC, et al. Circulating C-reactive protein and breast cancer risk- systematic literature review and meta-analysis of prospective cohort studies[J]. Cancer Epidemiol Biomarkers Prev, 2015, 24(10): 1439-49. [13] 王卫东, 范瑞芳, 韩庆, 等. 肝细胞癌术前血清C-反应蛋白水平与术后早期复发的关系[J]. 中国肿瘤临床, 2006, 33(17): 982-4. http://www.cnki.com.cn/Article/CJFDTOTAL-ZGZL200617007.htm Wang WD, Fan RF, Han Q, et al. Correlation between Postoperative early recurrence and preoperative serum C-reactive protein level in patients with hepatocellular carcinoma [J]. Zhongguo Zhong Liu Lin Chuang, 2006, 33(17): 982-4. http://www.cnki.com.cn/Article/CJFDTOTAL-ZGZL200617007.htm
[13] Wang WD, Fan RF, Han Q, et al. Correlation between Postoperative early recurrence and preoperative serum C-reactive protein level in patients with hepatocellular carcinoma [J]. Zhongguo Zhong Liu Lin Chuang, 2006, 33(17): 982-4. [王卫东, 范瑞芳, 韩庆, 等. 肝细胞癌术前血清C-反应蛋白水平与术后早 期复发的关系[J]. 中国肿瘤临床, 2006, 33(17): 982-4.] [14] 吴力群, 王祖森, 韩冰, 等. 术前血清C反应蛋白水平与原发性肝癌患者临床病理因素及肝切除术后生存率的关系[J]. 山东医药, 2010, 50(10): 34-5. http://www.cnki.com.cn/Article/CJFDTOTAL-SDYY201010020.htm Wu LQ,Wan ZS, Han B, et al. The relationship between preoperative serum C reactive protein level and both of clinical pathological factors and survival rate after hepatectomy in patients with primary hepatocellular carcinoma[J]. Shandong Yi Yao, 2010, 50(10): 34-5. http://www.cnki.com.cn/Article/CJFDTOTAL-SDYY201010020.htm
[14] Wu LQ,Wan ZS, Han B, et al. The relationship between preoperative serum C reactive protein level and both of clinical pathological factors and survival rate after hepatectomy in patients with primary hepatocellular carcinoma[J]. Shandong Yi Yao, 20 10, 50(10): 34-5. [吴力群, 王祖森, 韩冰, 等. 术前血清C反应 蛋白水平与原发性肝癌患者临床病理因素及肝切除术后生存 率的关系[J]. 山东医药, 2010, 50(10): 34-5.] [15] Arroyo V. Review article: albumin in the treatment of liver diseases-new features of a classical treatment[J]. Aliment Pharmacol Ther, 2002, 16 Suppl 5: 1-5. http://cn.bing.com/academic/profile?id=2062480155&encoded=0&v=paper_preview&mkt=zh-cn
[15] Arroyo V. Review article: albumin in the treatment of liver diseases-new features of a classical treatment[J]. Aliment Pharmacol Ther, 2002, 16 Suppl 5: 1-5. [16] Ranzani OT, Zampieri FG, Forte DN, et al. C-reactive protein/albumin ratio predicts 90-day mortality of septic patients[J]. PLoS One, 2013, 8(3): e59321. doi: 10.1371/journal.pone.0059321
[16] Ranzani OT, Zampieri FG, Forte DN, et al. C-reactive protein/ albumin ratio predicts 90-day mortality of septic patients[J]. PLoS One, 2013, 8(3): e59321. [17] Mocellin MC, Pastore e Silva Jde A, Camargo Cde Q, et al. Fish oil decreases C-reactive protein/albumin ratio improving nutritional prognosis and plasma fatty acid profile in colorectal cancer patients[J]. Lipids, 2013, 48(9): 879-88. doi: 10.1007/s11745-013-3816-0
[17] Mocellin MC, Pastore e Silva Jde A, Camargo Cde Q, et al. Fish oil decreases C-reactive protein/albumin ratio improving nutritional prognosis and plasma fatty acid profile in colorectal cancer patients[J]. Lipids, 2013, 48(9): 879-88. [18] Kinoshita A, Onoda H, Imai N, et al. The C-reactive protein/albumin ratio, a novel inflammation-based prognostic score, predicts outcomes in patients with hepatocellular carcinoma[J]. Ann Surg Oncol, 2015, 22(3): 803-10. doi: 10.1245/s10434-014-4048-0
[18] Kinoshita A, Onoda H, Imai N, et al. The C-reactive protein/ albumin ratio, a novel inflammation-based prognostic score, predicts outcomes in patients with hepatocellular carcinoma[J]. Ann Surg Oncol, 2015, 22(3): 803-10.
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