AIM To clarify the prognostic significance of preoperative albumin-to-alkaline phosphatase ratio(AAPR) in cholangiocarcinoma(CCA) subjects receiving surgery.METHODS In this retrospective study, we included 303 CCA pat...AIM To clarify the prognostic significance of preoperative albumin-to-alkaline phosphatase ratio(AAPR) in cholangiocarcinoma(CCA) subjects receiving surgery.METHODS In this retrospective study, we included 303 CCA patients receiving surgery without preoperative therapy between 2002 and 2014. Clinicopathological characteristics(including AAPR) were analyzed to determine predictors of postoperative overall survival and recurrence-free survival(RFS). In addition,univariate and multivariate Cox proportional hazards models were conducted,followed by application of time-dependent receiver operating curves to identify the optimal cut-off.RESULTS Univariate and multivariate analyses revealed both decreased overall survival[hazard ratio(HR): 2.88, 95%CI: 1.19-5.78] and recurrence-free survival(HR: 2.31,95%CI: 1.40–3.29) in patients with AAPR < 0.41 compared to those with AAPR ≥0.41. The optimal cut-off of AAPR was 0.41. Of the 303 subjects, 253(83.5%) had an AAPR over 0.41. The overall 1-, 3- and 5-year survival rates were 70.2%, 38.0% and 16.5%, respectively in the low(< 0.41) AAPR group, which were significantly lower than those in the high(≥ 0.41) AAPR group(81.7%, 53.9%, and 33.4%,respectively)(P < 0.0001). Large tumor size, multiple tumors, and advanced clinical stage were also identified as significant predictors of poor prognosis.CONCLUSION Our outcomes showed that AAPR was a potential valuable prognostic indicator in CCA patients undergoing surgery, which should be further confirmed by prospective studies. Moreover, it is necessary to investigate the mechanisms concerning the correlation of low AAPR with poor post-operative survival in CCA patients.展开更多
目的探讨γ-谷氨酰转移酶(γ-glutamyltransferase,GGT)、碱性磷酸酶(alkaline phosphatase,ALP)和外周血中性粒细胞与淋巴细胞比值(neutrophil to lymphocyte ratio,NLR)联合检测在肝癌诊断中的应用价值。方法回顾性选取2012年1月至202...目的探讨γ-谷氨酰转移酶(γ-glutamyltransferase,GGT)、碱性磷酸酶(alkaline phosphatase,ALP)和外周血中性粒细胞与淋巴细胞比值(neutrophil to lymphocyte ratio,NLR)联合检测在肝癌诊断中的应用价值。方法回顾性选取2012年1月至2020年12月广西医科大学附属武鸣医院收治的100例肝癌患者纳入肝癌组,100例肝硬化患者纳入肝硬化组,100例肝炎患者纳入肝炎组,另选取本院同期健康体检者100人纳入健康体检组。比较四组受试者的GGT、ALP、NLR水平,采用受试者操作特征曲线(receiver operating characteristic curve,ROC曲线)评价各指标对肝癌的诊断效能。结果肝癌组患者的NLR、GGT和ALP水平均显著高于肝硬化组、肝炎组和健康体检组(P<0.05);肝硬化组患者的NLR显著高于健康体检组和肝炎组(P<0.05);肝硬化组和肝炎组患者的GGT和ALP均显著高于健康体检组(P<0.05)。Spearman相关分析结果显示,NLR与GGT、ALP均呈正相关,GGT与ALP呈正相关(P<0.05)。NLR、GGT和ALP单独检测诊断肝癌时,NLR的曲线下面积(area under the curve,AUC)最大,为0.943(95%CI:0.901~0.971,P<0.001),ALP的AUC最小。三者联合检测的AUC为0.987(95%CI:0.959~0.998),敏感度为99.0%。结论NLR、GGT、ALP联合检测可显著提高肝癌的检出率,联合检测有更好的应用价值。展开更多
基金National Key Project Research and Development Projects,No.S2016G9012International Science and Technology Cooperation Projects,No.2015DFA30650the Capital Special Research Project for Clinical Application,No.Z151100004015170
文摘AIM To clarify the prognostic significance of preoperative albumin-to-alkaline phosphatase ratio(AAPR) in cholangiocarcinoma(CCA) subjects receiving surgery.METHODS In this retrospective study, we included 303 CCA patients receiving surgery without preoperative therapy between 2002 and 2014. Clinicopathological characteristics(including AAPR) were analyzed to determine predictors of postoperative overall survival and recurrence-free survival(RFS). In addition,univariate and multivariate Cox proportional hazards models were conducted,followed by application of time-dependent receiver operating curves to identify the optimal cut-off.RESULTS Univariate and multivariate analyses revealed both decreased overall survival[hazard ratio(HR): 2.88, 95%CI: 1.19-5.78] and recurrence-free survival(HR: 2.31,95%CI: 1.40–3.29) in patients with AAPR < 0.41 compared to those with AAPR ≥0.41. The optimal cut-off of AAPR was 0.41. Of the 303 subjects, 253(83.5%) had an AAPR over 0.41. The overall 1-, 3- and 5-year survival rates were 70.2%, 38.0% and 16.5%, respectively in the low(< 0.41) AAPR group, which were significantly lower than those in the high(≥ 0.41) AAPR group(81.7%, 53.9%, and 33.4%,respectively)(P < 0.0001). Large tumor size, multiple tumors, and advanced clinical stage were also identified as significant predictors of poor prognosis.CONCLUSION Our outcomes showed that AAPR was a potential valuable prognostic indicator in CCA patients undergoing surgery, which should be further confirmed by prospective studies. Moreover, it is necessary to investigate the mechanisms concerning the correlation of low AAPR with poor post-operative survival in CCA patients.
文摘目的探讨γ-谷氨酰转移酶(γ-glutamyltransferase,GGT)、碱性磷酸酶(alkaline phosphatase,ALP)和外周血中性粒细胞与淋巴细胞比值(neutrophil to lymphocyte ratio,NLR)联合检测在肝癌诊断中的应用价值。方法回顾性选取2012年1月至2020年12月广西医科大学附属武鸣医院收治的100例肝癌患者纳入肝癌组,100例肝硬化患者纳入肝硬化组,100例肝炎患者纳入肝炎组,另选取本院同期健康体检者100人纳入健康体检组。比较四组受试者的GGT、ALP、NLR水平,采用受试者操作特征曲线(receiver operating characteristic curve,ROC曲线)评价各指标对肝癌的诊断效能。结果肝癌组患者的NLR、GGT和ALP水平均显著高于肝硬化组、肝炎组和健康体检组(P<0.05);肝硬化组患者的NLR显著高于健康体检组和肝炎组(P<0.05);肝硬化组和肝炎组患者的GGT和ALP均显著高于健康体检组(P<0.05)。Spearman相关分析结果显示,NLR与GGT、ALP均呈正相关,GGT与ALP呈正相关(P<0.05)。NLR、GGT和ALP单独检测诊断肝癌时,NLR的曲线下面积(area under the curve,AUC)最大,为0.943(95%CI:0.901~0.971,P<0.001),ALP的AUC最小。三者联合检测的AUC为0.987(95%CI:0.959~0.998),敏感度为99.0%。结论NLR、GGT、ALP联合检测可显著提高肝癌的检出率,联合检测有更好的应用价值。
