术前丙氨酸氨基转移酶与天冬氨酸氨基转移酶比值作为胰腺癌根治性胰十二指肠切除术预后标志物的临床研究
Prognostic value of preoperative aspartate aminotransferase-to-alanine aminotransferase ratio in patients with pancreatic ductal adenocarcinoma undergoing radical pancreaticoduodenectomy
李明泰 1崔成昊 1王砚伟 1刘哲 2梁雨荣2
作者信息
- 1. 解放军医学院研究生院,北京 100853
- 2. 解放军总医院第一医学中心肝胆胰外科医学部解放军总医院肝胆外科研究所 全军数字肝胆外科重点实验室,北京 100853
- 折叠
摘要
目的 评估天冬氨酸氨基转移酶与丙氨酸氨基转移酶比值(DRR)对于接受根治性胰十二指肠切除术的胰腺导管腺癌(PDAC)患者术后总生存的预测价值.方法 回顾性分析2015年1月至2020年12月于解放军总医院行根治性胰十二指肠切除术且术后病理诊断为PDAC的137例患者临床资料,其中男性97例,女性40例,年龄(58±10)岁.根据DRR最佳生存风险截断值将患者分组,比较关键临床病理指标的组间差异.采用Kaplan-Meier法进行生存分析,生存率比较采用log-rank 检验.采用多因素Cox分析评估影响预后的危险因素.结果 将137例PDAC患者依据DRR最佳截断值1.1分为两组:DRR≥1.1为高DRR组(n=29);DRR＜1.1为低DRR组(n=108).低DRR组患者累积生存率优于高DRR组,差异有统计学意义(P=0.003).多因素Cox回归分析结果显示,DRR ≥1.1(HR=2.485,95％CI:1.449～4.261,P=0.001)、术前胆道引流(HR=1.845,95％CI:1.030～3.306,P=0.039)、淋巴结转移 N2 分期(HR=2.240,95％CI:1.123～4.470,P=0.022)、高级别肿瘤分化(HR=2.001,95％CI:1.279～3.129,P=0.002)、脉管内癌栓(HR=2.240,95％CI:1.123～4.470,P=0.022)是接受根治性胰十二指肠切除的PDAC患者总生存期差的危险因素.结论 DRR对于接受根治性胰十二指肠切除术的PDAC患者术后总生存具有预测价值,DRR≥1.1是PDAC患者术后总生存差的危险因素.
Abstract
J Objective To assess the predictive value of aspartate aminotransferase-to-alanine amino-transferase ratio(DRR)on overall survival of patients with pancreatic ductal adenocarcinoma(PDAC)who underwent radical pancreaticoduodenectomy.Methods A retrospective analysis was performed on the clini-cal data of 137 patients who underwent radical pancreaticoduodenectomy and were diagnosed with PDAC postoperatively at the Chinese PLA General Hospital from January 2015 to December 2020.There were 97 male and 40 female patients,with an average age of(58±10)years old.The patients were grouped according to the optimal survival risk cutoff value of DRR,and the differences in key clinical and pathological indicators between the groups were compared.Kaplan-Meier method was used for survival analysis,and log-rank test was used for comparison of survival rates.Multivariate Cox analysis was performed to evaluate the prognostic factors affecting survival.Results The 137 PDAC patients were divided into two groups based on the opti-mal cutoff value of DRR,namely 1.1:DRR≥1.1 was defined as the high-DRR group(n=29),and DRR＜1.1 was defined as the low-DRR group(n=108).The cumulative survival rate of the low-DRR group was better than that of the high-DRR group,and the difference was statistically significant(P=0.003).The results of the multivariate Cox regression analysis showed that DRR≥1.1(HR=2.485,95％CI:1.449-4.261,P=0.001),preoperative biliary drainage(HR=1.845,95％CI:1.030-3.306,P=0.039),lymph node metastasis N2 stage(HR=2.240,95％CI:1.123-4.470,P=0.022),high tumor differenti-ation(HR=2.001,95％CI:1.279-3.129,P=0.002),and intravascular cancer emboli(HR=2.240,95％CI:1.123-4.470,P=0.022)were risk factors for poor overall survival in PDAC patients who under-went radical pancreaticoduodenectomy.Conclusion DRR has predictive value for overall survival after surgery in PDAC patients undergoing radical pancreatoduodenectomy.A DRR of 1.1 or greater is a risk factor for poor overall survival after surgery in PDAC patients.
关键词
胰腺肿瘤/胰十二指肠切除术/天冬氨酸氨基转移酶/丙氨酸氨基转移酶/总生存期Key words
Pancreatic neoplasms/Pancreaticoduodenectomy/Aspartate aminotransferase/Alanine aminotransferase ratio/Overall survival引用本文复制引用
出版年
2024
NETL
NSTL
万方数据