内容紹介
Summary
Background: This study investigated the prognostic value of preoperative serum C-reactive protein(CRP)level in patients with gastric cancer(GC). Methods: This retrospective study examined 446 GC patients undergoing curative gastrectomy. The associations between preoperative CRP level and postoperative long-term outcomes were examined by univariate and multivariate analyses. Results: The patients were divided into high(n=147)or low(n=299)CRP groups based on an optimal cut-off CRP value of 0.13 mg/dL according to the ROC curve analysis. High CRP levels were significantly associated with other clinical factors such as older age(>_65 years), high BMI(>_25 kg/m2), poor performance status(PS), and advanced cT and cN+. In the survival analyses using only the clinical factors, high CRP levels were significantly associated with worse 5-year overall and cancer-specific survivals. The multivariate analysis for 5-year overall survival identified preoperative CRP to be an independent factor(HR: 1.95, 95%CI: 1.15-3.36, p=0.0129), as well as PS, tumor location, and cT. Conclusion: Preoperative CRP level could be a useful prognostic indicator in patients with GC undergoing curative gastrectomy.
要旨
目的: 胃癌根治切除後の長期予後予測における術前C-reactive protein(CRP)値の有用性について検討した。対象および方法: 2008～2013年に当院で胃癌根治切除を施行した446例を対象とし,術前CRP値と術後長期予後との関連を後方視的に検討した。結果: 5年全生存予測のROC曲線でAUCが最も高値となるCRP値0.13 mg/dLをカットオフとし,CRP高値群(n=147)と低値群(n=299)に分類した。CRP高値群では,65歳以上,BMI 25 kg/m2以上,performance status(PS)不良,cT2以深,cN+症例を有意に多く認めた。長期予後に関して,CRP高値群では術後5年全生存および癌特異的生存が有意に不良であり,胃癌再発,特に血行性再発を多く認めた。5年全生存に対する多変量解析では,PS,腫瘍局在,cTとともに,術前CRP値は独立した予後規定因子であった(ハザード比: 1.95,95%信頼区間: 1.15-3.36,p=0.0129)。結語: 術前CRP値は,胃癌根治切除後の長期予後予測マーカーとして有用である。
目次
Background: This study investigated the prognostic value of preoperative serum C-reactive protein(CRP)level in patients with gastric cancer(GC). Methods: This retrospective study examined 446 GC patients undergoing curative gastrectomy. The associations between preoperative CRP level and postoperative long-term outcomes were examined by univariate and multivariate analyses. Results: The patients were divided into high(n=147)or low(n=299)CRP groups based on an optimal cut-off CRP value of 0.13 mg/dL according to the ROC curve analysis. High CRP levels were significantly associated with other clinical factors such as older age(>_65 years), high BMI(>_25 kg/m2), poor performance status(PS), and advanced cT and cN+. In the survival analyses using only the clinical factors, high CRP levels were significantly associated with worse 5-year overall and cancer-specific survivals. The multivariate analysis for 5-year overall survival identified preoperative CRP to be an independent factor(HR: 1.95, 95%CI: 1.15-3.36, p=0.0129), as well as PS, tumor location, and cT. Conclusion: Preoperative CRP level could be a useful prognostic indicator in patients with GC undergoing curative gastrectomy.
要旨
目的: 胃癌根治切除後の長期予後予測における術前C-reactive protein(CRP)値の有用性について検討した。対象および方法: 2008～2013年に当院で胃癌根治切除を施行した446例を対象とし,術前CRP値と術後長期予後との関連を後方視的に検討した。結果: 5年全生存予測のROC曲線でAUCが最も高値となるCRP値0.13 mg/dLをカットオフとし,CRP高値群(n=147)と低値群(n=299)に分類した。CRP高値群では,65歳以上,BMI 25 kg/m2以上,performance status(PS)不良,cT2以深,cN+症例を有意に多く認めた。長期予後に関して,CRP高値群では術後5年全生存および癌特異的生存が有意に不良であり,胃癌再発,特に血行性再発を多く認めた。5年全生存に対する多変量解析では,PS,腫瘍局在,cTとともに,術前CRP値は独立した予後規定因子であった(ハザード比: 1.95,95%信頼区間: 1.15-3.36,p=0.0129)。結語: 術前CRP値は,胃癌根治切除後の長期予後予測マーカーとして有用である。