| Objective: Fibrinogen(FIB)is a multifunctional protein that affects many cellular proces ses during tumorigenesis and metastasis.Prealbumin(PA)has a similar function to album in,but has a shorter half-life,and can be used to assess nutritional status and immune func tion more sensitively,which is closely related to tumor recurrence and prognosis.Howeve r,there are few reports on the role of FIB and PA white indicators in preoperative progno sis assessment of renal cancer.The purpose of this study was to investigate the clinical ap plication value of preoperative FIB /PA Rate(FPR)and FIB /PA Rate(FPR)in predicting and evaluating the survival status of patients with renal cancer five years after operation.Methods: The clinical data of patients admitted to the Department of Urology,Affiliated Hospital of Qingdao University from January 2015 to December 2016 who underwent ren al cancer surgery and were confirmed as renal cancer by postoperative pathology were col lected.A combination of telephone follow-up and outpatient visits was used to investigate survival at 5 years and cancer deaths during follow-up.A total of 251 patients were selec ted,including 160 males and 91 females,with an average age of 57.2 years.First,ROC c urve analysis was used to determine the optimal threshold between preoperative FIB and PA as well as FPR to predict postoperative survival status of patients.All enrolled patient s were divided into survival group and death group based on survival status after 5 years o f followup.The two groups of quantitative data were tested for normality,and the two gr oups of quantitative data conforming to normal distribution were tested by independent sa mple T test.Qualitative data of the two groups were statistically analyzed by chi-square te st or exact probability method.Multivariate logistic regression test was used to analyze th e independent influencing factors of postoperative survival status.All patients were divid ed into high FPR group and low FPR group according to the optimal boundary value of F PR.The preoperative baseline data of the two groups were compared and analyzed.Multi variate COX regression analysis was conducted to determine the independent risk factors that ultimately influenced the survival status of patients.Kaplan-meier method was used f or univariate survival analysis of all related factors.Log rank test was used to analyze the statistical significance of the influence of each factor on the final survival status.All the a bove statistics and analyses were carried out by SPSS24.0 software,and P < 0.05 was reg arded as the test standard with statistically significant differences.Finally,R language sof tware was used to construct a rosette to better predict 5-year survival.Results: ROC curve analysis showed that the area under curve(AUC)of FIB was 0.659.The AUC of PA is 0.712.The AUC of FPR was 0.757,and the test value WAS P < 0.001.The optimal cut-off value is 0.009,the sensitivity is 0.553,and the 1-specificity is 0.116.There were 227 cases in the survival group and 24 cases in the death group.Chi-squar e test or accurate probability test showed that there were significant differences in tumor s ize,surgical method,pathological type,lymph node metastasis,TNM grade and FM grad e between the two groups,P < 0.05.Independent sample T test showed that there were sig nificant statistical differences between the two groups of fibrinogen,prealbumin and FPR samples,P < 0.05.Multivariate logistic regression analysis showed that o tumor size 、gender、FPR、fibrinogen and prealbumin are the independent risk factor that affect patient survival.According to the optimal boundary value o f FPR,89 patients were divided into high FPR group(>0.009)and 162 low FPR group(≤0.009).Chi-square test or precise probability test showed significant statistical differe nces in gender,age,tumor size,surgical method,pathological type,lymph node metastasi s,TNM grade and FM grade between the two groups.Multivariate COX regression analy sis found that:Only fibrinogen(P < 0.001,RR=0.257,95.0% confidence interval 0.117-0.544),prealbumin(P= 0.003,RR=1.029,95.0% confidence interval 1.101-6.027)and FPR(P=0.002,RR=0.180,95.0% confidence interval 0.100-0.834)was the independent ris k factor that ultimately influenced patient survival status.Univariate survival analysis by Kaplan-Meier method and log rank test showed that there were significant differences in FPR,gender,age group,pathological type,lymph node metastasis,TNM grade,FM grade and other factors(P < 0.05).The c-index was 0.816(95%CI: 0.751-0.880),which could be used to predict 5-year postoperative survival.Conclusion: The study confirmed that FIB,PA and FPR can effectively evaluate and pre dict the survival and prognosis of patients with renal cancer after operation,and FPR has t he strongest diagnostic efficacy.Preoperative FIB,PA and FPR can be used as independent factors influencing the survival and prognosis of patients with renal cancer after surgery,and the influencing attributes of the three are different.Further analysis s howed that the three indicators had significant clinical application value in predicting post operative survival of patients,and a newer and more powerful comprehensive model shou ld be established by combining with other clinical auxiliary examination indicators to imp rove the prediction and evaluation effectiveness of postoperative survival and prognosis o f patients with renal cancer. |
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