Prognostic significance of high triglyceride and apolipoprotein B levels in patients with stage III and high-risk stage II colorectal cancer undergoing curative surgery
Prognostic significance of high triglyceride and apolipoprotein B levels in patients with stage III and high-risk stage II colorectal cancer undergoing curative surgery
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高甘油三酯和载脂蛋白 B 水平对接受根治性手术的 III 期和高危 II 期结直肠癌患者的预后意义
DOI：
10.3892/ol.2020.11617
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发表时间：
2020-07-01
期刊：
影响因子：
2.9
通讯作者：
Yang, Li-Yong
中科院分区：
文献类型：
--
作者：
Chen, Xiu-Qing;Wu, Pei-Wen;Yang, Li-Yong
虽然流行病学研究表明血脂异常增加了结直肠癌(CRC)的风险，但血脂和载脂蛋白水平在结直肠癌中的预后价值仍不清楚。本研究的目的是探讨血脂和载脂蛋白水平对接受根治性手术的III期和高危II期结直肠癌患者预后的影响。观察结直肠癌患者手术前总胆固醇、甘油三酯、高密度脂蛋白、低密度脂蛋白、极低密度脂蛋白、载脂蛋白A1和载脂蛋白B水平。用最大x~2法确定这些因素的临界值，并将患者分为预后不良组和预后良好组。采用Kaplan-Meier曲线和Cox回归分析评估患者的预后价值。此外，分别使用诺模图和Harrells一致性指数来评估这些参数对预后的影响及其预测的准确性。总共有246名患者参加了这项评估。以甘油三酯(男性1.53 mmoL/L，女性1.58 mmoL/L)和载脂蛋白B(0.73 mmoL/L)为临界点，本研究确定甘油三酯和载脂蛋白B均为无病生存期(DFS)和总生存期(OS)的预测因子。多因素分析显示，高TG(男性，≥1.53 mmoL/L；女性，≥1.58 mmoL/L)和高apo-B(≥0.73 mmoL/L)水平与DFS和OS显著相关。与不包含这些值的诺模图相比，包含TG和APO-B水平值的诺模图显示出更高的预测准确性。提示TG和APO-B水平可能是结直肠癌根治术后良好的独立预后生物标志物。因此，将这些参数调整到适度的水平可能是有益的。
Although epidemiologic studies suggest that dyslipidemia increases the risk of colorectal cancer (CRC), the prognostic value of blood lipid and apolipoprotein levels in CRC remains unclear. The aim of the present study was to investigate the impact of blood lipid and apolipoprotein levels on the prognosis of patients with stage III and high-risk stage II CRC undergoing curative surgery. Preoperative levels of total cholesterol, triglycerides (TG), high-density lipoprotein, low-density lipoprotein, very-low-density lipoprotein, apolipoprotein A1 and apolipoprotein B (APO-B) in patients with CRC undergoing surgery were evaluated. The cut-off values of these factors were determined by the maximal x2 method and were used to classify patients into two prognostic groups: Poor and good prognosis groups. The patients prognostic values were assessed using the Kaplan-Meier curve and Cox regression analysis. In addition, the impact of these parameters on the prognosis and their predictive accuracy were evaluated using nomograms and Harrells concordance index, respectively. In total, 246 patients were included in this evaluation. Based on the cut-off points for TG (1.53 mmol/l in men and 1.58 mmol/l in women) and APO-B (0.73 mmol/l in men and women), the present study determined that both TG and APO-B were predictors of disease-free survival (DFS) and overall survival (OS). Multivariate analysis demonstrated that high TG (men, ≥1.53 mmol/l; women, ≥1.58 mmol/l) and high APO-B (≥0.73 mmol/l) levels were significantly associated with decreased DFS and OS. Nomograms that included values for TG and APO-B levels demonstrated higher predictive accuracy compared with that of nomograms without these values. These results indicated that TG and APO-B levels may be good independent prognostic biomarkers after radical CRC surgery. Therefore, adjusting these parameters to moderate levels may be beneficial.