胰腺癌根治术后患者脂蛋白(a)升高的预后意义

Prognostic Significance of Elevated Lipoprotein (a) in Patients with Pancreatic Cancer after Radical Surgery

摘要: 目的：本研究旨在评估脂蛋白(a) [Lp(a)]水平对胰腺癌根治术后患者总生存期(OS)的预后意义。方法：对215例胰腺癌根治术后患者进行回顾性分析。通过X-tile确定Lp(a)的最佳临界值，随后将患者分为高低两组。本研究采用倾向得分匹配(PSM)分析来减少选择偏倚的影响。本研究通过Kaplan-Meier方法和log-rank检验来比较两组总生存期(OS)的差异。进行单因素和多因素Cox回归分析，以确定患者OS的独立危险因素。结果：Lp(a)最佳截断值为30 mg/L。PSM前两组在肿瘤位置、甘油三酯水平、高密度脂蛋白水平、游离脂肪酸水平有显著差异(P < 0.05)。PSM后，上述指标间均无统计学差异，两组间均衡可比。高Lp(a)水平患者的OS明显短于低Lp(a)水平患者(P = 0.014)。多因素Cox回归分析显示，Lp(a)水平升高是胰腺癌根治术后患者较差OS的独立危险因素[HR = 3.13 (1.52~6.44), P = 0.002]。结论：测定Lp(a)水平对于评估胰腺癌根治术后患者的OS至关重要。测量胰腺癌患者的Lp(a)水平可被视为诊断或监测的一部分，以预测其预后并为治疗计划提供信息。

Abstract: Objective: This study was conducted to evaluate the prognostic significance of lipoprotein (a) [Lp(a)] levels for overall survival (OS) in patients with pancreatic cancer after radical surgery. Methods: 215 patients with pancreatic cancer after radical surgery were retrospectively analyzed. The optimal threshold for Lp(a) was determined by X-tile and patients were subsequently divided into high and low groups. In this study, propensity score matching (PSM) analysis was used to reduce the influence of selection bias. Kaplan-Meier method and log-rank test were used to compare the differences in OS between the two groups. Univariate and multivariate Cox regression analyses were performed to identify independent risk factors for OS in patients. Results: The optimal truncation value of Lp(a) was 30 mg/L. There were significant differences in tumor location, triglyceride level, high density lipoprotein level and free fatty acid level between the two groups before PSM (P < 0.05). After PSM, there was no statistical difference between the above indicators, and the balance between the two groups was comparable. Patients with high Lp(a) level had significantly shorter OS than those with low Lp(a) level (P = 0.014). Multivariate Cox regression analysis showed that increased Lp(a) level was an independent risk factor for poor OS in patients after radical pancreatic cancer surgery [HR = 3.13 (1.52~6.44), P = 0.002]. Conclusion: The determination of Lp(a) level is important for the evaluation of OS in patients with pancreatic cancer after radical surgery. Measuring Lp(a) levels in patients with pancreatic cancer may be considered as part of diagnosis or monitoring to predict their prognosis and inform treatment plans.