摘要: 目的：探讨术前CRP/ALB、P-CRP与宫颈癌预后的预测价值。方法：选取临沂市肿瘤医院自2015年1月至2019年1月收治的265例行经腹广泛性子宫切除的FIGO 2009 IB1-IIA2期宫颈癌患者的临床病理资料及随访资料。检测术前：CRP与ALB、血小板，计算CRP/ALB、P-CRP值，绘制受试者工作特征(ROC)曲线得到上述指标的最佳cut-off值并根据cut-off值分为相应指标的高水平组、低水平组。比较相应指标的高水平组、低水平组临床病理资料，采用Kaplan-Meier进行相应生存分析。采用COX多因素分析宫颈癌患者预后的相关影响因素。结果：随访最终截止时间为2024年1月，根据纳入患者随访期间生存、死亡情况将患者分为生存组(223例)、死亡组(42例)。ROC结果显示：CRP/ALB预测IB1-IIA2期宫颈癌生存的曲线下面积(AUC)为：0.866 (95%CI: 0.828~0.944, P < 0.05)，最佳临界值为：0.359，灵敏度为78.60%，特异度为：90.1%；P-CRP预测IB1-IIA2期宫颈癌生存的曲线下面积(AUC)为：0.767 (95%CI: 0.686~0.848, P < 0.05)，最佳临界值为：3.386，灵敏度为66.70%，特异度为：74.40%；高CRP/ALB 组IIA期患者比例、淋巴结转移率、浸润深度均高于低CRP/ALB组(
χ2 = 23.302, P < 0.01;
χ2 =12.305, P < 0.01;
χ2 =28.237, P < 0.01)；高CRP/ALB组共死亡33例(78.57%)，低组死亡9例(21.43％)，两组死亡率差异有统计学意义(
χ2 = 101.439, P < 0.01)。高P-CRP组IIA期患者比例、淋巴结转移率、浸润深度均高于低P-CRP组(
χ2 = 8.348, P= 0.004;
χ2 =7.225, P = 0.007;
χ2 = 9.887, P = 0.002)；高P-CRP组共死亡28例(66.67%)，低P-CRP组死亡14例(33.33%)，两组死亡率差异有统计学意义(
χ2 = 27.411, P < 0.01)。Kaplan-Meier生存分析结果显示，高CRP/ALB组患者5年累积生存率低于低CRP/ALB组患者(
χ2 = 125.945, P < 0.01)；高P-CRP组患者５年累积生存率低于低P-CRP组患者(
χ2 = 26.830, P < 0.01)；Cox 多因素分析结果显示，肿瘤分期(OR = 0.375, 95%CI: 0.157~0.895, P = 0.027)、肿瘤分化(OR = 2.393, 95%CI: 1.206~4.748, P = 0.013)、CRP/ALB (OR = 25.380, 95%CI: 9.671~66.610, P < 0.01)、P-CRP (OR = 4.646, 95%CI: 2.444~8.831, P < 0.01)是影响IB-IIA期宫颈癌患者总生存率的独立影响因素。结论：CRP/ALB > 0.359、P-CRP > 3.386是IB1-IIA2期宫颈癌生存的独立危险因子，且CRP/ALB、P-CRP对宫颈癌生存率具有一定的预测价值。术前检测CRP、白蛋白、血小板水平并及时干预对提高生存率具有一定意义。
Abstract: Objective: To investigate the predictive value of preoperative CRP/ALB and P-CRP in the prognosis of cervical cancer. Methods: The clinicopathological data and follow-up data of 265 patients with FIGO 2009 IB1-IIA2 cervical cancer who underwent radical abdominal hysterectomy admitted to Linyi Cancer Hospital from January 2015 to January 2019 were enrolled. Preoperatively, CRP, ALB and platelets were detected, CRP/ALB and P-CRP values were calculated, and the receiver operating characteristic (ROC) curve was drawn to obtain the best cut-off values of the above indexes, and the cut-off values were divided into high-level group and low-level group of corresponding indexes. The clinicopathological data of the high-level group and the low-level group were compared, and Kaplan-Meier was used for survival analysis. COX univariate and multivariate analysis were used to analyze the prognosis of cervical cancer patients. Results: The final cut-off time of follow-up was January 2024, and the patients were divided into survival group (223 cases) and death group (42 cases) according to their survival and death during the follow-up period. The ROC results showed that the area under the curve (AUC) of CRP/ALB for predicting mortality from stage IB1-IIA2 cervical cancer was 0.866 (95%CI: 0.828~0.944, P < 0.05), and the optimal cut-off value was 0.8660.359, the sensitivity was 78.60%, and the specificity was 90.1%. The area under the curve (AUC) of P-CRP for predicting mortality from stage IB1-IIA2 cervical cancer was 0.767 (95%CI: 0.686~0.848, P < 0.05), and the optimal cut-off value was 0.7673.386, the sensitivity was 66.70%, and the specificity was 74.40%. The proportion of stage IIA patients in the high CRP/ALB group, the rate of lymph node metastasis, and the depth of invasion were higher than those in the low CRP/ALB group (χ2 = 23.302, P < 0.01; χ2 =12.305, P < 0.01; χ2 = 28.237, P < 0.01); A total of 33 cases (78.57%) died in the high CRP/ALB group and 9 cases (21.43%) died in the low group, and the difference in mortality between the two groups was statistically significant (χ2 = 101.439, P < 0.01). The proportions of stage IIA patients in the high P-CRP group, the rate of lymph node metastasis and the depth of invasion were higher than those in the low P-CRP group (χ2 = 8.348, P = 0.004; χ2 = 7.225, P = 0.007; χ2 = 9.887, P = 0.002); a total of 28 cases (66.67%) died in the high P-CRP group and 14 cases (33.33%) died in the low P-CRP group, and the difference in mortality between the two groups was statistically significant (χ2 = 27.411, P < 0.01). The results of Kaplan-Meier survival analysis showed that the 5-year cumulative survival rate of patients in the high CRP/ALB group was lower than that in the low CRP/ALB group (χ2 = 125.945, P < 0.01). The results of Kaplan-Meier survival analysis showed that the 5-year cumulative survival rate of patients in the high P-CRP group was lower than that in the low P-CRP group (χ2 = 26.830, P < 0.01). The results of Cox multivariate analysis showed that tumor stage (OR = 0.375, 95%CI: 0.157~0.895, P = 0.027), tumor differentiation (OR = 2.393, 95%CI: 1.206~4.748, P = 0.013), CRP/ALB (OR = 25.380, 95%CI: 9.671~66.610, P < 0.01), P-CRP (OR = 4.646, 95%CI: 2.444~8.831, P < 0.01) were an independent influencing factor affecting the overall survival rate of patients with stage IB-II cervical squamous cell carcinoma. Conclusions: CRP/ALB > 0.359 and P-CRP > 3.386 are independent risk factors for the survival of stage IB1-IIA2 cervical cancer, and CRP/ALB and P-CRP have certain predictive value for the survival rate of cervical cancer. Preoperative detection of CRP, albumin, and platelet levels and timely intervention are of certain significance to improve the survival rate.