目的 探讨术前及术后乳酸脱氢酶与白蛋白比值（LDH/albumin ratio，LAR）的动态变化对结肠癌预后的评估价值。 方法 随机选择2013年 01 月至 2016 年 12 月间在江南大学附属医院胃肠外科接受手术治疗的134例结肠癌患者，收集患者临床病理特征，包括性别、年龄、TNM分期等，计算患者手术前及手术后一周以内的LAR值,采用受试者工作特征曲线（receiver operating characteristic curve ROC）确定最佳截断值，利用生存分析中的Kaplan-Meier法绘制生存曲线，log-rank检验进行单因素分析及Cox多因素回归分析法进行多因素分析。结果 根据术前LAR和术后LAR各自的最佳截断值，将134例患者分别分为术前高LAR组和术前低LAR组，术后高LAR组和术后低LAR组。术前高LAR 组、术前低LAR组的患者5 年OS率分别为43%和 85% ，5年PFS率为45%和83%；术后高 LAR 组、术后低 LAR 组的患者5 年OS率分别为 62%和 82%，5年PFS率分别为70%和77%。将术前、术后 LAR 联合分析，134例患者进一步分为 3 个组，分别为LAR1组（术前和术后LAR均高）、LAR2组（术前或术后只有一项LAR高）、LAR3组（术前和术后LAR均低）， 单因素及多因素分析显示，LAR1组、LAR2组、LAR3组患者5 年OS率分别为 33%、78%、85%，差异具有统计学意义（P＜0.01），淋巴结转移与患者OS、PFS显著相关（P＜0.01）；临床分期与患者PFS显著相关（P＜0.01）。结论 联合检测术前LAR和术后LAR动态变化有助于判断结肠癌的预后，术前和术后LAR两者均高是结肠癌患者OS独立的预后不良因素。
Objective: To investigate the value of preoperative and postoperative changes in lactate dehydrogenase to albumin ratio (LDH/albumin ratio, LAR) in assessing the prognosis of colon cancer. Methods: The clinical data of 134 colon cancer patients who underwent gastroenterology surgery at Jiangnan University Hospital from June 2012 to December 2015 were randomly selected. Patients’ clinical pathological characteristics were collected, including gender, age, TNM staging, etc. to calculate the LAR values before and within one week after surgery and to determine the optimal cut-offvalue by using the receiver operating characteristic curve(ROC). Kaplan-meier method of survival analysis was used to draw the survival curve, log-rank test to perform univariate analysis and Cox multivariate regression analysis to conduct multivariate analysis. Results: Median follow-up time was 72 months (2-102 months). According to the optimal cut-off values of preoperative and postoperative LAR, 134 patients were divided into preoperative high-LAR group, preoperative low-LAR group, postoperative high-LAR group and postoperative low-LAR group. The 5-year OS (overall survival) rate was 43% in the preoperative high-LAR group and 85% in the preoperative low-LAR group, and the 5-year PFS rate was respectively 45% and 83%; while the 5-year OS rate was 62% in the postoperative high-LAR group and 82% in the postoperative low LAR group, and the 5-year PFS rate was respectively 70% and 77%. Based on the joint analysis of preoperative and postoperative LAR, 134 patients were further divided into 3 groups: LAR1 group (both preoperative and postoperative high LAR), LAR2 group (either preoperative or postoperative high LAR), and LAR3 group (both preoperative and postoperative low LAR). Univariate and multivariate analysis suggested that the 5-year OS rate of LAR1 group, LAR2 group and LAR3 group was 33%, 78% and 85% respectively with statistically significant differences (P<0.01). Lymph node metastasis was significantly correlated with patients’ OS and PFS (P<0.01) and clinical staging with PFS (P<0.01). Conclusion: Joint detection of dynamic changes of preoperative and postoperative LAR can help determine the prognosis of colon cancer and guide further individualized treatment. Preoperative and postoperative high LAR is an independent factor of poor prognosis for OS in colon cancer patients.