目的 分析血清总蛋白动态变化与胃癌根治术后患者生存之间的相关。 方法 选取 2010 年 1 至 2022 年 12 间在安 徽医科大学第一附属医院接受 D2 根治术治疗的胃或胃食管交界处腺癌患者作为研究对象,记录术后随访的总蛋白水平,并 通过死因比对或电话随访确认患者的生存状态及时间。 采用 K-prototype 算法对患者肿瘤学特征进行聚类分析。 在联合模型 中,纵向子模型选择线性混合模型,生存子模型选择 Cox 比例风险回归模型,探索总蛋白与肿瘤学特征亚组的交互作用,分析 随访期总蛋白变化趋势对生存的影响,并对个体生存概率进行动态预测。 结果 共纳入 601 例患者,中位随访时间 5. 74 年, 438 例随访至死亡,中位生存时间 2. 18 年。 聚类分析揭示了两个肿瘤学特征集群,A 集群患者肿瘤分期较晚,分化程度较 低,更易出现神经侵犯和脉管侵犯。 联合模型提示,肿瘤学特征亚组与瞬时血清总蛋白水平的交互作用是影响术后生存的关 键因素,在 A 亚组中血清总蛋白水平与死亡呈负相关。 结论 胃癌根治术后血清总蛋白水平在特定亚组中和死亡呈负相关,定 期监测总蛋白可能为胃癌术后营养管理和预后干预提供线索。

Objective To investigate the association between the longitudinal dynamics of serum total protein TP and postoperative survival outcomes in patients undergoing radical gastrectomy for gastric cancer. Method Patients with adenocarcinoma of the stomach or gastroesophageal junction who underwent D2 radical surgery between 2010 and 2022 were enrolled. Longitudinally measured TP levels during follow-up were recorded and patient survival status and duration were ascertained via cause-of-death verification or telephone follow-up. Cluster analysis of oncological characteristics was performed using the K-prototype algorithm. In the joint model a linear mixed model was adopted for the longitudinal sub - model and a Cox proportional hazards model was used for the survival sub - model. This joint model aimed to explore the interaction between TP and oncological characteristic subgroups analyze the impact of temporal trends in TP changes during follow-up on survival and dynamically predict individual survival probabilities. Result A total of 601 patients were enrolled with a median follow-up duration of 5. 74 years. Among these 438 patients were followed up until death with a median survival time of 2. 18 years. Cluster analysis revealed two oncological characteristic clusters cluster A was featured by more advanced tumor stages poorer differentiation and an increased risk of neural and vascular invasion. The joint model demonstrated that the interaction between oncological characteristic subgroups and time - varying TP levels represents a critical determinant of postoperative survival. Notably a negative association was observed between TP levels and mortality in cluster A. Conclusion Serum TP levels following radical gastrectomy for gastric cancer exhibit a subgroup - specific negative association with mortality. Regular monitoring of TP may offer valuable insights for optimizing nutritional support and prognostic management.