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目的探讨应用小野寺营养预后指数(Onodera’s prognostic nutritional index,Onodera’s PNI)评估胃癌患者预后的价值。方法 2000年1月~2014年1月收治的胃癌患者386例,收集患者术前血液检查结果(包括血清白蛋白水平、外周血总淋巴细胞计数),计算每~例患者术前Onodera’s PNI。根据PNI分为营养较好组(201例,PNI≥48)和营养较差组(185例,PNI<48)。分析PNI与临床病理特征、术后并发症及预后的相关性,并通过Cox回归模型筛选影响胃癌患者的预后因素。结果 386例患者术前平均PNI为50.6±5.7。年龄≥65岁者平均PNI为48.5±5.7,<65岁者为51.8±5.4,两组比较差异有统计学意义(P<0.01);pT3/T4期及有淋巴结转移者与pT1/T2期及无淋巴结转移者比较平均PNI均明显降低(P<0.01)。两组患者术后总体并发症发生率分别为6.5%(13/201)和15.6%(29/185),差异有统计学意义(P<0.01)。有并发症组平均PNI值为(49.2±5.4),无并发症组为(51.6±5.3),两组比较差异有统计学意义(P<0.05)。相关分析显示,PNI与患者年龄、肿瘤侵润深度、淋巴结转移状况、术后总体并发症率具有相关性(P<0.05)。营养较好组和营养较差组术后5年总体生存(OS)率及无瘤生存(DFS)率分别为86.2%比52.1%(χ~2=9.28,P<0.01)及83.5%比53.7%(χ~2=9.36,P<0.01)。多因素Cox回归分析证实,营养预后指数是影响胃癌患者预后的独立预测因素(HR=2.16,95%CI:1.57~3.26,P<0.01)。结论小野寺营养预后指数能较好地反映胃癌患者的营养状态、手术风险及预后,是独立于TNM分期的一种胃癌患者长期结果的预测指标,其获得简单方便。
Objective To evaluate the value of Onodera’s prognostic nutritional index (Onodera’s PNI) in assessing the prognosis of patients with gastric cancer. Methods From January 2000 to January 2014, 386 gastric cancer patients were collected. Preoperative blood test results (including serum albumin level and total peripheral blood lymphocyte count) were collected and Onodera’s PNI was calculated for each patient. According to PNI, we divided them into better nutrition group (201 cases, PNI≥48) and poor nutrition group (185 cases, PNI <48). The correlation between PNI and clinical and pathological features, postoperative complications and prognosis was analyzed. The prognostic factors affecting gastric cancer patients were screened by Cox regression model. Results The average preoperative PNI of 386 patients was 50.6 ± 5.7. The average PNI of patients aged 65 or older was 48.5 ± 5.7, and those of patients under 65 years old were 51.8 ± 5.4. There was significant difference between the two groups (P <0.01). The differences of pT3 / T4 and those with lymph node metastasis and pT1 / T2 and The mean PNI of patients without lymph node metastasis was significantly lower (P <0.01). The overall incidence of postoperative complications in both groups was 6.5% (13/201) and 15.6% (29/185), respectively, with significant difference (P <0.01). The average PNI in patients with complications was (49.2 ± 5.4) and in patients without complications was (51.6 ± 5.3), the difference was statistically significant (P <0.05). Correlation analysis showed that there was a correlation between PNI and patient’s age, tumor invasion depth, lymph node metastasis and postoperative overall complication rate (P <0.05). The overall survival (OS) and disease-free survival (DFS) at 5 years after surgery were 86.2%, 52.1% (χ ~ 2 = 9.28, P <0.01) and 83.5% % (χ ~ 2 = 9.36, P <0.01). Multivariate Cox regression analysis confirmed that nutritional prognostic index was an independent predictor of prognosis in patients with gastric cancer (HR = 2.16, 95% CI: 1.57-3.26, P <0.01). Conclusion The nutrition prognosis index of Ono Temple can better reflect the nutritional status, operation risk and prognosis of patients with gastric cancer. It is a predictor of long-term outcome of patients with gastric cancer independent of TNM stage, which is simple and convenient to obtain.