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结直肠癌是世界范围内常见的消化道恶性肿瘤,其发病率位于男性肿瘤的第三位,女性肿瘤的第二位。近年来随着诊治技术迅速发展,其5年生存率已经得到了很大提高[1-2]。但由于肿瘤的复发及化疗等原因,其临床疗效尚不能令人满意。因此,临床上仍然迫切需要寻求临床和生物标记物来提高结直肠癌病人的诊治效果。预后营养指数(prognostic nutritional index,PNI)是使用血清白蛋白和淋巴细胞的绝对值计算而来,最初用于评价外科病人的营养状态。近年来有研究表明PNI与肿瘤的发生发展有着密切的关系[3-4]。体质量指数(body mass index,BMI)是评价肥胖的可靠指标。最近国外有研究[5]表明BMI与食管癌的预后有关。然而目前国内外尚无研究使用PNI和BMI建立联合预测模型来评估结直肠癌病人术后预后。因此,该研究探讨PNI和BMI与病人预后关系,并评估二者的联合预测价值是否优于单独预测价值。现作报道。
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根据病人术后5年生存结局使用ROC曲线选取敏感性和特异性均较高的PNI值为截断值,PNI的截断值为47.5(约登指数为1.133)(见图 1)。47例高PNI组5年生存率40.4%高于69例低PNI组的5年生存率21.7%(χ2=4.712,P<0.05)(见图 2)。BMI>18.5 kg/m2病人53例,5年生存率43.4%,BMI≤18.5 kg/m2病人63例,5年生存率15.9%。高BMI组5年生存率高于比低BMI组的5年生存率(χ2=10.71,P<0.01)(见图 3)。
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Kaplan-Meier法分析结果提示,PNI和BMI影响结直肠癌预后。高PNI组中位生存时间为46.00个月(95% CI:32.94~59.06),大于低PNI组中位生存时间39.00个月(95% CI:32.99~45.01)(χ2=5.72,P<0.05)(见图 2)。高BMI组中位生存时间为52.00个月(95% CI:32.09~71.09.00),高于低BMI组平均生存时间36.00 d(95% CI:29.26~49.74)(χ2=8.01,P<0.01)(见图 3)。将病人性别、年龄、肿瘤位置、肿瘤分化程度、浸润深度、淋巴结转移、远处转移、临床分期、PNI和BMI进行单因素多重变量的Cox等比例风险模型分析,结果表明肿瘤分化、浸润深度、淋巴结转移、远处转移、临床分期、PNI和BMI对病人预后有意义(P<0.05~P<0.01)。将单因素分析有意义的变量纳入多因素分析,结果表明肿瘤分化、远处转移、临床分期、PNI、BMI等与病人预后有关系(P<0.05),其中低PNI病人死亡风险是高PNI病人死亡风险的1.752倍(95%CI:1.131~2.713)(P<0.05),低BMI病人死亡风险是高病人死亡风险的1.620倍(95%CI:1.052~2.495)(P<0.05)(见表 1)。
自变量 单因素分析结果 多因素分析结果 HR 95% CI χ2 P HR 95% CI χ2 P 年龄 1.144 0.762~1.716 0.42 >0.05 — — — — 性别 1.192 0.796~1.783 0.73 >0.05 — — — — 肿瘤位置 1.231 0.946~1.601 2.41 >0.05 — — — — 分化程度 0.428 0.259~0.705 12.72 <0.01 0.575 0.335~0.989 3.99 <0.05 浸润深度 1.343 1.086~1.661 7.76 <0.01 — — — — 淋巴结转移 1.280 1.001~1.635 3.36 <0.05 — — — — 远处转移 57.166 5.184~630.661 5.71 <0.01 21.015 1.827~241.723 5.97 <0.05 临床分期 1.605 1.243~2.072 13.55 <0.01 1.349 1.025~1.776 4.55 <0.05 脉管侵犯 0.750 0.467~1.206 1.34 >0.05 — — — — 神经侵犯 0.629 0.370~1.070 2.66 >0.05 — — — — PNI 1.648 1.075~2.526 5.49 <0.05 1.752 1.131~2.713 6.32 <0.05 BMI 1.774 1.173~2.684 7.56 <0.01 1.620 1.052~2.495 4.79 <0.05 表 1 结直肠癌病人单因素和多因素生存分析
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PNI和BMI联合预测价值D组与第A、B、C组比较,均具有较低的1、3、5年生存率(P<0.01)(见表 2)。低PNI且低BMI病人预示着更差的预后,因此PNI和BMI联合预测结直肠癌预后相较于单独作用更加精确(见图 4)。
分组 n 1年生存 3年生存 5年生存 A组 19 19(100.0) 14(73.7) 9 (47.4) B组 28 27(96.4) 18(64.3) 8(28.3) C组 34 34(100.0) 23(67.6) 13(38.2) D组 35 28(80.0)** △△## 15(42.9)**△△## 0(0.0)**△△## 合计 116 109(94.0) 70(60.3) 30(25.9) χ2 — 13.37 6.83 19.62 P — 0.003 0.078 <0.01 χ2分割检验:与A组比较**P<0.01;与B组比较△△P<0.01;与C组比较##P<0.01 表 2 4组病人生存情况的比较[n; 百分率(%)]
术前营养预后指数和体质量指数与结直肠癌病人预后关系的研究
Study on the correlations of the PNI and BMI with prognosis in patients with colorectal cancer
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摘要:
目的探讨术前营养预后指数(PNI)和体质量指数(BMI)与结直肠癌病人术后预后的关系。 方法选取接受结直肠癌根治术的病人116例,使用受试者工作特征曲线曲线得出PNI的截断值。使用Kaplan-Meier法绘制术后生存曲线,Cox回归模型分析影响术后生存的独立影响因素。 结果PNI的截断值为47.5,高PNI组5年生存率36.2%高于低PNI组的18.8%(P < 0.05);单因素分析表明肿瘤分化程度、浸润深度、淋巴结转移、远处转移、临床分期、PNI、BMI与病人预后相关(P < 0.05~P < 0.01)。Cox多因素分析结果表明分化程度、远处转移、临床分期、PNI和BMI是结直肠癌根治术后病人预后的独立影响因素(P < 0.05)。PNI与BMI联合预测病人预后价值高于其单独预测价值。 结论PNI与BMI是结直肠癌病人术后预后的独立影响因素,使用PNI与BMI联合评估病人预后能够提高准确性。 Abstract:ObjectiveTo explore the correlations of the prognostic nutritional index(PNI) and body mass index(BMI) with prognosis in patients with colorectal cancer. MethodsThe clinicopathological data of 116 colorectal cancer patients treated with radical colectomy were retrospectively analyzed.The receiver operating characteristic curve was used to determine the cut-off value of PNI, the survival curve was plotted using the Kaplan-Meier method, and the cox regression model was used to analyze the independent factor affecting postoperative. ResultsThe cut-off value of PNI was 47.5.The 5-year survival rate in high P survival NI group(36.2%) was higher than that in low PNI group(18.8%)(P < 0.05).The results of univariate analysis showed that the tumor differentiation, invasion depth, lymph node metastasis, distant metastasis, clinical staging, PNI and BMI were correlation with prognosis of patients(P < 0.05 to P < 0.01).The results of Cox multi-factor analysis showed that the tumor differentiation, distant metastasis, clinical staging, PNI and BMI were the independent factor affecting prognosis of patients(P < 0.05).The value of PNI combined with BMI in predicting the prognosis of patients was higher than that of PNI or BMI(P < 0.05). ConclusionsPNI and BMI are the independent factors affecting prognosis of patients with colorectal cancer, and the combination of PNI with BMI can improve the accuracy in evaluating prognosis of patients. -
Key words:
- colorectal cancer /
- prognostic nutritional index /
- body mass index
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表 1 结直肠癌病人单因素和多因素生存分析
自变量 单因素分析结果 多因素分析结果 HR 95% CI χ2 P HR 95% CI χ2 P 年龄 1.144 0.762~1.716 0.42 >0.05 — — — — 性别 1.192 0.796~1.783 0.73 >0.05 — — — — 肿瘤位置 1.231 0.946~1.601 2.41 >0.05 — — — — 分化程度 0.428 0.259~0.705 12.72 <0.01 0.575 0.335~0.989 3.99 <0.05 浸润深度 1.343 1.086~1.661 7.76 <0.01 — — — — 淋巴结转移 1.280 1.001~1.635 3.36 <0.05 — — — — 远处转移 57.166 5.184~630.661 5.71 <0.01 21.015 1.827~241.723 5.97 <0.05 临床分期 1.605 1.243~2.072 13.55 <0.01 1.349 1.025~1.776 4.55 <0.05 脉管侵犯 0.750 0.467~1.206 1.34 >0.05 — — — — 神经侵犯 0.629 0.370~1.070 2.66 >0.05 — — — — PNI 1.648 1.075~2.526 5.49 <0.05 1.752 1.131~2.713 6.32 <0.05 BMI 1.774 1.173~2.684 7.56 <0.01 1.620 1.052~2.495 4.79 <0.05 表 2 4组病人生存情况的比较[n; 百分率(%)]
分组 n 1年生存 3年生存 5年生存 A组 19 19(100.0) 14(73.7) 9 (47.4) B组 28 27(96.4) 18(64.3) 8(28.3) C组 34 34(100.0) 23(67.6) 13(38.2) D组 35 28(80.0)** △△## 15(42.9)**△△## 0(0.0)**△△## 合计 116 109(94.0) 70(60.3) 30(25.9) χ2 — 13.37 6.83 19.62 P — 0.003 0.078 <0.01 χ2分割检验:与A组比较**P<0.01;与B组比较△△P<0.01;与C组比较##P<0.01 -
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