动态观察预后营养指数对局部进展期食管鳞癌放化疗患者预后评估的价值
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摘要
目的探讨动态观察预后营养指数(PNI)在局部进展期食管鳞癌同步放化疗患者预后评估中的临床意义。方法收集2012年4月至2016年3月81例局部进展期食管鳞癌同步放化疗患者的病历资料,包括性别、年龄、BMI、肿瘤位置、分化程度、TNM分期、治疗前PNI(PNI1)和治疗后PNI(PNI2)。采用RECIST 1. 1版标准评价近期疗效;生存分析采用Kap-lan Meier法并行Log-rank检验;采用Cox风险比例回归模型分析影响预后的因素。结果 81例患者均可评价疗效,获CR 24例、PR 47例、SD 10例。全组患者中位无进展生存时间(PFS)为22. 71个月(13. 80～45. 15个月),中位总生存时间(OS)为27. 47个月(17. 66～57. 02个月)。单因素分析显示,肿瘤位置胸下段、TNM分期Ⅳ期、PNI1≤45和PNI2≤45与患者较短的PFS、OS有关(P <0. 05)。多因素Cox风险比例回归模型分析显示,Ⅳ期和PNI1≤45是影响PFS、OS的独立危险因素。PNI均> 45、治疗前后PNI变化不一致和PNI均≤45组患者的PFS和OS差异均有统计学意义(P <0. 05),PNI均> 45患者的PFS和OS最佳。治疗前后PNI变化不一致患者中,PNI2好转组与恶化组的PFS和OS差异均无统计学意义(P> 0. 05)。结论PNI是个简单、方便、有效的营养-免疫指标,临床上可用于预测肿瘤治疗疗效。动态观察治疗前后的PNI或许能更好地预测局部进展期食管鳞癌放化疗的远期疗效。
Objective To investigate the clinical significance of dynamic prognostic nutrition index( PNI) in evaluating the prognosis of patients with locally advanced esophageal squamous cell carcinoma after concurrent radiotherapy and chemotherapy. Methods Data of 81 patients with locally advanced esophageal squamous cell carcinoma treated with concurrent radiotherapy and chemotherapy from April 2012 to March 2016 were collected,including gender,age,BMI,tumor location,differentiation,TNM stage,pretreatment PNI( PNI1) and post-treatment PNI( PNI2). RECIST 1. 1 standard was used to evaluate the short-term efficacy,and Kaplan Meier method and Log-rank test were used for survival analysis. Cox proportional-hazards regression model was used to analyze the factors affecting the prognosis. Results The short-term efficacy was evaluated in all 81 patients,including 24 cases of CR,47 cases of PR and 10 cases of SD. The median progression free survival( PFS) was 22. 71 months( 13. 80-45. 15 months) and the median overall survival( OS) was 27. 47 months( 17. 66-57. 02 months). Univariate analysis showed that lower thoracic segment,stage Ⅳ,PNI1≤45 and PNI2≤45 were associated with short PFS and OS. Multivariate Cox proportional-hazards regression model analysis showed that stage Ⅳ and PNI1≤45 were independent risk factors for PFS and OS. There were significant differences in PFS and OS among groups with PNI > 45,inconsistent changes of PNI before and after treatment and those with PNI≤45( P < 0. 05). PFS and OS in PNI > 45 group were the best. The patients with inconsistent of PNI were divided into two groups: the PNI2 improvement group and the PNI2 deterioration group. There was no significant difference in PFS and OS between the two groups( P > 0. 05). Conclusion PNI is a simple,convenient and effective nutrition-immunity index,which can be used to predict the therapeutic effect of cancer in clinic. Dynamic observation of PNI before and after treatment may better predict the long-term efficacy of radiotherapy and chemotherapy for locally advanced esophageal squamous cell carcinoma.
Objective To investigate the clinical significance of dynamic prognostic nutrition index( PNI) in evaluating the prognosis of patients with locally advanced esophageal squamous cell carcinoma after concurrent radiotherapy and chemotherapy. Methods Data of 81 patients with locally advanced esophageal squamous cell carcinoma treated with concurrent radiotherapy and chemotherapy from April 2012 to March 2016 were collected,including gender,age,BMI,tumor location,differentiation,TNM stage,pretreatment PNI( PNI1) and post-treatment PNI( PNI2). RECIST 1. 1 standard was used to evaluate the short-term efficacy,and Kaplan Meier method and Log-rank test were used for survival analysis. Cox proportional-hazards regression model was used to analyze the factors affecting the prognosis. Results The short-term efficacy was evaluated in all 81 patients,including 24 cases of CR,47 cases of PR and 10 cases of SD. The median progression free survival( PFS) was 22. 71 months( 13. 80-45. 15 months) and the median overall survival( OS) was 27. 47 months( 17. 66-57. 02 months). Univariate analysis showed that lower thoracic segment,stage Ⅳ,PNI1≤45 and PNI2≤45 were associated with short PFS and OS. Multivariate Cox proportional-hazards regression model analysis showed that stage Ⅳ and PNI1≤45 were independent risk factors for PFS and OS. There were significant differences in PFS and OS among groups with PNI > 45,inconsistent changes of PNI before and after treatment and those with PNI≤45( P < 0. 05). PFS and OS in PNI > 45 group were the best. The patients with inconsistent of PNI were divided into two groups: the PNI2 improvement group and the PNI2 deterioration group. There was no significant difference in PFS and OS between the two groups( P > 0. 05). Conclusion PNI is a simple,convenient and effective nutrition-immunity index,which can be used to predict the therapeutic effect of cancer in clinic. Dynamic observation of PNI before and after treatment may better predict the long-term efficacy of radiotherapy and chemotherapy for locally advanced esophageal squamous cell carcinoma.
引文
[1] Yang Y,Gao P,Song Y,et al. The prognostic nutritional indexis a predictive indictor of prognosis and postoperative complica-tions in gastric cancer:A meta-analysis[J]. Eur J Surg Oncol,2016,42(8):1176-1182.
[2] Zhao Y,Xu P,Kang H,et al. Prognostic nutritional index as aprognostic biomarker for survival in digestive system carcinomas[J]. Oncotarget,2016,7(52):86573-86583.
[3]孙开宇,何裕隆.胃肠道恶性肿瘤患者预后营养指数的研究进展[J].消化肿瘤杂志(电子版),2015,7(2):112-114.
[4] Mantzorou M,Koutelidais A,Theocharis S,et al. Clinical valueof nutritional status in cancer:what is its impact and how it af-fects disease progression and prognosis?[J]. Nutr Cancer,2017,69(8):1151-1176.
[5] Zheng J,Seier K,Gonen M,et al. Utility of serum inflammatorymarkers for predicting microvascular invasion and survival for pa-tients with hepatocellular carcinoma[J]. Ann Surg Oncol,2017,24(12):3706-3714.
[6] Zhang W,Liu K,Liang W,et al. Pretreatment C-reactive pro-tein/albumin ratio is associated with poor survival in patients withstage IB-ⅡA cervical cancer[J]. Cancer Med,2018,7(1):105-113.
[7] Cui J,Chen S,Bo Q,et al. Preoperative prognostic nutritionalindex and nomogrampredicting recurrence-free survival in patientswith primary non-muscle-invasive bladder cancer without carcino-ma in situ[J]. Onco Targets Ther,2017,10:5541-5550.
[8] Shimakawa T,Asaka S,Sagawa M,et al. Nutritional screeningbefore surgery for esophageal cancer:current status and evalua-tion results[J]. Gan To Kagaku Ryoho,2014,41(10):1301-1303.
[9] Buzby GP,Mullen JL,Matthews DC,et al. Prognostic nutrition-al index in gastrointestinal surgery[J]. Am J Surg,1980,139(1):160-167.
[10] Matsumoto H,Okamoto Y,Kawai A,et al. Prognosis predictionfor postoperative esophageal cancer patients using Onodera's prog-nostic nutritional index[J]. Nutr cancer,2017,69(6):849-854.
[11] Feng JF,Chen QX. Significance of the prognostic nutritional in-dex in patients with esophageal squamous cell carcinoma[J]. T-her Clin Risk Manag,2014,10:1-7.
[12] Filip B,Scarpa M,Cavallin,F,et al. Postoperative outcome af-ter oesophagectomy for cancer:nutritional status is the missingring in the current prognostic scores[J]. Eur J Surg Oncol,2015,41(6):787-794.
[13] Ikeguchi M,Kouno Y,Kihara K,et al. Evaluation of prognosticmarkers for patients with curatively resected thoracic esophagealsquamous cell carcinomas[J]. Mol Clin Oncol,2016,5(6):767-772.
[14] Miyazaki T,Sakai M,Sohda M,et al. Prognostic significance ofinflammatory and nutritional parameters in patients with esopha-geal cancer[J]. Anticancer Res,2016,36(12):6557-6562.
[15] Nakatani M,Migita K,Matsumoto S,et al. Prognostic signifi-cance of the prognostic nutritional index in esophageal cancer pa-tients undergoing neoadjuvant chemotherapy[J]. Dis Esophagus,2017,30(8):1-7.
[16] Yamamoto J,Hayashi T,Izuisawa Y,et al. Clinical experienceof nutritional support in patients treated with chemoradiotherapyfor locally advanced esophageal cancer[J]. Gan To Kagaku Ryo-ho,2015,42(10):1246-1248.
[17] Migita K,Takayama T,Saeki K,et al. The prognostic nutrition-al index predists long-term outcomes of gastric cancer patients in-dependent of tumor stage[J]. Ann Surg Oncol,2013,20(8):2647-2654.
[18] Murakami Y,Saito H,Kono Y,et al. Combined analysis of thepreoperative and postoperative prognostic nutritional index offers aprecise predictor of the prognosis of patients with gastric cancer[J]. Surg Today,2018,48(4):395-403.
[19] Kang M,Chang CT,Sung HH,et al. Prognostic significance ofpre-to postoperative dynamics of the prognostic nutritional indexfor patients with renal cell carcinoma who underwent radical ne-phrectomy[J]. Ann Surg Oncol,2017,24(13):4067-4075.
[2] Zhao Y,Xu P,Kang H,et al. Prognostic nutritional index as aprognostic biomarker for survival in digestive system carcinomas[J]. Oncotarget,2016,7(52):86573-86583.
[3]孙开宇,何裕隆.胃肠道恶性肿瘤患者预后营养指数的研究进展[J].消化肿瘤杂志(电子版),2015,7(2):112-114.
[4] Mantzorou M,Koutelidais A,Theocharis S,et al. Clinical valueof nutritional status in cancer:what is its impact and how it af-fects disease progression and prognosis?[J]. Nutr Cancer,2017,69(8):1151-1176.
[5] Zheng J,Seier K,Gonen M,et al. Utility of serum inflammatorymarkers for predicting microvascular invasion and survival for pa-tients with hepatocellular carcinoma[J]. Ann Surg Oncol,2017,24(12):3706-3714.
[6] Zhang W,Liu K,Liang W,et al. Pretreatment C-reactive pro-tein/albumin ratio is associated with poor survival in patients withstage IB-ⅡA cervical cancer[J]. Cancer Med,2018,7(1):105-113.
[7] Cui J,Chen S,Bo Q,et al. Preoperative prognostic nutritionalindex and nomogrampredicting recurrence-free survival in patientswith primary non-muscle-invasive bladder cancer without carcino-ma in situ[J]. Onco Targets Ther,2017,10:5541-5550.
[8] Shimakawa T,Asaka S,Sagawa M,et al. Nutritional screeningbefore surgery for esophageal cancer:current status and evalua-tion results[J]. Gan To Kagaku Ryoho,2014,41(10):1301-1303.
[9] Buzby GP,Mullen JL,Matthews DC,et al. Prognostic nutrition-al index in gastrointestinal surgery[J]. Am J Surg,1980,139(1):160-167.
[10] Matsumoto H,Okamoto Y,Kawai A,et al. Prognosis predictionfor postoperative esophageal cancer patients using Onodera's prog-nostic nutritional index[J]. Nutr cancer,2017,69(6):849-854.
[11] Feng JF,Chen QX. Significance of the prognostic nutritional in-dex in patients with esophageal squamous cell carcinoma[J]. T-her Clin Risk Manag,2014,10:1-7.
[12] Filip B,Scarpa M,Cavallin,F,et al. Postoperative outcome af-ter oesophagectomy for cancer:nutritional status is the missingring in the current prognostic scores[J]. Eur J Surg Oncol,2015,41(6):787-794.
[13] Ikeguchi M,Kouno Y,Kihara K,et al. Evaluation of prognosticmarkers for patients with curatively resected thoracic esophagealsquamous cell carcinomas[J]. Mol Clin Oncol,2016,5(6):767-772.
[14] Miyazaki T,Sakai M,Sohda M,et al. Prognostic significance ofinflammatory and nutritional parameters in patients with esopha-geal cancer[J]. Anticancer Res,2016,36(12):6557-6562.
[15] Nakatani M,Migita K,Matsumoto S,et al. Prognostic signifi-cance of the prognostic nutritional index in esophageal cancer pa-tients undergoing neoadjuvant chemotherapy[J]. Dis Esophagus,2017,30(8):1-7.
[16] Yamamoto J,Hayashi T,Izuisawa Y,et al. Clinical experienceof nutritional support in patients treated with chemoradiotherapyfor locally advanced esophageal cancer[J]. Gan To Kagaku Ryo-ho,2015,42(10):1246-1248.
[17] Migita K,Takayama T,Saeki K,et al. The prognostic nutrition-al index predists long-term outcomes of gastric cancer patients in-dependent of tumor stage[J]. Ann Surg Oncol,2013,20(8):2647-2654.
[18] Murakami Y,Saito H,Kono Y,et al. Combined analysis of thepreoperative and postoperative prognostic nutritional index offers aprecise predictor of the prognosis of patients with gastric cancer[J]. Surg Today,2018,48(4):395-403.
[19] Kang M,Chang CT,Sung HH,et al. Prognostic significance ofpre-to postoperative dynamics of the prognostic nutritional indexfor patients with renal cell carcinoma who underwent radical ne-phrectomy[J]. Ann Surg Oncol,2017,24(13):4067-4075.
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