预后营养指数评估局部进展期结直肠癌预后的价值
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摘要
目的:探讨预后营养指数(PNI)对局部进展期结直肠癌者预后的评估价值。方法:收集400例2013年1月～2018年4月行结直肠癌根治术并经病理确诊为Ⅱ～Ⅲ期结直肠癌患者临床资料,所有入组患者从手术结束随访至失访、或死亡;计算PNI指数,使用分类变量(χ~2),单向ANOVA(正态分布)或Kruskal-Wallis H(偏斜分布)分析不同PNI组(低值、中值、高值组)之间基线特征的分布差异;使用单变量和广义Cox回归模型评估暴露因素与结果的相关性,使用Cox比例风险回归模型分析PNI对局部进展期结直肠癌预后价值。结果:Cox回归单变量及多变量模型分析发现,PNI与局部进展期结直肠癌并行结直肠癌根治切除术的死亡率无关(OR=0. 88,95%CI为0. 78～1. 00);线性回归模型分析发现PNI与结直肠癌患者死亡为非线性相关,当PNI≤41. 35时,PNI每增加一个单位,患者死亡的风险降低68%;当PNI> 41. 35,即使PNI再增加,也无法进一步降低患者死亡率; PNI中值组累积总生存率显著高于PNI低值组(P=0. 028),在一定范围内(PNI为26～41),PNI是死亡风险的独立保护因素。结论:PNI值具有一定预测局部进展期结直肠癌根治性切除术后预后的价值,PNI在26～41范围是进展期结直肠癌根治性切除术后死亡风险的独立保护因素。
Objective: To investigate the value of prognostic nutritional index( PNI) in predicting prognosis in patients with locally advanced colorectal cancer. Methods: The clinical information of400 patients with colorectal cancer who underwent radical resection of colorectal cancer from January2013 to April 2018 and were pathologically diagnosed as Ⅱ ～ Ⅲ stage colorectal cancer were collected. All patients in the group were followed up from the end of the operation to the loss of follow-up or death. The PNI index was calculated and the distribution differences of baseline characteristics between different PNI groups( low value,median value and high value group) were analyzed by using categorical variables( χ~2),one-way ANOVA( normal distribution) or Kruskal-Wallis H( skew distribution).Univariate and generalized Cox regression models were used to assess the association between exposure factors and outcomes. In addition,Cox proportional hazard regression model was used to analyze the prognostic value of PNI in locally advanced colorectal cancer. Results: Univariate and multivariate Cox regression analysis showed that PNI was not associated with mortality in locally progressive colorectal cancer patients undergoing radical resection of colorectal cancer( OR = 0. 88,95% CI,0. 78 ～ 1. 00).Linear regression model analysis found that the correlation between PNI and colorectal cancer patients was non-linear. When PNI was no more than 41. 35,the risk of death was reduced by 68% for each additional unit of PNI. However,when it exceeded 41. 35,even if the PNI increased again,the mortality rate could not be further reduced. The cumulative overall survival rate of the PNI median group was significantly higher than that of the PNI low value group( P = 0. 028). Within a certain range( PNI =26 ～ 41),PNI),PNI was an independent protective factor for the risk of death. Conclusions: PNI values have a certain predictive value for prognosis in patients with locally advanced colorectal cancer after radical resection. Within a certain range( PNI = 26 ～ 41),PNI is an independent protective factor for death risk after radical resection of advanced colorectal cancer.
Objective: To investigate the value of prognostic nutritional index( PNI) in predicting prognosis in patients with locally advanced colorectal cancer. Methods: The clinical information of400 patients with colorectal cancer who underwent radical resection of colorectal cancer from January2013 to April 2018 and were pathologically diagnosed as Ⅱ ～ Ⅲ stage colorectal cancer were collected. All patients in the group were followed up from the end of the operation to the loss of follow-up or death. The PNI index was calculated and the distribution differences of baseline characteristics between different PNI groups( low value,median value and high value group) were analyzed by using categorical variables( χ~2),one-way ANOVA( normal distribution) or Kruskal-Wallis H( skew distribution).Univariate and generalized Cox regression models were used to assess the association between exposure factors and outcomes. In addition,Cox proportional hazard regression model was used to analyze the prognostic value of PNI in locally advanced colorectal cancer. Results: Univariate and multivariate Cox regression analysis showed that PNI was not associated with mortality in locally progressive colorectal cancer patients undergoing radical resection of colorectal cancer( OR = 0. 88,95% CI,0. 78 ～ 1. 00).Linear regression model analysis found that the correlation between PNI and colorectal cancer patients was non-linear. When PNI was no more than 41. 35,the risk of death was reduced by 68% for each additional unit of PNI. However,when it exceeded 41. 35,even if the PNI increased again,the mortality rate could not be further reduced. The cumulative overall survival rate of the PNI median group was significantly higher than that of the PNI low value group( P = 0. 028). Within a certain range( PNI =26 ～ 41),PNI),PNI was an independent protective factor for the risk of death. Conclusions: PNI values have a certain predictive value for prognosis in patients with locally advanced colorectal cancer after radical resection. Within a certain range( PNI = 26 ～ 41),PNI is an independent protective factor for death risk after radical resection of advanced colorectal cancer.
引文
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[13]杜艳平,李玲玲,贺青,等.胃肠道肿瘤患者的营养风险筛查及营养状况评价[J].中华胃肠外科杂志,2012,15(5):460-463.
[14]MOHRI Y,INOUE Y,TANAKA K,et al. Prognostic nutritional index predicts postoperative outcome in colorectal cancer[J]. World J Surg,2013,37(11):2688-2692.
[15]曹祥龙,赵刚,余涛,等.预后营养指数在结直肠癌预后评估中的应用[J].中华结直肠疾病电子杂志,2015,4(3):266-271.
[16]SHIBUTANI M,MAEDA K,NAGAHARA H,et al. The prognostic significance of the postoperative prognostic nutritional index in patients with colorectal cancer[J]. BMC Cancer,2015,15(1):1-10.
[2]CHAN A W,CHAN S L,WONG G L,et al. Prognostic Nutritional Index(PNI)predicts tumor recurrence of very Early/Early stage hepatocellular carcinoma after surgical resection[J]. Ann Surg Onco,2015,22(13):4138-4148.
[3]ZHAO P,MA J,QIN S Z,et al. China cancer clinical yearbook[J]. Chinese Journal of Frontier Medicine,2017,9(5):153-160.
[4]SUN K Y,HE Y L. Progress in research on prognosis nutritional index of patients with gastrointestinal malignant cancer[J]. J Dig Oncol,2015,7:112-114.
[5]GUO J Y,FANG L J,GUO J Y. Correlation analysis between prognostic nutritional index and clinical features and prognosis of resectable gastric cancer[J]. Chin J Clin Oncol,2015,42(2):100-104.
[6]ONODERA T,GOSEKI N,KOSAKI G. Prognostic nutritional index in gastrointestinal surgery of malnourished cancer patients[J]. Nihon Geka Gakkai Zasshi,1984,85(9):1001-1005.
[7]CAO X L,ZHAO G,YU T,et al. Application of prognostic nutritional index in prognostic evaluation of colorectal cancer[J]. Chin J Colorectal Dis,2015,4:266-271.
[8]YANG Y C,GAO P,CHEN X W,et al. Prognostic significance of preoperative prognostic nutritional index in colorectal cancer:results from a retrospective cohort study and a meta-analysis[J]. Oncotarget,2016,36:58544-58552.
[9]VANDENBROUCKE J P,VON ELM E,ALTMAN D G,et al. Strengthening the reporting of observational studies in epidemiology(STROBE):explanation and elaboration[J]. PLo S Med,2007,4:297.
[10]HEINZL H,KAIDER A. Gaining more flexibility in Cox proportional hazards regression models with cubic spline functions[J]. Computer Methods&Programs In Biomedicine,1997,54(3):201-208.
[11]LIU S,WANG X,LU Y,et al. The effects of intraoperative cryoprecipitate transfusion on acute renal failure following orthotropic liver transplantation[J]. Hepatol Int,2013,7:901-909.
[12]蒋志强,韩广森,张健,等.淋巴细胞总数水平对直肠癌根治术后患者的临床意义及长期预后的影响[J].中华结直肠疾病电子杂志,2016,5(3):228-232.
[13]杜艳平,李玲玲,贺青,等.胃肠道肿瘤患者的营养风险筛查及营养状况评价[J].中华胃肠外科杂志,2012,15(5):460-463.
[14]MOHRI Y,INOUE Y,TANAKA K,et al. Prognostic nutritional index predicts postoperative outcome in colorectal cancer[J]. World J Surg,2013,37(11):2688-2692.
[15]曹祥龙,赵刚,余涛,等.预后营养指数在结直肠癌预后评估中的应用[J].中华结直肠疾病电子杂志,2015,4(3):266-271.
[16]SHIBUTANI M,MAEDA K,NAGAHARA H,et al. The prognostic significance of the postoperative prognostic nutritional index in patients with colorectal cancer[J]. BMC Cancer,2015,15(1):1-10.
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