放化疗前预后营养指数、体质指数及N分期在鼻咽癌患者预后预测中的应用价值探索

Prognostic value of nutritional index body mass index and N stage before chemoradiotherapy in prognostic prediction of nasopharyngeal carcinoma patients

目的探讨放疗前预后营养指数(PNI)、体质指数(BMI)及N分期在鼻咽癌放化疗患者临床结局预测中的价值。方法选取2010年1月至2015年12月于成都医学院第二附属医院·核工业四一六医院行放化疗的鼻咽癌患者128例,回顾性分析其一般信息、治疗方案、实验室检查、病理及影像学资料,随访临床结局至2021年12月20日,分析鼻咽癌患者预后的影响因素。结果中位数为69.5个月的随访期内患者死亡率为21.88%,128例患者3年和5年生存率分别为94.53%和80.47%。受试者操作特征(ROC)曲线发现:白蛋白(ALB)、淋巴细胞计数(LYM)、PNI、白细胞计数(WBC)和BMI等5个指标对预测患者生存率有统计学意义(P<0.05),其截止点分别为37.5 g/L、1.75×10^(9)/L、45.0、4.55×10^(9)/L和21.85 kg/m^(2)。单因素分析发现PNI、ALB、LYM、WBC均是患者预后的危险因素,肿瘤分期、T分期、N分期和BMI均是患者预后的保护因素,多因素Cox回归发现:PNI≥45.0和BMI≥21.85 kg/m^(2)是患者预后的保护因素,而N分期2~3期则是患者预后的危险因素,其HR(95%CI)分别为0.784(0.725-0.847)、0.824(0.700-0.970)和4.289(1.737-10.589)(P<0.05)。结论鼻咽癌患者放化疗前营养状况与临床预后有关,PNI、BMI和N分期可以作为患者预后的独立预测因素。

Objective To discuss the application value of prognostic nutritional index(PNl),body mass index and N stage before radiotherapy in predicting the clinical outcome of nasopharyngeal carcinoma(NPC)patients undergoing radiochemotherapy.Method From January 2010 to December 2015,128 NPC patients undergoing radiochemotherapy in No.416 Hospital of the nuclear industry were selected and retrospectively analyzed their general information,treatment plan,laboratory examination,pathology and imaging data.The clinical outcomes were followed up until December 20,2021.Kaplan-Meier method was used to draw the survival curve.Log rank X2Test and Cox regression analysis was used to explore the prognositic factors of nasopharyngeal carcinoma patients.Result The mortality was 21.88%during the median at 69.5 months follow-up.The 3-year and 5-year survival rates of 128 patients were 94.53%and 80.47%,respectively.Receiver operating characteristic(ROC)curve showed that albumin(ALB),lymphocyte(LYM),PNl,white blood cell(WBC)and body mass index(BMl)were statistically significant in predicting the survival rate of patients(P<0.05),with cut-off values at 37.5 g/L,1.75 ×10^(9)/L,45.0,4.55×10^(9)/L and 21.85 kg/m^(2),respectively.Univariate analysis showed that PNl,ALB,LYM and WBC were all risk factors for prognosis,while tumor stage,T stage,N stage and BMl were all protective factors for prognosis.Multivariate Cox regression showed that PNl=545.0 and BMl^21.85 kg/m^(2) were protective factors,while N stage 2 to 3 was a risk factor for the prognosis of nasopharyngeal carcinoma patients,with HR(95%CI)0.784(0.725-0.847),0.824(0.700-0.970)and 4.289(1.737-10.589),respectively(P<0.05).Conclusion The nutritional status of nasopharyngeal carcinoma patients before radiochemotherapy is related to the clinical prognosis.PNI,BMI and N stage can be used as independent prognostic factors of nasopharyngeal carcinoma patients.