小野寺预后营养指数在进展期中低位直肠肿瘤术后辅助化疗副反应监测中的应用

Application of Onodera’s Prognostic Nutrition Index in Monitoring Postoperative Side Effects of Adjuvant Chemotherapy for Advanced Low Rectal Cancer

目的探讨小野寺预后营养指数(PNI)在进展期中低位直肠癌术后辅助化疗副反应监测中的应用,为临床及时干预治疗提供科学依据。方法选取某院普通外科2018年1月1日-2018年12月31日收治的直肠癌术后行辅助化疗的患者80例为研究对象,化疗方案均为mFOLFOX6,根据血液学检测指标计算PNI值,统计患者的临床特征,分析其与PNI值的关系;同时,观察并统计患者化疗副反应的发生情况,包括消化道反应,骨髓抑制,肝功能损伤和神经毒性反应;应用受试者工作特征曲线计算发生副反应的Youden指数,确定分界值,将研究对象分为高值组和低值组,比较2组之间化疗副反应的发生率。结果所纳入的直肠癌术后化疗患者的PNI值最小为34.2,最大为72.1,平均值为50.4±5.8;肿瘤直径≤4cm、高、中分化的直肠癌患者的PNI平均值显著升高,P<0.001,P=0.013。根据是否发生化疗副反应绘制PNI值的ROC曲线,曲线下面积为0.59,当PNI值为43时,Youden指数最大,敏感度为43.6,特异度为79.2。因此取PNI的分界值为43,并将PNI≧43分为高PNI组,PNI<43分为低PNI组,而在4类化疗副反应当中消化道反应是发生率最高的化疗副反应,高PNI组的发生率均明显低于低PNI组,具有统计学差异,P<0.05。结论PNI的分界值为43,高PNI患者的化疗毒副反应发生率更低,应用小野寺指数监测患者术后营养状态,可以有效的预测辅助化疗副反应的发生风险。

Objectives To investigate the prognostic role of the Onodera’s prognosis nutritional index in adjuvant chemotherapy for advanced low rectal cancer and provides scientific basis for timely clinical intervention.Methods Eighty cases of postoperative adjuvant chemotherapy for rectal cancer admitted by a Hospital from January 1 st 2018 to December 31 st 2018 were selected as the research objects.All the chemotherapy regimentation was m FOLFOX6.Onodera’s prognostic nutrition index was calculated according to the hematological indicators,and the clinical characteristics of the patients were analyzed to analyze the relationship between them and PNI value.Meanwhile,the incidence of side effects of chemotherapy was observed and counted,including gastrointestinal reactions,bone marrow suppression,liver function injury and neurotoxic reactions.The Youden index of adverse reactions was calculated using ROC to determine the cutoff value.Subjects were divided into high-value group and low-value group to compare the incidence of adverse reactions between the two groups.Results The PNI value of the included patients with postoperative chemotherapy for rectal cancer was the minimum 34.2,the maximum 72.1,and the mean value was 50.4±5.8.The mean value of PNI was significantly increased in patients with high or medium differentiated rectal cancer whose tumor diameter was no more than 4 cm,P<0.001,P=0.013.The ROC curve of PNI valuewas plotted according to whether there were side effects of chemotherapy.The area under the curve was 0.59.When the PNI value was 43,the Youden index was the largest,the sensitivity was 43.6,and the specificity was 79.2.Therefore,the boundary value of PNI was 43,and PNI≥43 was divided into the high PNI group,and PNI<43 was divided into the low PNI group.Among the four types of chemotherapy side reactions,the gastrointestinal reaction had the highest incidence of chemotherapy side reactions,and the incidence of the high PNI group was significantly lower than that of the low PNI group,with statistically significant difference(P<0.05).Conclusions The cut-off value of PNI was 43,and the incidence of toxic and side effects of chemotherapy in patients with high PNI was lower.The Onodera’s prognosis nutritional index could be used to monitor the postoperative nutritional status of patients,which could effectively predict the risk of side effects of adjuvant chemotherapy,and was suggested to promote widely in clinical practice.