影响癌性肠梗阻病人预后的多因素分析

Multivariate analysis of prognosis of patients with malignant bowel obstruction

目的:多因素分析影响癌性肠梗阻(malignant bowel obstruction,MBO)病人预后的危险因素,构建MBO病人生存期预测的列线图模型。方法:回顾性分析我院2013年6月至2019年6月203例MBO病人的临床资料及随访。结果:随访143例(70.4%)病人。单因素分析结果显示,性别、年龄、血小板、C反应蛋白、总蛋白含量、合并症数量、使用生长抑素治疗、肠内营养和肠外营养治疗、住院时间与MBO病人的生存无相关性。肿瘤TNM分期晚(P<0.001)、肿瘤继发转移(P<0.001)、贫血(P=0.001)、低白蛋白(P<0.001)、高白细胞(P=0.023)、非手术治疗(P=0.013)、生活质量评分低(P<0.001)以及肝功能差[包括高丙氨酸转氨酶(P=0.023)、高天冬氨酸转氨酶(P=0.005)]等因素与预后差有关。多因素分析显示,肿瘤分期(P=0.003)、白蛋白水平(P=0.001)是影响MBO病人预后的独立危险因素。采用TNM晚期、继发肿瘤以及血红蛋白低和白蛋白低4个指标构建的列线图。通过40例病人3~12个月的内部预测生存期,结果良好。结论:构建列线图和预后分析显示,MBO病人不良的主要因素是肿瘤晚期以及全身营养不良。

Objective To analyze the risk factors for prognosis of patients with malignant bowel obstruction(MBO)using multiple factors,and establish the nomogram model for predicting the survival of patients with MBO.Methods The clinical data of 203 patients with MBO from June 2013 to June 2019 who were followed up in our hospital were analyzed retrospectively.Results A total of 143(70.4%)patients have been followed up.It was shown with univariate analysis that indexes of gender,age,platelet,C-reactive protein,and total protein levels,comorbidities,the treatment with somatostatin,enteral nutrition,and parenteral nutrition,length of hospital were not related to the survival of patients with MBO.There were some factors including late TNM stage of tumor(P<0.001),tumor metastasis(P<0.001),anemia(P=0.001),lower albumin(P<0.001),higher white blood cell(P=0.023),non-surgical treatment(P=0.013),low quality of life score(P<0.001)and poor liver function[including high alanine aminotransferase(P=0.023),high aspartate aminotransferase(P=0.005)]which related with poorer prognosis in patients with MBO.Multivariate analysis showed that tumor stage(P=0.003)and albumin level(P=0.001)were independent risk factors affecting the prognosis of MBO.Nomogram was constructed using 4 in-dexes including late TNM stage,tumor metastasis,lower hemoglobin and lower albumin.It was indicated that the results of internal prognosis were better for the prediction of survival of 3 to 12 months of 40 cases.Conclusions The study on poor prognosis of patients with MBO combined with nomogram showed that both late stage of tumor and malnutrition were main factors.