小野寺预后营养指数在老年结直肠癌患者预后评估中的应用

Application of Onodera prognostic nutrition index in prognostic evaluation of elderly patients with colorectal cancer

目的探讨小野寺预后营养指数（简称小野寺指数）在老年结直肠癌患者预后评估中的应用价值。方法回顾性分析2004年11月至2006年12月间广州市第一人民医院收治的163例老年（65岁以上）结直肠癌患者的临床和随访资料。根据患者入院后首次血常规和生化检查结果，计算小野寺指数[小野寺指数=白蛋白值（g／L）＋5×淋巴细胞总数（10^9L）]。分析小野寺指数与临床病理特征、手术方式、术后并发症及胃肠道功能恢复的相关性，并通过Cox回归模型筛选影响老年结直肠癌患者的预后因素。结果163例结直肠癌患者小野寺指数为24．3～60．3（44．0±6．9），根据小野寺指数分为营养较好组（小野寺指数大于或等于45，77例）和营养较差组（小野寺指数小于45，86例）。两组根治性切除的患者比例分别为90．9％（70／77）和62．8％（54／86），差异有统计学意义（P〈0．01）。两组根治性切除术后总并发症发生率分别为17．1％（12／70）和53．7％（29／54），差异有统计学意义（P〈0．01）。相关分析显示，小野寺指数与患者年龄、肿瘤部位、肿瘤大小、手术方式、术后总并发症及术后肛门排粪时间具有相关性（均P〈0．05）。营养较好组和营养较差组术后5年生存率分别为64％和24％，差异有统计学意义（P〈0．01）；多因素Cox回归分析证实，小野寺指数是影响术后总体生存的独立预后因素（RR=0．888，95％CI：0．800～0．985，P=0．025）。结论小野寺指数能较好地反映老年结直肠癌患者的营养状态、手术风险及预后，是一个较有价值的结直肠癌术前评估及预后分析指标。

Objective To study the applied valuation of Onodera prognostic nutrition index （Onodera index） in elderly patients with colorectal cancer. Methods Onodera indexes of 163 elderly patients with colorectal cancer were calculated and these patients were divided into better-nourished group （Onodera index ≥45） and under-nourished group （Onodera index 〈45）. Correlations of Onodera index with general data, operation type, postoperative complication, recovery of gastrointestinal function, clinicopathologieal feature and prognosis were analyzed. Cox proportional hazards model was also established to identify the independent prognostic factors for prognosis of elderly patients with colorectal cancer. Results Patients in better-nourished group had significantly higher radical resection rate [90.9% （70/77） vs. 62.8% （54/86）, P〈0.011, lower postoperative complication rate [ 17.1% （12/70） vs. 53.7%o（29/54）, P〈0.01] and earlier postoperative defecation [（3.09±1.14） d vs. （3.43±1.98） d, P〈0.05] than those in under-nourished group. Onodera index was found to be related to age, tumor location, tumor size, and operation type （all P〈0.05）. Better-nourished group had significantly better survival than worse-nourished group （5-year survival rate： 64% vs. 24%, P〈0.01）. Onodera index was identified as an independent prognostic factor for elderly patients with colorectal cancer （RR=0.888, 95% CI：0.800-0.985, P=0.025）. Conclusion Onodera index is a valuable clinical marker in preoperative estimation as well as prognosis prediction for elderly patients with colorectal cancer.