结直肠癌患者术后预后营养指数在预后评估中的应用

Application of postoperative nutritional index in prognosis evaluation of colorectal cancer patients

目的评估结直肠癌患者术后的预后营养指数(Postoperative prognostic nutritional index,p-PNI)在预后评估中的应用价值。方法回顾性分析2009年8月—2012年8月间南京鼓楼医院集团宿迁市人民医院收治的经病理确诊为结直肠癌并行结直肠癌根治术的89例患者的临床资料。根据患者出院后第一次复诊的血常规及生化检查结果计算p-PNI。采用受试者工作特征曲线(Receiver operating characteristic curve,ROC)计算Youden指数,以最佳敏感度和特异度组合的PNI值作为PNI分组的分界值。Kaplan-Meier法绘制生存曲线,Cox回归模型筛选研究p-PNI对结直肠癌患者术后预后的影响。结果 89例结直肠癌患者p-PNI为25.18~60.74(43.81±6.47)。患者中年龄小于70岁、淋巴结转移数目小于4个、术前CEA小于5 ng/m L、术中出血量小于150 m L的p-PNI显著增高(P<0.05)。p-PNI值为43时,Youden指数最大。数据分析显示p-PNI与患者年龄、淋巴结转移数目、术中出血量及术前CEA值具有相关性(P<0.05)。高p-PNI组患者生存率高于低p-PNI组(χ~2=15.639,P<0.001)。单因素及多因素分析证实,p-PNI是影响结直肠癌患者预后的独立因素(HR=2.179,95%CI:1.057~3.561,P<0.001)。结论 p-PNI在结直肠癌患者中是一个独立的预后影响因素,与结直肠癌患者术后的长期预后相关。

Objective The objective of this study was to evaluate the prognostic value of postoperative prognostic nutritional index（p - PNI） in the prognosis of colorectal cancer patients. Methods Retrospective ana-lytical cases came from 89 patients with radical resection of colorectal cancer confirmed by the pathological section in Nanjing Drum Tower Hospital Suqian City Peopled Hospital from August 2009 to August 2012. The p - PNI was calculated based on the results of blood routine and biochemical tests after the first visit to the hospital. The Youden index was calculated using the receiver operating characteristic curve （ROC） ,and the PNI value com-bined with the best sensitivity and specificity was used as the threshold for the PNI packet. Kaplan - Meier meth-od was used to study the effect of p - PNI on postoperative prognosis of patients with colorectal cancer. Cox regres- sion model was selected to study the effect of p - PNI on the prognosis of colorectal cancer patients after surgery. Results The p - PNI of 89 cases of colorectal cancer patients was 25. 18 -60. 74（43. 81 ± 6 .4 7 ）. The p-PNI in patients（ less than 70 years old） was significantly increased when the number of lymph node metastases was less than 4,the preoperative CEA was less than 5ng/mL,and the intraoperative hemorrhage was less than 150 mL（P 〈 0. 05）. When the p - PNI value was 43, the Youden exponent was the largest. Data analysis showed that p - PNI was correlated with age,lymph node metastasis, intraoperative blood loss and preoperative CEA（ P 〈 0.05 ）. The survival rate of patients with high p - PNI was higher than that of low p - PNI group（ χ2 =15.639 yP 〈0 .0 01 ） . Sin-gle factor and multivariate analysis confirmed that p - PNI was an independent factor in the prognosis of patients with colorectal cancer（ HR=2. 179,95% CI： 1.057 - 3. 561,P〈0. 001）. Conclusion p - PNI is an independentprognostic factor in patients with colorectal cancer,which is associated with long-term prognosis after surgery.