预后营养指数与胃癌病理特征的相关性分析

The prognostic nutritional index and pathological features of gastric cancer

目的探讨OPNI及临床病理特征对胃癌患者预后的影响。方法选取46例接受胃癌根治术患者,回顾性分析其临床资料,根据每例患者入院时化验结果计算每位患者的OPNI,计算公式为OPNI=血清白蛋白水平(g/L)+5×外周血淋巴细胞总数(×10~9/L)。采用受试者工作特征曲线计算Youden指数,获取具有最佳敏感度和特异度组合的OPNI作为本组患者OPNI分界值,并以此将本组患者分为高OPNI组及低OPNI组,采用Kaplan-Meier生存曲线和Cox比例风险模型研究OPNI对胃癌预后的影响。结果淋巴结无转移、p TNM分期为Ⅱ期、CEA及CA199未升高、术后未出现并发症的胃癌患者OPNI平均值均明显高于对照组。而采用4年生存作为终点绘制OPNI的ROC曲线,当OPNI值为38.175时,Youden指数最大,因此以OPNI=38.175将本组患者分为高OPNI组和低OPNI组,与低OPNI组的患者相比,高OPNI组的患者肿瘤浸润深度更浅、淋巴结转移更少、p TNM分期相对早期、CEA及CA199水平均处于正常范围内。单因素及多因素分析显示,患者年龄和OPNI值是胃癌患者总生存时间的独立预后因素。结论 OPNI可作为一项简洁直观的指标来协助临床医生判断胃癌患者的预后。

Objective To investigate the application of Onodera＇s prognostic nutrition index（OPNI） and clinicalpathological features in risk evaluation of prognosis of gastric cancer patients. Methods The clinical data of 46 gastric cancer patients who underwent radical gastrectomy in our hospital during 2012 was analyzed retrospectively. The OPNI value was calculated by serum albiumin（g/L）＋5×lymphocyte count（×10~9/L）. The receiver operating characteristic（ROC） curve and Youden index were used to determine the cutoff value of the OPNI. Survival curves were describe by the Kaplan-Meier method and compared by the Log-rank test. The univariate and multivariate analyses were performed with Cox proportional hazard model to identify the prognostic factors. Results The mean values of the OPNI in negative lymph node, p TNM, normal CEA and CA199, no postoperative complication were significantly higher than those in patients without such factors. When the OPNI was 38.175, the Youden index was maximal. Tumor infiltration depth in high OPNI group was less than in low OPNI group. The proportion of lymph node invasion in high OPNI group was significantly lower than in low OPNI group. The overall survival rate in high OPNI group was higher than in low OPNI group. The univariate and multivariate analyses showed that patient age and OPNI were independent factors for predicting overall survival rate. Conclusions The OPNI value is a simple and intuitive tool to predict the prognosis of patients with gastric cancer.