预后营养指数对非小细胞肺癌患者术后并发症和预后的影响

The influence of the prognostic nutritional index on postoperative complications and prognosis in patients with resect-able non-small cell lung cancer

目的分析预后营养指数（prognostic nutritional index，PNI）和可切除非小细胞肺癌患者临床病理因素之间的关系，比较分析高PNI（PNI≥50）组和低PNI（PNI〈50）组非小细胞肺癌患者的术后并发症发生率和预后情况。方法回顾性分析2010年7月至2011年12月216例术后病理诊断为RO切除的非小细胞肺癌患者资料。其中127例高PNI，89例低PNI。比较两组患者临床病理特征、中位生存期和5年生存率。结果两组患者性别、年龄、吸烟史、手术方式、病理类型、外周血淋巴细胞计数和有无接受放疗差异无统计学意义（P〉0．05）。相对于高PNI组患者，低PNI组患者的TNM分期更晚、瘤直径更大、接受辅助性化疗更多（P〈0．05）。低PNI组患者中血清白蛋白值低者多于高PNI组患者（P〈0．05）。高PNI组总并发症、肺部并发症发生率低于低PNI组，结果有统计学意义（P〈0．05）。高PNI组中位生存期和第1、3、5年生存率分别为61．6个月和91．3％、80．1％、74．1％。低PNI组中位生存期和第1、3、5年生存率分别为49．9个月和82．0％、63．5％、53．5％，两组比较差异有统计学意义（P〈0．05）。单因素分析发现，肿瘤最大径、TNM分期、手术方式、辅助性化疗、血清白蛋白含量和PNI水平与生存率显著相关（P〈0．05）。Cox模型进行多因素分析显示TNM分期和PNI水平是影响患者生存率的独立因素（P〈0．05）。结论不同PNI水平的非小细胞肺癌患者存在一定的异质性，高PNI者术后并发症发生率低于低PNI者，远期生存优于低PNI者。

Objective To investigate the correlation between the prognostic nutritional index（PNI） and the clinicopatho- logic features of patients with non-small cell lung cancer（NSCLC） , and to compare postoperative complications and survival be- tween patients with High-PNI（H-PNI） and Low-PNI（L-PNI） after operation. Methods This study retrospectively reviewed and analyzed the medical records of 216 patients underwent surgery between July 2010 and December 2011 who were pathologi- cally dignosed with NSCLC. Among these, 127 patients with H-PNI, and 89 patients with L-PNI. The clinicopathologic fea- tures, median survival time and 5-year survival rates between two groups were analyzed. Results Patients in the L-PNI group had greater pathologic TNM stage, larger tumors, lower Serum albumin levels, and greater percentage of chemotherapy than those in the H-PNI group（ P 〈 0.05 ）. The H-PNI group was associated with significantly fewer postoperative complications than the L-PNI group（ P 〈 0.05 ）. For the patients with H-PNI, the MST was 61.6 months an the 1-, 3-, and 5-year OS were 91. 3% ,80.1% , and 74.1% , respectively. For the patients with L-PNI, the MST was 49.9 months and the 1-, 3-, and 5-year OS were 82.0% ,63.5% ,and 53.5%, respectively. There was significant difference in survival between the two groups（ P 〈 O. 05）. TNM staging and PNI were showed to be independent prognostic factors. Coneluslon Different PNI of NSCLC has cer- tain heterogeneity. Patients with H-PNI show better survival and lower postoperative complications rate than those with L-PNI.