食管胃结合部腺癌炎性反应和营养状态变化及对预后的影响

Changes of inflammation and nutritional status after operation in adenocarcinoma of the esophagogastric junction and its effect on prognosis

目的探讨炎性指标中性粒细胞-淋巴细胞比(NLR)、血小板-淋巴细胞比(PLR和营养状态指标预后营养因子(PNI)、体质量指数(BMI)、血红蛋白、白蛋白、前白蛋白对于食管胃结合部腺癌(AEG)患者预后的影响。方法回顾性分析2010年4月至2013年4月东南大学附属中大医院溧水分院150例Ⅱ/Ⅲ型AEG手术患者的临床资料,术前1周内获得NLR、PLR、BMI、血红蛋白、白蛋白、前白蛋白和PNI数据并分组,采用受试者工作特征曲线(ROC)分析各个检测指标的敏感度、特异度、准确性、最佳截断值以及曲线下面积(AUC),评估其诊断价值;Kaplan-Meier曲线和Log-rank检验计算生存率;COX模型来分析患者预后的影响因素。结果 NLR、PLR和PNI的最佳截断值分别是3.5(AUC为0.591,敏感度为26.8,特异度为89.4)、171(AUC为0.531,敏感度为23.6,特异度为81.3)和51.3(AUC为0.599,敏感度为63.1,特异度为57.2)。5年平均生存时间46.3个月,Kaplan-Meier生存曲线显示,前白蛋白<180 mg/L(P<0.001)、NLR>3.5(P<0.001)和BMI<18.5 kg/m2(P<0.001)的AEG患者预后生存时间较短(均P=0.010)。多因素回归分析显示,TNM分期(P<0.001,95%CI=1.739～3.525)、BMI(P=0.011,95%CI=0.564～0.928)、NLR(P<0.001,95%CI=1.617～3.280)和前白蛋白水平(P<0.001,95%CI=0.310～0.592)是影响AEG患者预后的独立危险因素。NLR与患者的肿瘤分型、肿瘤大小有关(χ~2=7.156、7.567,P=0.028、0.023);BMI与患者年龄、手术时间有关(χ~2=7.339、6.414,P=0.025、0.011);前白蛋白与患者性别、肿瘤大小、分化程度和TNM分期有关(χ~2=4.746、13.574、3.888、4.024,P=0.029、<0.001、0.049、0.045)。结论炎性反应和营养状态会促进Ⅱ/Ⅲ型AEG手术患者的疾病进展,BMI、NLR和前白蛋白水平是影响AEG患者预后的独立危险因素。

Objective To investigate the value of inflammatory markers (NLR and PLR) and nutritional indicators including prognostic nutritional factors (PNI), body mass index (BMI), hemoglobin, albumin, and prealbumin in patients with adenocarcinoma of the esophagogastric junction (AEG). Methods Between April 2010 and April 2013, a total of one hundred and fifty surgical AEG patients of type Ⅱ/Ⅲ. Data of NLR, PLR, BMI, hemoglobin, albumin, prealbumin and PNI were obtained within 1 week before operation. The sensitivity, specificity, accuracy, best cut-off value and area under the curve (AUC) of each index were analyzed by the receiver operating characteristic curve (ROC) to evaluate their diagnostic value. Kaplan-Meier curve and Log-rank test were used to calculate the survival rate. COX model was used to analyze the prognostic factors. Results The cut-off values of NLR, PLR and PNI were 3.5 (AUC 0.591, sensitivity 26.8, specificity 89.4), 171 (AUC 0.531, sensitivity 23.6, specificity 81.3) and 51.3 (AUC 0.599, sensitivity 63.1, specificity 57.2), respectively. The average survival time was 46.3 months in 5 years. Kaplan-Meier survival curve showed that the prognostic survival time of AEG patients with prealbumin<180 mg/L, NLR>3.5 and low BMI (<18.5 kg/m2) was shorter (all P=0.010). Multivariate regression analysis showed that TNM stage (P<0.001, 95%CI=1.739-3.525), BMI (P=0.011, 95%CI=0.564-0.928), NLR (P<0.001, 95%CI=1.617-3.280) and prealbumin (P<0.001, 95%CI=0.310-0.592) were independent risk factors for the prognosis of AEG patients. NLR was correlated with tumor type and tumor size (χ^2=7.156, 7.567;P=0.028, 0.023);BMI was correlated with age and operation time (χ^2=7.339, 6.414;P=0.025, 0.011);prealbumin was correlated with gender, tumor size, differentiation and TNM stage (χ^2=4.746, 13.574, 3.888, 4.024;P=0.029,<0.001, 0.049, 0.045). Conclusions Inflammatory response and nutritional status promote disease progression in AEG patients with type /. BMI, NLR and prealbumin levels are independent risk factors for the prognosis of AEG patients.