术前营养指数结合分子病理学对较低级别胶质瘤患者临床预后的影响

Preoperative prognostic nutritional index predicts clinical outcomes in patients with lower-grade gliomas

目的研究术前营养指数结合分子病理学对较低级别胶质瘤患者临床预后的影响。方法收集在郑州大学第一附属医院2011年2月至2016年5月手术并术后经过病理学确诊的初发的较低级别胶质瘤患者的临床资料及生存资料,共计纳入379例。采用Kaplan-Meier法计算生存率,用log-rank进行组间分析。Cox模型比例风险评估做多因素分析。结果预后营养指数(PNI)的最佳临界值值为47.80。单因素分析显示,PNI≤47.80的患者平均生存期为46.76个月,PNI>47.80的患者平均生存期为67.37个月,两者的5年生存率分别为41.2%和69.9%,差异有统计学意义(P<0.001),高的PNI水平和患者较好的临床预后明显相关。多因素分析显示,PNI是影响较低级别胶质瘤患者临床预后的独立危险因素(P=0.003)。不同分子病理学分型组间分析显示,仅TERT突变组(PNI≤46.70比PNI>46.70;0比35.4%)(P=0.003)及三阴组(PNI≤53.70比PNI>53.70;29.2%比71.4%)差异有统计学意义(P=0.007),高的PNI水平和患者较好的临床预后明显相关,而三阳组、IDH和TERT突变组及仅IDH突变组中不同PNI水平组间差异无统计学意义,均P>0.05。结论较高的PNI水平预示着较好的预后,并且在仅TERT突变组和三阴组患者中,高的PNI水平和患者较好的临床预后明显相关,PNI可作为潜在的预测较低级别胶质瘤患者预后的标志物。

Objective To investigate the prognostic values of preoperative prognostic nutritional index(PNI)in patients with lower-grade gliomas.Methods In the study,379 patients with pathological diagnosis of lower-grade gliomas were enrolledwhich were confirmed in The First Affiliated Hospital of Zhengzhou University(2011-02 to 2016-05).Kaplan-Meier method was used to calculate the survival rates.log-rank was used to calculate the differences in group.Cox regression model was used to conduct multivariate analysis.Results The cutoff value of PNI was 46.70.The median survival time of PNI≤47.80 and PNI>47.80 subgroups were 46.76 and 67.37 months with statistical significance(P<0.001).High PNI predicted a better survival rate.Multivariate survival analysis demonstrated that low PNI was an independent risk factor to evaluate the prognosis of glioma patients.In lower-grade gliomas,high PNI predicted better survivals in TERT mutation only(P=0.003)and triple-negative group(P=0.007).Conclusion In lower-grade gliomas,low PNI predicts worse survivals and PNI have differential prognostic significances in molecular groups of lower-grade gliomas.