预后营养指数与晚期结直肠癌患者三线治疗的生存相关性分析

Prognostic significance of prognostic nutritional index in advanced colorectal cancer with third-line therapy

目的探讨营养预后指数与接受替吉奥联合阿帕替尼治疗的晚期三线结直肠癌患者的疗效的相关性。方法回顾性收集接受阿帕替尼联合替吉奥治疗的43例三线结直肠癌患者的临床资料,计算预后营养指数(PNI)、白蛋白/球蛋白比值(AGR)、中性粒细胞/淋巴细胞比值(NLR)、血小板/淋巴细胞比值(PLR)以及淋巴细胞/单核细胞比值(LMR)等营养免疫评估指标,采用Cox比例风险回归模型及Kaplan-Meier生存曲线评价相关免疫营养指标对于患者生存的影响。结果根据总生存时间(OS)的受试者工作特征曲线(ROC)曲线分析,PNI最佳临界值定义为47.08;单因素分析结果显示,美国东部肿瘤协作组(ECOG)评分、PNI、AGR、血红蛋白(HGB)、NLR及LMR与患者OS显著相关;多变量分析显示ECOG评分及PNI是OS的独立预后因素。低PNI患者中位生存时间(mOS)为5.70个月(95%CI=4.42~6.98),高PNI患者mOS为15.77个月(95%CI=7.43~24.1),P=0.000;低PNI的患者中位无进展生存时间(mPFS)为3.42个月(95%CI=2.31~4.53),高PNI患者mPFS为6.29个月(95%CI=4.96~7.62),P=0.003。结论PNI在作为晚期结直肠癌接受替吉奥联合阿帕替尼三线治疗的生存预测方面具有较好临床应用价值,简单易行。

Objective To investigate the prognostic value of prognostic nutritional index(PNI)in the advanced colorectal cancer patients of third-line therapy.Methods Clinical data of 43 advanced colorectal cancer patients were retrospectively analysed,who were treated with S-1 plus apatinib as third-line therapy.PNI(prognostic nutritional index),AGR(albumin-to-globulin ratio),PLR(platelet lymphocyte ratio)and LMR(lymphocyte monocyte ratio)were calculated.Cox proportional hazards regression models and Kaplan-Meier curve were used to evaluate the impact on survival.Results According to receiver operating characteristic(ROC)curves,the cutoff value for PNI was 47.08;the result of univariate analysis showed PNI,AGR,ECOG,HGB,NLR and LMR were significantly correlated with overall survival(OS);multivariate analysis showed that ECOG and PNI were independent prognostic factor of OS.The median overall survival for PNI-low patients were 5.70months(95%CI=4.42-6.98),while the mOS for PNI-high patients were 15.77months(95%CI=7.43-24.1),P=0.000.The mPFS for PNI-low and PNI-high patients were 3.42months(95%CI=2.31-4.53)and 6.29months(95%CI=4.96-7.62)respectively,P=0.003.Conclusion PNI could be a useful prognostic indicator for advanced colorectal cancer patients who received the combination of S1 plus apatinib as third-line treatment.