术前预后营养指数对结直肠癌根治术后生存的预测价值研究

Value of preoperative prognostic nutrition index in postoperative survival of colorectal cancer after radical resection

目的探讨术前预后营养指数(PNI)对结直肠癌根治术后患者预后的评估价值。方法回顾性分析2011年1月至2014年1月在蚌埠医学院第一附属医院行结直肠癌根治术的182例结直肠癌患者临床资料和随访资料。根据入院首次采血检查结果,计算PNI、中性粒细胞-淋巴细胞比(NLR)和淋巴细胞-单核细胞比(LMR)。采用受试者工作特征曲线(receiver operating characteristic curve,ROC)曲线获取PNI、NLR和LMR指标最佳截断值。采用Kaplan-Meier生存曲线进行生存分析,Cox比例风险模型分析术前PNI与患者预后的关联性。结果患者术前PNI为22.03~71.06(47.62±9.88),最佳截断值为45.61。高PNI组(≥45.61,115例)患者的5年总生存率明显高于低PNI组(<45.61,67例)(χ2=19.706,P<0.001)。术前PNI与体质指数、肿瘤大小、T分期、N分期、癌胚抗原、CA19-9、NLR和LMR有关。PNI是影响结直肠癌根治术后5年生存的独立危险因素(HR=1.835,95%CI:1.067~3.157,P=0.028)。结论术前PNI是影响结直肠癌患者根治术后生存的独立危险因素,对结直肠癌的预后评估有一定的临床应用价值。

Objective To explore the prognostic value of preoperative prognostic nutritional index(PNI)for patients with colorectal cancer after radical resection.Methods The clinical data and follow-up data of 182 patients with colorectal cancer undergoing radical colorectal cancer surgery in the First Affiliated Hospital of Bengbu Medical College from January 2011 to January 2014 were retrospectively analyzed.Preoperative PNI,neutrophil-lymphocyte ratio(NLR)and lymphocyte-monocyte ratio(LMR)were calculated,according to the results of the first blood sampling before operation.Receiver operating characteristic curve(ROC)curve was used to obtain the best cut-off value of PNI index,NLR and LMR.Kaplan-Meier survival curve and Cox proportional hazard model were used to analyze the correlation between preoperative PNI and patients’prognosis.Results The preoperative PNI was 22.03-71.06(47.62±9.88),with the best cut-off value of 45.61.The 5-year survival rate of patients in the high PNI group(≥45.61,115 cases)was significantly higher than that in the low PNI group(<45.61,67 cases),the difference was statistically significant(χ2=19.706,P<0.001).Preoperative PNI was associated with body mass index,tumor size,T stage,N stage,CEA,CA19-9,NLR and LMR,pointing out to be an independent risk factor for 5-year survival after radical resection of colorectal cancer(HR=1.835,95%CI:1.067-3.157,P=0.028).Conclusion Preoperative PNI is an independent risk factor that affects the survival of patients after colorectal cancer radical surgery,which has a certain clinical value for the prognosis evaluation of colorectal cancer.