预后营养指数及EORTC-GUCG评分对膀胱癌患者复发预测价值的探讨

Predictive value of PNI and EORTC-GUCG score for recurrence of bladder cancer

目的:探讨预后营养指数(prognostic nutritional index,PNI)及EORTC-GUCG评分对膀胱癌患者复发的预测价值。方法:收集96例非肌层浸润性膀胱癌(non-muscle invasive bladder cancer,NMIBC)患者为研究对象。根据术前EORTC-GUCG评分,将患者分为低危组、中危组及高危组,比较不同风险患者的无复发生存期(recurrence-free survival,RFS)。采用ROC曲线确定PNI预测复发风险的截断值,比较不同PNI患者的RFS。结果:肿瘤数量、肿瘤大小、肿瘤分级、T分期是影响膀胱癌患者EORTC-GUCG评分的主要危险因素(P<0.05),而年龄、肿瘤分级是影响患者PNI的主要危险因素(P<0.05)。EORTC-GUCG低危组、中危组、高危组分别出现2例、23例、13例复发。Kaplan-Meier生存曲线显示,高危组RFS最差,中危组次之,低危组最好,差异均具有统计学意义(P<0.05)。ROC曲线显示,PNI对RFS评价的曲线下面积为0.757,最佳截断值为53.3。PNI<53.3组与PNI≥53.3组的复发率分别为23.1%、59.1%,生存曲线显示,PNI≥53.3组患者RFS显著差于PNI<53.3组(P=0.001)。低危组、中危组、高危组中,PNI<53.3的患者分别为13例、34例、5例,PNI≥53.3的分别有6例、22例、16例。生存曲线显示,在低危组内,PNI<53.3组与PNI≥53.3组患者之间的生存率无明显差异(P=0.106),在中危组及高危组内,PNI≥53.3组患者的RFS明显更差(P=0.000,P=0.031)。结论:53.3可作为PNI的最佳截断值,用于评价NMIBC患者复发风险。将PNI与EORTC-GUCG评分相结合,对中危及高危患者的复发风险有较高的预测价值。

Objective:To investigate the difference of predictive value of PNI and EORTC-GUCG scores for recurrence of bladder cancer.Methods:96 patients with non-muscle invasive bladder cancer(NMIBC)were collected as the study subjects.The patients were divided into low-risk group,medium-risk group and high-risk group,and RFS of different risk patients was compared.ROC curve was used to determine the cut-off value of PNI for predicting recurrence risk,and RFS of different PNI patients was compared.Results:Number of tumors,size of tumors,grade of tumors and T stage were risk factors affecting EORTC-GUCG score(P<0.05).Age and tumor grade were the main risk factors for PNI(P<0.05).EORTC-GUCG recurrence occurred in 2 cases,23 cases and 13 cases respectively in low-risk group,medium-risk group and high-risk group.Survival curve showed that RFS was the worst in high-risk group,followed by medium-risk group and the best in low-risk group(P<0.05).ROC curve showed that the area under the curve of PNI for RFS evaluation was 0.757,and the best truncation value was 53.3.The recurrence rates of PNI≥53.3 group and PNI<53.3 group were 23.1%and 59.1%,respectively.The RFS of PNI<53.3 group was significantly worse than that of PNI<53.3 group(P=0.001).In low-risk group,medium-risk group and high-risk group,there were 13,34 and 5 patients with PNI<53.3,6,22 and 16 patients with PNI≥53.3,respectively.In low-risk group,there was no significant difference in survival rate between PNI<53.3 group and PNI≥53.3 group(P=0.106).In middle-risk group and high-risk group,the RFS of PNI≥53.3 group was significantly worse.Conclusion:53.3 can be used as the best cut-off value of nutritional prognosis index.The combination of PNI and EORTC-GUCG score has a high predictive value for the recurrence risk of middle-risk and high-risk patients.