预后营养指数评估食管癌病人术后并发症及预后的临床价值

The clinical value of prognostic nutritional index in the evaluation of postoperative complications and prognosis of esophageal cancer patients

目的探讨预后营养指数(PNI)评估食管癌病人术后并发症及预后的临床价值。方法选取遂宁市中心医院2010年1月至2014年6月接受食管癌根治术的食管癌病人136例,根据术前1周内血常规和生化检查结果计算PNI值。采用受试者工作特征曲线(ROC)计算Youden指数,并得出PNI的最佳截断值,根据最佳截断值将病人分为高PNI组与低PNI组。比较两组临床病理特征、术后并发症。采用Kaplan-Meier法绘制生存曲线,以Log-rank检验分析组间差异。采用Cox比例风险模型分析影响食管癌病人预后的危险因素。结果最佳截断值为45.38,79例病人PNI≥45.38分为高PNI组,57例病人PNI<45.38分为低PNI组。两组在饮酒史、肿瘤长度、浸润深度、淋巴结转移、临床分期等方面比较,差异有统计学意义(P<0.05)。高PNI组吻合口瘘、肺部感染等并发症低于低PNI组(P<0.05)。全组病人中位生存期48.9月,5年生存率为36.8%。高PNI组中位生存期为56.2个月,5年生存率为48.1%。低PNI组中位生存期为38.7个月,5年生存率为21.1%。高PNI组病人总生存时间明显优于低PNI组(P<0.001)。单因素分析结果显示,病人饮酒史、肿瘤浸润深度、淋巴结转移、临床分期、PNI与病人预后显著相关(P<0.05)。多因素分析结果显示,淋巴结转移、临床分期、PNI是影响病人预后的独立危险因素。结论PNI临床上容易获取、计算简便,与食管癌病人术后并发症相关,是影响病人预后的独立危险因素,可用于评估食管癌病人的术后并发症及预后。

Objective To investigate the clinical value of prognostic nutritional index in the evaluation of postoperative complications and prognosis of esophageal cancer patients.Methods The clinical data of 136 patients who underwent curative esophagectomy from January 2010 to June 2014 in Suining Central Hospital were selected.The PNI value was calculated according to the blood routine and biochemical examination results within one week before operation.The Youden index was calculated by receiver operating characteristic curve,and the best cut-off value of PNI was obtained.The patients were divided into high PNI group and low PNI group according to the best cut-off value.The clinicopathological characteristics and postoperative complications of the two groups were analyzed and compared.Kaplan-Meier method was used to draw survival curve,and Log-rank test was used to analyze the differences between groups.Cox proportional risk model was used to analyze the risk factors influencing the prognosis of esophageal cancer patients.Results The best cut-off value was 45.38,79 patients with PNI≥45.38 were divided into high PNI group and 57 patients with PNI<45.38 were divided into low PNI group.There were significant differences between the two groups in drinking history,tumor length,invasion depth,lymph node metastasis and clinical stage(P<0.05).The complications of anastomotic leakage and pulmonary infection in high PNI group were lower than those in low PNI group(P<0.05).The median survival time of the whole group was 48.9 months,and the fifth year survival rate was 36.8%.The median survival time of high PNI group was 56.2 months,and the fifth year survival rate was 48.1%.The median survival time of low PNI group was 38.7 months,and the fifth year survival rate was 21.1%.The overall survival time of patients in high PNI group is significantly better than that in low PNI group(P<0.001).The results of univariate analysis showed that drinking history,tumor invasion depth,lymph node metastasis,clinical staging and PNI were significantly correlated with prognosis(P<0.05).The results of multivariate analysis showed that lymph node metastasis,clinical staging and PNI were independent risk factors for prognosis.Conclusion sPNI is clinically easy to obtain and calculate.It is correlated with postoperative complications of esophageal cancer patients,is an independent risk factor influencing the prognosis of patients,and can be used to evaluate postoperative complications and prognosis of esophageal cancer patients.