预后营养指数对恶性胸膜间皮瘤患者疗效和预后的预测价值

Clinical significance of prognostic nutritional index in predicting the efficacy and outcomes of malignant pleural mesothelioma

目的:探讨治疗前的预后营养指数(prognostic nutritional index,PNI)在恶性胸膜间皮瘤(malignant pleural mesothelioma,MPM)患者中化疗疗效以及预后判定中的作用。方法:回顾性分析2006年01月01日至2019年12月31日中国医科大学肿瘤医院的52例MPM患者,收集临床及实验室数据,PNI计算公式为:血清白蛋白值(g/L)+5×外周血淋巴细胞总数(×10^(9)/L)。利用单因素分析及多因素分析评价患者总生存时间和各项临床及实验室数据与PNI的关系。结果:所有患者治疗前平均PNI为46.8。治疗前的PNI与性别(P=0.012)、CT下分型(P=0.015)、TNM分期(P=0.010)以及一线化疗2周期后疗效评价相关(P=0.000),治疗前高PNI(>46.8)组的患者疗效更好。生存分析显示治疗前PNI是MPM的独立预后因素,与高PNI(>46.8)患者相比,低PNI(≤46.8)患者具有更高的死亡风险,差异具有统计学意义(HR:2.323;95%CI:1.125~4.799;P=0.023)。结论:治疗前PNI与恶性胸膜间皮瘤患者的化疗疗效相关,低PNI与恶性胸膜间皮瘤患者的不良预后密切相关,PNI是恶性胸膜间皮瘤的独立预后因素。

Objective:To evaluate the clinical significance of prognostic nutritional index(PNI)in predicting efficacy and outcomes in patients with malignant pleural mesothelioma(MPM).Methods:The clinical data from 52 patients with MPM,who were diagnosed in the Liaoning Provincial Cancer Hospital from January 1,2006 to December 31,2019,were retrospectively analyzed.Their clinical and laboratory data were collected.The PNI was calculated as serum albumin value(g/L)+5×total lymphocyte count(×10^(9)/L)in peripheral blood.We used univariate and multivariate analyses to identify the efficacy and prognostic factors.Results:Mean pretreatment PNI was 46.8.Pretreatment PNI was significantly associated with gender(P=0.012),tumor type based on the chest CT(P=0.015),TNM stage(P=0.010)and the efficacy of chemotherapy on first-line(P=0.000).The patients with higher pretreatment PNI(PNI>46.8)had better efficacy to chemotherapy than those patients with lower PNI(PNI≤46.8).Survival analysis showed pretreatment PNI was an independent prognostic factor in MPM.Compared with patients with higher PNI(PNI>46.8),patients with lower PNI(PNI≤46.8)had greater risk of death(hazard ratio:2.323;95%confidence interval:1.125~4.799,P=0.023).Conclusion:The level of pretreatment PNI could provide certain basis for efficacy evaluation.The lower PNI is related to poor prognosis in MPM.Pretreatment PNI is an independent prognostic factor in MPM.