预后营养指数对老年食管癌患者根治性放疗后长期生存的预测价值

The predictive value of prognostic nutritional index for long-term survival after radical radiotherapy in elderly patients with esophageal cancer

目的探讨预后营养指数(PNI)对接受根治性放疗或放化疗的老年食管癌患者长期生存的预测价值。方法对接受根治性放疗或放化疗且符合入组条件的188例老年食管癌患者进行回顾性分析。计算每例患者放疗前PNI值[PNI=血清白蛋白值(g/L)+5×外周血淋巴细胞总数(×109/L)],运用受试者工作特征(ROC)曲线确定其预测患者长期生存的最佳临界值,分为高PNI组及低PNI组,并比较2组患者生存预后及急性不良反应。结果全组患者1、3、5年总生存率分别为74.5%、33.5%、24.9%。依据ROC曲线计算得出放疗前PNI最佳临界值为48.65,测量曲线下面积为0.649,敏感度为60.2%,特异度为70.1%。高PNI组(≥48.65)的86例和低PNI组(<48.65)的102例患者1、3、5年总生存率分别为83.7%、43.0%、32.5%和66.7%、24.5%、15.7%(Log-rankχ^(2)=11.719,P<0.01)。TNM分期为Ⅲ期和放疗前PNI<48.65为影响患者生存率的独立危险因素(P<0.05)。另外,高PNI组≥3级急性放射性食管炎发生率低于低PNI组(χ^(2)=4.438,P<0.05)。结论PNI对于老年食管癌接受根治性放疗后的长期生存具有较高的预测价值,PNI较高的患者具有相对良好的预后。

Objective To investigate the predictive value of prognostic nutritional index(PNI)in the long-term survival of elderly patients with esophageal cancer after radical radiotherapy or chemoradiotherapy.Methods Data of a total of 188 elderly patients with esophageal cancer who received radical radiotherapy or chemoradiotherapy and met the eligibility criteria were retrospectively analyzed.PNI values before radiotherapy were calculated for each patient[PNI=serum albumin level(g/L)+5×absolute lymphocyte count(×109/L)].ROC curve was used to determine the optimal cutoff value for predicting long-term survival of the patients.The patients were divided into high PNI group and low PNI group,and the survival prognosis and acute adverse reactions were compared between the two groups of patients.Results The 1-,3-and 5-year overall survival rates were 74.5%,33.5%and 24.9%,respectively.According to the ROC curve,the optimal cutoff value of PNI before treatment was 48.65,the area under curve was 0.649,the sensitivity was 60.2%and the specificity was 70.1%.The 1-,3-and 5-year overall survival rates were 83.7%,43.0%and 32.5%for 86 patients in the high PNI group(≥48.65)and 66.7%,24.5%and 15.7%for 102 patients in the low PNI group(<48.65,χ^(2)=11.719,P<0.01).TNM stageⅢand pretreatment PNI<48.65 were independent risk factors that affect the overall survival rate of patients(P<0.05).In addition,the incidence of grade≥3 acute radiation esophagitis was significantly lower in the high PNI group than that in the low PNI group(χ^(2)=4.438,P<0.05).Conclusion PNI has a good predictive value for the long-term survival of the elderly patients with esophageal cancer after radical radiotherapy.Patients with high level of PNI have relatively good prognosis.