老年营养风险指数对根治性放化疗食管鳞癌患者长期生存的预测价值

Prognostic value of geriatric nutritional risk index in patients with esophageal squamous cell carcinoma treated by definitive chemoradiotherapy

目的:探讨老年营养风险指数(geriatric nutritional risk index,GNRI)对接受根治性放化疗(definitive chemoradiotherapy,dCRT)的食管鳞状细胞癌(esophageal squamous cell carcinoma,ESCC)患者长期生存的预测价值。方法:共收集2013年1月至2015年12月期间202例在河北医科大学第四医院接受根治性放化疗ESCC患者的临床资料。计算放疗前1周内患者GNRI和预后营养指数(prognostic nutritional index,PNI),将患者分为高GNRI组(GNRI≥98)和低GNRI组(GNRI<98)。回顾性分析GNRI对无进展生存(progression-free survival,PFS)和总生存(overall survival,OS)的影响。利用R软件建立列线图预测模型,以一致性指数(C-index)和校准曲线评估模型准确度,进一步探索GNRI和N分期、GNRI和PNI联合指标的预后预测价值。结果:202例患者中,高GNRI组145例(71.8%),低GNRI组57例(28.2%)。多因素分析显示,N分期、放疗剂量和GNRI是PFS和OS的独立预后因素。根据预后因素分别建立PFS和OS的列线图模型,C-index分别是0.663,0.656,1,3,5年PFS和OS的校准图显示出预测值与实际值具有较好的一致性。将GNRI和N分期联合、GNRI和PNI联合分析时,发现两项指标较单纯GNRI相比,其预测预后生存的精确度显著增加(GNRI、coGNRI-N、coGNRI-PNI的AUROCs=0.628、0.657、0.694)。结论:GNRI可作为根治性放化疗食管鳞癌患者生存的一个简便高效的预测指标。GNRI联合N分期与GNRI联合PNI可提高预测准确性。

To evaluate the prognostic value of the geriatric nutritional risk index(GNRI)in patients with esophageal squamous cell carcinoma(ESCC)treated with definitive chemoradiotherapy(dCRT).Methods:A total of 202 ESCC patients treated with definitive chemoradiotherapy in The Fourth Hospital of Hebei Medical University from January 2013 to December 2015 were recruited.GNRI and prognostic nutritional index(PNI)were calculated before treatment,and the patients were assigned into the higher GNRI group(GNRI≥98)and lower GNRI group(GNRI<98).The effects of GNRI on progression-free survival(PFS)and overall survival(OS)were retrospectively analyzed.The nomogram for survival prediction was established using R software.The accuracy of prediction of the nomogram was evaluated using the C-index and calibration curve.The prognostic value of combined GNRI and N stage,GNRI,and PNI was further analyzed.Results:Of the 202 patients,145 patients(71.8%)were in the higher GNRI group and 57 patients(28.2%)were in the lower GNRI group.Multivariate analysis showed that N stage,radiotherapy prescription dose,and GNRI were independent prognostic factors of PFS and OS.A nomogram for PFS and OS was generated using the significant characteristics in the multivariate analysis.C-index was 0.663 and 0.656,respectively.The calibration plots presented a good agreement between the nomogram prediction and actual observation for 1-,3-,and 5-year PFS and OS.The predictive capacity became stronger when the two parameters GNRI-N stage and GNRI-PNI were used in combination(AUROCs of GNRI,GNRI-N stage,and GNRI-PNI was 0.628,0.657,and 0.694,respectively).Conclusions:GNRI can be used as a new simple and effective indicator for predicting survival in ESCC patients treated with definitive chemoradiotherapy.The combination of GNRI and N stage,GNRI,and PNI can enhance the accuracy of prognosis prediction.