营养控制状态评分联合预后营养指数评估老年胆管癌患者预后的研究

Study of controlling nutritional status score and prognostic nutritional index for prognostic evaluation of elderly patients with cholangiocarcinoma

目的评估营养控制状态(CONUT)评分及预后营养指数(PNI)与姑息治疗的老年胆管癌患者预后的关系。方法回顾性分析南通大学第二附属医院姑息治疗的104例老年胆管癌患者,评估患者的CONUT及PNI评分。根据CONUT评分将患者分为CONUT≥5组和CONUT≤4组;根据PNI评分将患者分为PNI>46.2组和PNI≤46.2组。随访患者的预后,使用Kaplan-Meier曲线评价患者的整体生存率,采用单因素和多因素回归分析影响患者生存的危险因素。结果CONUT和PNI预测患者结局是否死亡的受试者工作曲线下面积分别为0.76和0.83.CONUT≥5组或PNI≤46.2组整体生存率显著低于CONUT≤4组(中位生存期40周vs 61周,P<0.001)或PNI>46.2组(中位生存期34周vs 50周,P<0.001)。COX回归分析提示,糖类抗原CA199(HR=2.12,95%CI:1.34~2.89)、CONUT(HR=2.01,95%CI:1.44~3.12)及PNI(HR=1.95,95%CI:1.32~2.74)是患者预后的独立危险因素。结论CONUT及PNI是姑息治疗的老年胆管癌患者预后的潜在指标。CONUT≥5或PNI≤46.2提示患者预后不良。

Objective To explore the relationship between the controlling nutritional status(CONUT))score and the prognostic nutritional index(PNI)and the prognosis of elderly patients with cholangiocarcinoma treated with palliative care.Methods 104 elderly patients with cholangiocarcinoma treated with palliative care in the Second Affiliated Hospital of Nantong University were analyzed retrospectively,and the scores of CONUT and PNI were assessed.According to CONUT score,the patients were divided into CONUT≥5 group and CONUT≤4 group,and according to PNI score,they were divided into PNI>46.2 group and PNI≤46.2 group.The prognosis of the patients was followed up,the overall survival rate was evaluated by Kaplan-Meier curve,and the risk factors that affect the survival of patients were analyzed by univariate and multivariate regression.Results The area under the receiver operating curve of CONUT and PNI predicting whether a patient would die or not were 0.76 and 0.83,respectively.The overall survival rate of the CONUT≥5 group or PNI≤46.2 group was significantly lower than that of the CONUT≤4 group(median survival time 40 weeks VS 61 weeks,P<0.001)or PNI>46.2 group(median survival time 34 weeks VS 50 weeks,P<0.001).Cox regression analysis showed that carbohydrate antigenCA199(HR=2.12,95%CI:1.34-2.89),CONUT(HR=2.01,95%CI:1.44-3.12)and PNI(HR=1.95,95%CI:1.32-2.74)were independent risk factors for prognosis.Conclusion CONUT and PNI are potential predictors of the prognosis of elderly patients with cholangiocarcinoma treated with palliative care.CONUT≥5 or PNI≤46.2 indicates a poor prognosis.