小野寺预后营养指数对食管鳞癌调强放疗预后的影响

Effect of Onodera's prognostic nutritional index on the prognosis of esophageal squamous cell carcinoma after intensity-modulated radiotherapy

目的探讨小野寺预后营养指数(PNI)与根治性放化疗或放疗的食管鳞癌患者的预后关系,为评估疗后长期生存提供方便、有效、准确的预测指标。方法回顾分析2013—2015年在河北医科大学第四医院行根治性放化疗或放疗并符合入组条件的食管鳞癌患者共231例,统计分析每例患者不同放疗阶段的PNI值并运用ROC曲线确定放疗前PNI的最佳临界值,将231患者分为营养良好组(86例)和营养不良组(145例)。应用Kaplan-Meier法生存分析,Cox模型分析不同营养状况与预后关系。比较两组患者近期疗效及不良反应。结果全组患者放疗前、第3周、第6周及结束后1月时的PNI均值分别为48.68±5.08、39.68±4.87、43.74±4.89、48.31±4.92。运用ROC曲线确认的患者疗前PNI最佳临界值为49.25,曲线下面积为0.655,敏感性为68.6%,特异性为60.9%。营养良好组(PNI≥49.25)的5年总生存率和无进展生存率分别为36.0%和31.3%,均优于营养不良组(PNI<49.25)的19.3%和18.6%(P=0.001、0.039)。多因素分析显示疗前PNI为总生存的独立预后因素(P=0.021)。进一步分层分析发现临床分期为Ⅰ、Ⅱ期以及同期化疗者营养良好组的总生存优于营养不良组(P=0.007、0.004)。另外,营养良好组放疗后缓解率高于营养不良组(P=0.047),而≥3级急性放射性食管炎发生率有低于营养不良组趋势(P=0.060)。结论疗前患者的PNI作为方便、可靠的指标可预测食管鳞癌根治性放化疗或放疗后的生存状况,PNI较高者具有较好的预后和放疗耐受性,尤其是在分期偏早或同期化疗患者中PNI的预测价值更大。

Objective To investigate the relationship between Onodera's prognostic nutritional index(PNI)and prognosis of patients with esophageal squamous cell carcinoma(ESCC)after definitive chemoradiotherapy or radiotherapy,aiming to provide a convenient,effective and accurate predictive indicator for evaluating the long-term survival of patients after treatment.Methods Clinical data of 231 ESCC patients treated with definitive chemoradiotherapy or radiotherapy at the Fourth Hospital of Hebei Medical University from 2013 to 2015 were retrospectively analyzed.The PNI values of each patient at different radiotherapy periods were calculated and the ROC curve was used to determine the optimal cutoff value of PNI before radiotherapy,231 patients were divided into the better-nourishment group(n=86)and worse-nourishment group(n=145).Kaplan-Meier method was used for survival analysis.Cox proportional hazards model was utilized to analyze the relationship between different nutritional status and prognosis.The short-term clinical efficacy and incidence of acute toxicities were statistically compared between two groups.Results The mean values of PNI before,at week 3,week 6 and 1 month after radiotherapy were48.68±5.08,39.68±4.87,43.74±4.89 and48.31±4.92,respectively.The optimal cutoff value of pretreatment PNI was 49.25,the area under the curve(AUC)was 0.655,the sensitivity and specificity were 68.6%and 60.9%,respectively.The 5-year overall survival(OS)and progression-free survival(PFS)rates in the better-nourishment group(PNI≥49.25)were 36.0%and 31.3%,significantly better than 19.3%and 18.6%in the worse-nourishment group(PNI<49.25)(P=0.001,P=0.039).Multivariate analysis showed PNI before the therapy was an independent prognostic factor for OS(P=0.021).Stratified analysis demonstrated that StageⅠ/Ⅱand concurrent chemotherapy patients in the better-nourishment group all obtained significantly better OS than their counterparts in the worse-nourishment group(P=0.007,P=0.004).In addition,the Objective response rate in the better-nourishment group was significantly higher than that in the worse-nourishment group(P=0.047),whereas the incidence of≥3 grade radiation esophagitis was lower than that in the worse-nourishment group(P=0.060).Conclusions Pretreatment PNI is a convenient and reliable indicator for predicting the long-term survival of ESCC patients after definitive chemoradiotherapy or radiotherapy.Patients with higher PNI have relatively better prognosis and radiotherapy tolerance,especially in those with early stage or concurrent chemotherapy.