A/G与PNI对子宫内膜癌手术切除患者预后的评估价值

The evaluation value of preoperative albumin/globulin ratio and prognosis nutrition index in the prognosis of patients after endometrial cancer resection

目的分析术前白蛋白/球蛋白比值(A/G)与预后营养指数(PNI)在子宫内膜癌(EC)手术切除患者预后的评估价值。方法回顾性总结2016年3月至2018年3月苏州大学附属张家港医院病理确诊EC患者101例,接受根治性切除术及术后放化疗,随访时间38~60个月,中位时间50.5个月。根据受试者操作特征曲线(ROC曲线)获得术前血清A/G和PNI预测总生存率的曲线下面积(AUC)和最佳临界值,并将患者分为低A/G组58例(<1.5)和高A/G组43例(≥1.5),低PNI组62例(<45.0)和高PNI组39例(≥45.0)。分析A/G和PNI与EC临床资料(包括年龄、体质指数、肿瘤直径、FIGO分期、病理分型和分化级别、治疗方式、肌层浸润深度和淋巴血管间隙浸润)的关系,筛选无进展生存率和总生存率的独立预测因素。结果ROC曲线显示,血清A/G和PNI预测总生存率的AUC值分别为0.802和0.856(P<0.05),约登指数分别为0.742和0.739。低A/G组患者年龄、FIGO分期、肌层浸润深度和淋巴血管间隙浸润比高A/G组增加,低PNI组FIGO分期、肌层浸润深度、淋巴血管间隙浸润、低分化、放化疗比高PNI组增加(P<0.05)。单因素Cox回归分析显示,年龄、FIGO分期、肌层浸润深度、淋巴血管间隙浸润、分化级别、治疗方式、血清A/G和PNI是无进展生存率和总生存率的危险因素(P<0.05)。多因素Cox回归分析显示,年龄≥65岁、FIGO分期Ⅲ~Ⅳ期、肌层浸润深度≥1/2、淋巴血管间隙浸润、A/G<1.5和PNI<45.0是无进展生存率和总生存率的独立危险因素(P<0.05)。Kalpan⁃Meier曲线显示,低A/G组比高A/G组、低PNI组比高PNI组的无进展生存率和总生存率明显降低(P<0.05)。结论术前血清A/G和PNI降低对预测EC患者术后无进展生存率和总生存率有较好效能,其中A/G<1.5和PNI<45.0可作为指导临床早期评估EC患者预后不良的重要参考依据。

Objective To analyze the evaluation value of preoperative albumin/globulin ratio(A/G)and prognosis nutrition index(PNI)for the prognosis in patients with endometrial carcinoma(EC)after operation.Methods 101 patients with EC admitted into our hospital from March 2016 to March 2018 were reviewed.The patients were treated with radical resection and radiochemotherapy after operation.The follow⁃up time was 38⁃60 months and the median time was 50.5 months.According to receiver operating curve(ROC curve),the area under curve(AUC)and optimal cut⁃off value of preoperative serum A/G and PNI for predicting and overall survival rate were obtained.They were divided into low A/G group(<1.5,n=58)and high A/G group(≥1.5,n=43),low PNI group(<45.0,n=62)and high PNI group(≥45.0,n=39).The relationship between A/G,PNI and EC clinical data(including age,body mass index,tumor diameter,FIGO stage,pathological classification and differentiation grade,treatment mode,myometric infiltration depth and lymphatic vascular space infiltration)were analyzed,and independent predictors of progression free survival rate and overall survival rate were screen.Results ROC showed that the AUC values of A/G and PNI for overall survival rate were 0.802 and 0.856,respectively(P<0.05),Youden index were 0.742 and 0.739.The age,FIGO stage,myometric infiltration depth and lymph vessel space infiltration in low A/G group were higher than high A/G group,FIGO stage,myometric infiltration depth,lymph vessel space infiltration,low differentiation and radiochemotherapy in low PNI group were higher than high PNI group(P<0.05).The univariate Cox regression analysis showed that age,FIGO stage,myometric invasion depth,lymph vessel space infiltration,differentiation grade,treatment mode,serum A/G and PNI were risk factors of progression free survival rate and overall survival rate(P<0.05).The multivariate Cox regression analysis showed that age≥65 years,FIGO stageⅢ~Ⅳ,myometric infiltration depth≥1/2,lymph vessel space infiltration,A/G<1.5 and PNI<45.0 were independent risk factors of progression free survival rate and overall survival rate(P<0.05).The Kalpan⁃Meier curve showed that progression free survival rate and overall survival rate in low A/G group were significantly lower than high A/G group,low PNI group were significantly lower than high PNI group(P<0.05).Conclusion Lower serum A/G and PNI are of great value for predicting the adverse outcome of progression free survival rate and overall survival rate in EC patients.A/G<1.5 and PNI<45.0 can be used as important references for early evaluation of worse prognosis in EC patients.