非小细胞肺癌化疗患者营养状况评估及其对患者预后的影响

Evaluation of nutritional status of patients with non-small cell lung cancer after chemotherapy and its influence on prognosis

目的非小细胞肺癌化疗患者营养状况评估及其对患者预后的影响。方法选择2015年6月至2016年6月于我院首次确诊的中晚期NSCLC患者124例,随访至2020年6月,记录患者治疗前1d化验血清白蛋白及外周血淋巴细胞计数,计算预后营养指数(PNI),应用Kaplan-Meier法计算生存曲线,采用Cox风险模型进行多因素分析。结果出现肺漏气的患者的PNI水平明显低于无肺漏气患者(P<0.05)。高PNI组四年死亡率为54.55%显著低于低PNI组的75.36%(P<0.05)。高PNI组患者中位OS为40个月,低PNI组患者中位OS为18个月(P<0.05)。COX多因素分析得出,PNI、年龄、吸烟、临床分期、胸腔积液及联合手术是影响中晚期NSCLC预后情况因素(P<0.05)。结论在中晚期NSCLC中,低PNI、年龄≥65岁、存在胸腔积液、吸烟、Ⅳ期、不联合手术、咯血,均是NSCLC患者OS的影响因素,PNI在中晚期NSCLC预后评估方面发挥重要作用,可作为OS的评估指标在临床中广泛应用。

Objective To evaluate the nutritional status of patients with non-small cell lung cancer(NSCLC)after chemotherapy and its influence on prognosis.Methods 124 patients with advanced NSCLC who were first diagnosed in our hospital from June 2015 to June 2016 were selected and followed up to June 2020.Serum albumin and peripheral blood lymphocyte count were recorded one day before treatment,prognostic nutritional index(PNI)was calculated,survival curve was calculated by Kaplan Meier method,and univariate and multivariate analysis was performed by Cox risk model.Results The PNI level of patients with pulmonary leakage was significantly lower than that of patients without pulmonary leakage(P<0.05).The 4-year mortality of the high PNI group was 54.55%,which was significantly lower than that of the low PNI group(75.36%)(P<0.05).The median OS was 40 months in the high PNI group and 18 months in the low PNI group(P<0.05).Cox multivariate analysis showed that PNI,age,smoking,clinical stage,pleural effusion and combined surgery were the prognostic factors of advanced NSCLC(P<0.05).Conclusion In advanced NSCLC,low PNI,age≥65 years old,pleural effusion,smoking,stageⅣ,no combined surgery,and hemoptysis are the influencing factors of OS.PNI plays an important role in the prognosis evaluation of advanced NSCLC,and can be widely used as the evaluation index of OS in clinic.