预后营养指数对进展期胃癌患者术后并发症及短期生存率的影响分析

Effect of Prognostic Nutritional Index on Postoperative Complications and Short-term Survival Rate for Patients with Advanced Gastric Cancer

目的探讨预后营养指数(PNI)对进展期胃癌患者术后并发症及3年生存率的影响。方法回顾性分析我院2015年10月~2017年9月收治的106例进展期胃癌患者的临床资料。通过外周血淋巴细胞数和白蛋白数值计算患者的PNI值,应用ROC曲线计算Yo u n d e n指数,进一步计算出PNI的最佳临界值。计算出全部患者PNI的均值,根据PNI均值将患者分为高PNI组和低PNI组。比较两组患者的临床病理特征以及总体生存率(OS)的差异。分别使用logistic回归分析和Co x比例风险模型分析PNI和术后并发症、远期生存率的关系。结果PNI的最佳临界值为46。PNI均值为45.6,高PNI组患者为69例,低PNI组患者为37例。两组患者在年龄(χ^(2)=4.049,P=0.044)、BMI(χ^(2)=4.381,P=0.036)、淋巴结转移(χ^(2)=5.110,P=0.024)、浆膜浸润(χ^(2)=20.856,P<0.001)以及术后并发症(χ^(2)=5.384,P=0.020)方面有显著差异。两组患者OS有显著差异(χ^(2)=15.232,P<0.001)。非条件二元Logistic回归分析显示PNI<46(OR=2.256,P<0.001)和浆膜侵犯(OR=2.038,P<0.001)是术后并发症出现的独立危险因素。在多变量分析中,显示年龄≥60岁(HR=2.963,P=0.012)、PNI<46(HR=10.430,P<0.001)、出现淋巴结转移(HR=3.600,P=0.025)、发生术后并发症(HR=4.056,P=0.039)是总体生存率的独立预测因子。结论影响胃癌患者术后并发症和生存率的因素较多,PNI不仅可以用来评估进展期胃癌患者术后并发症的增加风险,还可预测术后的短期生存率,应纳入胃癌患者的常规评估并加强胃癌患者围手术期管理。

Objective To investigate the effect of prognostic nutritional index(PNI)on postoperative complications and 3-year survival rates for patients with advanced gastric(AGC)cancer.Methods The data of 106 AGC patients were extracted and analyzed between October 2015 and September 2017 in our hospital.The PNI value was calculated based on the peripheral blood lymphocyte count and albumin value,and the optimal cut-off value of PNI was calculated by a receiver operating characteristic(ROC)curve.The mean PNI of all patients was calculated.Patients were divided into high PNI group and low PNI group according to the mean PNI.The clinicopathological characteristics and overall survival rate(OS)were compared between two groups.Logistic regression analysis and Cox proportional hazard model were used to analyze the relationship between PNI and postoperative complications and long-term survival rate.Results The optimal cut-off value of PNI was 46.The mean PNI was 45.6.Sixty-nine cases were classified in high PNI group and 37 cases were in low PNI group.There were significant differences in age(χ^(2)=4.049,P=0.044),BMI(χ^(2)=4.381,P=0.036),lymph node metastasis(χ^(2)=5.110,P=0.024),serosal invasion(χ^(2)=20.856,P<0.001)and postoperative complications(χ^(2)=5.384,P=0.020)between two groups.There was significant difference in OS between two groups(χ^(2)=15.232,P<0.001).Unconditional binary logistic regression analysis showed that PNI<46(OR=2.256,P<0.001)and serosal invasion(OR=2.038,P<0.001)were independent risk factors for postoperative complications.In multivariate analysis,age≥60 years(HR=2.963,P=0.012),PNI<46(HR=10.430,P<0.001),lymph node metastasis(HR=3.600,P=0.025)and postoperative complications(HR=4.056,P=0.039)were independent predictors of overall survival.Conclusion Many factors affect postoperative complications and survival rate of AGC patients.PNI can be used not only to assess the increased risk for postoperative complications,but also to predict short-term survival rate after surgery.It should be included in a routine evaluation and strengthen the perioperative management of gastric cancer patients.