预后营养指数对Ⅲ期结肠癌根治术患者术后复发的预测价值及影响因素分析

Predictive value of prognostic nutritional index for postoperative recurrence in patients with stage Ⅲ colon cancer radical resection and influencing factors analysis

目的 探讨预后营养指数(PNI)对Ⅲ期结肠癌根治术患者术后复发的预测价值及影响因素分析。方法 选取304例Ⅲ期结肠癌根治术患者,术前1周常规抽血化验,计算PNI。术后随访3年,记录复发情况,比较复发和未复发患者术前的PNI,绘制受试者工作特征(ROC)曲线,计算曲线下面积(AUC),评估术前PNI对Ⅲ期结肠癌患者术后复发的预测价值。结肠癌根治术患者术后3年复发的影响因素采用多因素Logistic回归分析。结果 随访3年,304例Ⅲ期结肠癌根治术患者病死37例,病死率为12.17%,除外死亡病例,复发93例,未复发174例,复发率为34.83%,复发患者的术前PNI明显低于未复发患者(P﹤0.01)。术前1周的PNI预测Ⅲ期结肠癌根治术患者术后3年复发的AUC为0.775(95%CI:0.720~0.830),此时的灵敏度为59.20%,特异度为86.02%,最佳截断值为51.39。Logistic回归分析结果显示,淋巴结转移、血管侵犯、分化程度为低分化、N分期为N;期、脉管内癌栓均为Ⅲ期结肠癌根治术患者术后3年复发的独立危险因素(P﹤0.05),术后辅助化疗是Ⅲ期结肠癌根治术患者术后3年复发的独立保护因素(P﹤0.05)。结论 Ⅲ期结肠癌根治术患者术前1周的PNI较低,可早期预测术后复发风险,淋巴结转移、血管侵犯、分化程度为低分化、N分期为N3期、脉管内癌栓均为Ⅲ期结肠癌根治术患者术后3年复发的独立危险因素,术后辅助化疗是独立保护因素。

Objective To explore the predictive value of prognostic nutritional index (PNI) for postoperative recurrence in patients with stage Ⅲ colon cancer radical resection and influencing factors. Method A total of 304 patients with stage Ⅲ colon cancer undergoing radical resection were selected. One week before surgery, routine blood test was performed to calculate PNI. The recurrence was recorded after 3 years of follow up. The preoperative PNI was compared between recurrent and non-recurrent patients, and receiver operating characteristic(ROC) curve was drawn, and the area under the curve (AUC) was calculated to evaluate the predictive value of preoperative PNI for postoperative recurrence in patients with stage Ⅲ colon cancer. Multivariate Logistic regression analysis was used to analyze the influencing factors of 3-year postoperative recurrence in patients with colon cancer. Result After 3 years of follow up, there were 37 cases of death, with the mortality rate of 12.17%, and there were 93 cases of recurrence and 174 cases of non-recurrence after death cases were excluded, with the recurrence rate of 34.83%, the preoperative PNI in the recurrence group was significantly lower than that in the non-recurrence group (P<0.01). The AUC of PNI values 1 week before operation in predicting postoperative recurrence of stage Ⅲ colon cancer 3 years after operation was 0.775 (95%CI: 0.720-0.830), with sensitivity of 59.20%, specificity of 86.02% and best cut-off value of 51.39. Logistic regression showed lymph node metastasis, vascular invasion, lower tumor differentiation, N;staging and endovascular cancer embolus were independent risk factors of postoperative recurrence of stage Ⅲ colon cancer 3 years after operation(P<0.05), and postoperative adjuvant chemotherapy was an independent protective factor (P<0.05). Conclusion The PNI values of stage Ⅲ colon cancer patients treated with colon cancer radical operation 1 week before operation are low, which can be used to predict the clinical recurrence;lower tumor differentiation, N3staging and endovascular cancer embolus are independent risk factors of postoperative recurrence of stage Ⅲ colon cancer 3 years after operation and postoperative adjuvant chemotherapy is an independent protective factor.