预后营养指数对原发性非小细胞肺癌患者预后的预测意义及列线图的建立研究

Value of Prognostic Nutritional Index in Predicting the Prognosis of Patients with Primary Non-small Cell Lung Cancer and a Nomogram Model Construction

目的 研究预后营养指数对原发性非小细胞肺癌患者预后的预测意义及列线图的建立。方法 选取122例原发性非小细胞肺癌患者作为研究对象,根据患者1年内生存死亡情况分为生存组(n=89)和死亡组(n=33),分析两组患者不同临床特征(性别、年龄、病理类型、是否存在淋巴结转移、TMN分期和是否吸烟)以及患者预后营养指数水平(PNI),创建COX同时构建风险回归分析,绘制原发性非小细胞肺癌患者预后生存风险列线图。结果 两组患者在是否存在淋巴结转移、TMN分期以及预后营养指数方面存在明显差异(P<0.05)。将单因素分析中具有统计学意义的因素列入COX回归分析结果提示,是否存在淋巴结转移、TMN分期以及预后营养指数是原发性非小细胞肺癌患者的预后独立预测因子,原发性非小细胞肺癌患者预后风险函数模型表达式为:h(t)=h_(0(t))exp(1.472X1+1.665X+1.593X)。该函数模型表现为取值越大,则风险函数h(t)相应较高,患者的预后越差,死亡风险越高。该模型一致性系数为0.701,其标准差为0.012,内部一致性极高。根据列线图可以得出患者评分越高,则预后效果越差。结论 预后营养指数对原发性非小细胞肺癌患者预后的预测意义较大,同时为患者创建列线图有利于预测患者预后,为患者制定个性化治疗方案。

Objective To investigate the prognostic value of prognostic nutritional index(PNI) in patients with primary non-small cell lung cancer,and to develop a Nomogram prognostic model.Methods A total of 122 patients with primary non-small cell lung cancer were enrolled,and divided into 2 groups according to the 1-year survival status,survival group(n=89) and death group(n=33).PNI was compared among patients with different clinical characteristics(gender,age,pathological type,lymph node metastasis,TMN stage and smoking) and different prognosis status.Based on Cox proportional hazards regression model,a nomogram to predict the prognosis of primary non-small cell lung cancer patients was constructed.Results A significant difference was found in lymph node metastasis,TMN stage and prognostic nutritional index between the 2 groups(P<0.05).Statistically significant variables from univariate analysis were included,and the COX regression analysis suggested that the presence of lymph node metastasis,TMN stage and prognostic nutritional index were independent predictors of prognosis in patients with primary non-small cell lung cancer.For Cox regression model,the prognostic hazard function was given by formula:h(t)=h_(0(t))exp(1.472 X1+1.665 X+1.593 X).The functional model revealed that the hazard function h(t) increased correspondingly when the value was large,6 patients with worse prognosis suffered a higher risk of death.The consistency coefficient and standard deviation of the model were 0.701 and 0.012 respectively,indicating very high internal consistency.Nomogram indicated that patients with higher score had a worse prognosis.Conclusion Prognostic nutritional index is of great prognostic significance in primary non-small cell lung cancer patients,moreover,the construction of nomograms for patients is beneficial in predicting the clinical outcomes and develoPNIg personalized treatment regimens for patients.