预后营养指数和白蛋白球蛋白比值对胆管癌晚期患者的预后价值

Prognostic value of prognostic nutritional index and albumin to globulin ratio in patients with advanced cholangiocarcinoma

目的探讨预后营养指数(PNI)和白蛋白球蛋白比值(AGR)在胆管癌晚期患者的总体预后价值。方法分析2015年1月至2019年12月在郑州大学第一附属医院收治125例胆管癌晚期患者的临床资料, 通过受试者工作特征曲线(ROC)得到PNI和AGR最佳截断值, 分别以46.50和1.67为分界值分组, 分为高PNI组和低PNI组, 高AGR组和低AGR组, 分析各组年龄、性别、吸烟、糖尿病、黄疸、肿瘤位置、分化程度、转移、辅助化疗的统计学差异, 采用Cox回归模型分析有可能影响胆管癌晚期预后因素。结果 Kaplan-Meier生存曲线分析提示高PNI组中位生存时间(OS)为19个月[95%可信区间(CI):15.4~22.5], 低PNI组中位OS为13个月(95%CI:10.5~15.1), 差异有统计学意义(P<0.01);高AGR组中位OS为19个月(95%CI:16.2~21.7), 低AGR组中位OS为15个月(95%CI:12.4~17.5, 均P<0.05);单因素分析提示黄疸[风险比(HR)=2.145, 95%CI:1.380~3.335]、转移(HR=3.121, 95%CI:2.058~4.733)、PNI(HR=0.242, 95%CI:0.156~0.375)和AGR均是影响晚期胆管患者OS的危险因素(HR=0.656, 95%CI:0.440~0.977, 均P<0.05)。多因素分析提示PNI是影响患者OS的独立危险因素(HR=0.209, 95%CI:0.078~0.564)。结论胆管癌晚期患者低PNI提示预后不良, PNI是影响患者预后的独立危险因素。

Objective To explore the prognostic value of the prognostic nutritional index(PNI)and albumin to globulin ratio(AGR)in patients with advanced cholangiocarcinoma.Methods A retrospective analysis was performed on the clinical data of 125 patients with advanced cholangiocarcinoma who were admitted to the First Affiliated Hospital of Zhengzhou University from January 2015 to December 2019.The optimal cut-off values of PNI and AGR were obtained through the receiver operating characteristic(ROC)curves.PNI and AGR were grouped based on the cut-off points of 46.50 and 1.67 respectively and divide into high PNI group and low PNI group,high AGR group and low AGR group,and the differences in age,gender,smoking,diabetes,jaundice,metastasis,tumor location,tumor differentiation,and adjuvant chemotherapy were analyzed.The prognostic factors were analyzed via univariate and Cox multivariate regression analyses.Results Kaplan-Meier survival curve analysis showed that the median survival time of high PNI group and low PNI group was 19 months[95%confidence interval(CI):15.4-22.5]and 13 months(95%CI:10.5-15.1),respectively.The median survival time of high AGR group and low AGR group was 19 months(95%CI:16.2-21.7)and 15 months(95%CI:12.4-17.5),respectively.The univariate analysis revealed that jaundice[hazard ratio(HR)=2.145,95%CI:1.380-3.335],metastasis(HR=3.121,95%CI:2.058-4.733),PNI(HR=0.242,95%CI:0.156-0.375),and AGR(HR=0.656,95%CI:0.440-0.977)were the risk factors for the prognosis of patients with advanced cholangiocarcinoma(P<0.05).The multivariate analysis in the Cox proportional hazards model showed that the PNI(HR=0.209,95%CI:0.078-0.564)was an independent predictor for the survival of the patients.Conclusion Low PNI in patients with advanced cholangiocarcinoma indicates poor prognosis and PNI is an independent risk factor affecting the prognosis of the patient.