GNRI对老年消化道肿瘤患者术后并发症和生存的预测价值研究

Predictive value of GNRI in postoperative complications and survival of elderly patients with gastrointestinal tumor

目的探讨老年营养风险指数对老年消化道肿瘤患者术后并发症及预后的影响。方法选择255例老年消化道肿瘤患者(年龄≥65岁),根据老年营养风险指数(geriatric nutritional risk index,GNRI)值分为GNRI正常组(GNRI>98)和GNRI异常组(GNRI≤98),其中老年肝癌患者85例(GNRI正常组n=70,GNRI异常组n=15),老年食管鳞癌患者90例(GNRI正常组n=70,GNRI异常组n=20),老年胃癌患者80例(GNRI正常组n=60,GNRI异常组n=20),严格按照纳入与排除标准,收集患者的相关临床资料并进行回顾性分析,采用Kaplan-Meier法计算生存率,Log-rank检验比较各组间生存率,评估营养风险指数对老年癌症患者术后并发症和预后的影响。结果肝癌手术后2个月内,统计并发症患者共计23例(27.06%),体重指数(body mass index,BMI)、手术时间、清蛋白含量以及GNRI是肝癌患者术后并发症的危险因素;GNRI正常组(n=15)第1、3、5年的生存率分别为82.85%、68.57%、57.14%,显著优于GNRI异常组(n=70)(73.33%、53.33%、40.00%),差异有统计学意义(P<0.05);食管鳞癌手术后2个月内,统计并发症患者共计29例(32.22%),BMI、FVE1.0%以及GNRI是食管鳞癌术后并发症发生的危险因素;GNRI正常组(n=70)第1、3、5年的生存率分别为85.71%、71.43%、55.71%显著高于GNRI异常组(n=20)(75.00%、55.00%、40.00%),差异有统计学意义(P<0.05);胃癌手术后2个月内,统计并发症患者共计16例(20.00%),BMI、心律失常以及GNRI是胃癌患者术后发生并发症的危险因素,GNRI正常组(n=60),第1、3、5年的生存率分别为83.33%、70.00%、58.33%,显著高于GNRI异常组(n=20),差异有统计学意义(P<0.05)。结论术前GNRI水平与老年消化道癌症患者的生物学行为有关,可以有效预测术后并发症和生存率。

Objective To investigate the effect of geriatric nutritional risk index(GNRI)on postoperative complications and prognosis of elderly patients with gastrointestinal tumor.Methods A total of 255 elderly patients with gastrointestinal tumor(age≥65 years)were divided into normal GNRI group(GNRI>98)and abnormal GNRI group(GNRI≤98),including 85 elderly patients with liver cancer(70 in normal GNRI group and 15 in abnormal GNRI group),90 elderly patients with esophageal squamous cell carcinoma(ESCC)(70 in normal GNRI group and 20 in abnormal GNRI group),and 80 elderly gastric cancer patients(60 in normal GNRI group and 20 in abnormal GNRI group).According to the inclusion and exclusion criteria,the clinical data of patients were collected and analyzed retrospectively.The survival rate was calculated by Kaplan Meier method,and the survival rate was compared by Log-rank test.The impact of GNRI on postoperative complications and prognosis of elderly cancer patients was evaluated.Results Within two months after liver cancer operation,23 patients(27.06%)had complications.Body mass index(BMI),duration of operation,albumin content and GNRI were the risk factors for postoperative complications in patients with liver cancer.The 1,3 and 5-year survival rates of normal GNRI group(n=15)were 82.85%,68.57%and 57.14%,respectively,which were significantly better than those(73.33%,53.33%,40.00%)of abnormal GNRI group(n=70),and the difference was statistically significant(P<0.05).Within two months after operation for ESCC,29 patients(32.22%)had complications.BMI,FVE 1.0%and GNRI were the risk factors for postoperative complications of ESCC.The 1,3 and 5-year survival rates of normal GNRI group(n=70)were 85.71%,71.43%and 55.71%,respectively,which were significantly higher than those(75.00%,55.00%,40.00%)of abnormal GNRI group(n=20),and the difference was statistically significant(P<0.05).Within two months after operation for gastric cancer,16 patients(20.00%)had complications.BMI,arrhythmia and GNRI were the risk factors for postoperative complications in patients with gastric cancer.The 1,3 and 5-year survival rates of normal GNRI group(n=60)were 83.33%,70.00%and 58.33%,respectively,which were significantly higher than those in abnormal GNRI group(n=20),and the difference was statistically significant(P<0.05).Conclusion Preoperative GNRI is related to the biological behavior of elderly patients with gastrointestinal cancer,which can be used to effectively predict the postoperative complications and survival rate.