肿瘤位置、预后营养指数与晚期非小细胞肺癌预后的关系研究

The relationship between tumor location,prognostic nutritional index(PNI)and prognosis of advanced non-small cell lung cancer(NSCLC)

目的探讨肿瘤位置、预后营养指数(PNI)与晚期非小细胞肺癌(NSCLC)预后的关系。方法回顾性分析2016年2月至2019年3月在湖州市中心医院住院的晚期NSCLC患者的临床资料,包括一般资料、肿瘤位置、PNI等,分析晚期NSCLC患者预后的影响因素及肿瘤位置、PNI对预后的影响,探讨肿瘤位置、PNI对患者3年预后的预测价值,并观察不同肿瘤位置、PNI患者3年生存情况。结果共纳入120例晚期NSCLC患者,根据3年生存情况分组,生存组42例,死亡组78例。根据美国东部肿瘤协作组(ECOG)体力状况评分、临床分期、分化程度、淋巴转移、肿瘤位置、PNI比较,差异有统计学意义(P<0.05)。COX回归分析发现,ECOG体力状况评分、临床分期、分化程度、淋巴转移、肿瘤位置、PNI均为晚期NSCLC患者死亡的影响因素,且在矫正ECOG体力状况评分、临床分期、分化程度、淋巴转移等混杂因素的影响后,显示肿瘤位置、PNI仍与晚期NSCLC患者死亡风险有相关性(P<0.05)。绘制ROC曲线显示,肿瘤位置、PNI均对晚期NSCLC患者预后具有一定预测价值,联合预测时效能更高,曲线下面积为0.821,敏感度为70.51%,特异度为83.33%。将患者分为下叶、中上叶患者与低PNI(≤cut-off值)、高PNI(>cut-off值)患者,采取Kaplan-Meier曲线分析显示,下叶患者3年生存率低于中上叶患者,低PNI患者3年生存率低于高PNI患者(P<0.05)。结论肿瘤位置、PNI为晚期NSCLC预后死亡的重要影响因素,联合预测患者预后死亡价值较高,可为临床诊治提供可靠依据。

Objective To analyze the relationship between tumor location,prognostic nutritional index(PNI)and prognosis of advanced non-small cell lung cancer(NSCLC).Methods The clinical data of 120 patients with advanced NSCLC accepted by the hospital from February 2016 to March 2019 were retrospectively analyzed,and the 3-year survival of the patients was observed.According to these,the patients were divided into a survival group and a death group.The general data,tumor location,and PNI were compared between the two groups.The influencing factors of prognosis of patients with advanced NSCLC and the influence of tumor location and PNI on prognosis were analyzed.To explore the predictive value of tumor location and PNI in 3-year prognosis of patients,the 3-year survival of patients with different tumor locations and PNI was observed.Results Among the 120 advanced NSCLC patients in this group,42 survived within 3 years and were classified as the survival group.78 patients died within 3 years and were classified as the death group.The Eastern Cooperative Oncology Group(ECOG)physical status score,clinical stage,degree of differentiation,lymph node metastasis,tumor location,and PNI were compared between the two groups,and the differences were statistically significant(P<0.05).By using COX regression analysis,it was found that ECOG physical status score,clinical stage,degree of differentiation,lymph node metastasis,tumor location,and PNI were all influencing factors of death in patients with advanced NSCLC.After adjusting for the influence of confounding factors such as ECOG physical status score,clinical stage,degree of differentiation,and lymph node metastasis,it showed that tumor location and PNI were still significantly correlated with the risk of death in patients with advanced NSCLC(P<0.05).The ROC curve plotting showed that both tumor location and PNI had certain predictive value for the prognosis of advanced NSCLC patients,and the combined prediction was more efficient.The area under the curve was 0.821,the sensitivity was 70.51%,and the specificity was 83.33%.The patients were divided into lower lobe,middle and upper lobe patients,and patients with low PNI(≤cut-off value)and high PNI(>cut-off value).Kaplan-Meier curve analysis showed that the 3-year survival rate of lower lobe patients was lower than that of the middle and upper lobe patients,and the 3-year survival rate of patients with low PNI was lower than that of patients with high PNI(P<0.05).Conclusion Tumor location and PNI are important influencing factors for the prognosis and death of advanced NSCLC.The combined prediction value of the prognosis of patients with death is high,which can provide a reliable basis for clinical diagnosis and treatment.