基于炎症-免疫-营养状态的大阪预后评分对可切除食管鳞状细胞癌患者生存结局的预测价值

Predictive value of Osaka prognostic score based on inflammatory-immune-nutrition status for resectable esophageal squamous cell carcinoma patients

目的探讨基于血清C-反应蛋白、清蛋白和外周血总淋巴细胞计数的大阪预后评分(OPS)在可切除食管鳞状细胞癌(ESCC)患者中的预后价值。方法研究队列由2015—2019年于该院初诊并接受食管癌根治性手术切除的156例ESCC患者构成,回顾性收集所有患者的临床资料。采用受试者工作特征(ROC)曲线比较OPS与格拉斯哥预后评分(GPS)、全身免疫炎症指数(SII)及预后营养指数(PNI)对ESCC患者总体生存(OS)的预测价值。通过Kaplan-Meier生存曲线和单、多因素Cox回归分析评估不同炎症-免疫-营养参数与ESCC患者OS的关系。结果ROC曲线结果显示,与GPS、PNI和SII比较,OPS的曲线下面积(AUC)最大,为0.708,提示其对ESCC患者OS的预测效能更好。生存曲线结果显示,OPS为0、1和2~3分的患者5年OS率分别为58.9%,43.5%和24.0%,组间OS率比较差异均有统计学意义(P<0.05)。OPS越高,ESCC患者的OS率越低,提示预后不佳。此外,GPS1~2分、PNI<49.5和SII≥384.4与ESCC患者不良预后相关(P<0.05)。单、多因素Cox回归分析表明,OPS是唯一能够独立预测ESCC患者OS的炎症-免疫-营养参数(P<0.05)。结论OPS综合反映了机体的炎症-免疫-营养状态,可作为一项有效的预后工具,为接受手术治疗的ESCC患者提供更为准确的术后风险分层。

Objective To investigate the prognostic value of Osaka prognostic score(OPS)based on serum C-reactive protein,albumin and total lymphocyte count for resectable esophageal squamous cell carcinoma(ESCC)patients.Methods This study cohort consisted of totally 156 ESCC patients who were initially diagnosed and underwent R0 surgical resection in the hospital from 2015 to 2019,and the clinical data of all patients were collected retrospectively.Receiver operating characteristic(ROC)curve was plotted to compare the predictive value of OPS,Glasgow prognostic score(GPS),systemic immune inflammation index(SII)and prognostic nutritional index(PNI)for the overall survival(OS)of ESCC patients.The relationships between various inflammatory-immune-nutrition parameters and OS of ESCC patients were analyzed by the Kaplan-Meier survival curve and the univariate and multivariate Cox regression analysis.Results ROC curve results showed that the area under curve(AUC)of OPS was 0.708,which was the greatest when compared with GPS,PNI and SII.These data suggested that OPS score had a better predictive ability for OS of ESCC patients.All patients were grouped according to the scores.The survival curve analysis revealed that the 5-year OS rates of patients with OPS 0,1 and 2-3 were 58.9%,43.5%and 24.0%,respectively,and there was statistically significant difference in OS rate between groups(P<0.05).The higher OPS score,the worse OS rate in ESCC patients,suggesting a poor prognosis.In addition,it was observed that GPS 1-2,PNI<49.5 and SII≥384.4 were significantly correlated with poor prognosis of ESCC patients(P<0.05).The results of the univariate and multivariate Cox regression analysis demonstrated that OPS was the only inflammation-immune-nutrition parameter that could independently predict OS in ESCC patients(P<0.05).Conclusion OPS comprehensively reflects the inflammation-immune-nutrition status of the body,and could be used as an effective prognostic tool to provide more accurate postoperative risk stratification for ESCC patients undergoing surgery.