预后营养指数及其他临床指标与脑胶质瘤术后患者预后的相关性分析

Correlation of prognostic nutritional index and related indicators with prognosis of postoperative patients with glioma

目的探讨预后营养指数(PNI)及其他临床指标与脑胶质瘤术后患者预后的相关性。方法回顾性选取行手术治疗的151例脑胶质瘤患者作为研究对象,收集患者临床资料并进行随访。绘制受试者工作特征(ROC)曲线分析不同指标对患者预后的预测效能,采用Kaplan-Meier法绘制生存曲线,通过Log-rank检验和Cox回归分析探讨患者预后的影响因素。结果151例患者中位随访时间为13个月,平均生存周期21.89个月,随访期内死亡101例(占66.89%)。白蛋白(ALB)、前白蛋白(PA)、淋巴细胞计数(LYM)、PNI、体质量指数(BMI)和C反应蛋白(CRP)预测患者预后的最佳截断值分别为36.45 g/L、206.0 mg/L、1.85×10^(9)/L、46.9、21.45 kg/m^(2)和8.55 mg/L,曲线下面积分别为0.885、0.683、0.867、0.955、0.635和0.646。单因素分析显示,世界卫生组织(WHO)中枢神经系统肿瘤分级(简称WHO分级)、术式、术前卡氏功能状态(KPS)评分、ALB、PA、LYM、BMI、CRP和PNI均为脑胶质瘤患者预后的影响因素(P<0.05)。多因素Cox回归分析显示,PNI≥46.9、术前KPS评分≥60分和WHO分级Ⅱ级、Ⅲ级(相对于Ⅳ级)均为脑胶质瘤患者预后的保护因素(HR=0.925、0.964、0.122、0.577,P<0.05)。WHO分级Ⅱ级、Ⅲ级、Ⅳ级患者的1年生存率分别为85.37%、50.75%、16.28%,PNI<46.9和PNI≥46.9患者的1年生存率分别为34.38%和87.27%,术前KPS评分<60分和KPS评分≥60分患者的1年生存率分别为30.23%和62.96%。结论脑胶质瘤患者的临床预后较差,PNI、术前KPS评分和WHO分级均与患者预后相关。

Objective To discuss the correlation of prognostic nutritional index(PNI)and related indicators with prognosis of postoperative patients with glioma.Methods A total of 151 patients with glioma were retrospectively selected as study objects,and relevant clinical data were collected and the follow-up was conducted.Receiver operating characteristic(ROC)curve was drawn to analyze the efficacy of different indicators in predicting prognosis.Kaplan-Meier method was used to draw the survival curve,and Log-rank test and Cox regression were used to analyze the influencing factors of prognosis.Results Of the 151 patients,the median follow-up duration was 13 months,and the average survival period was 21.9 months.The death rate during the follow-up period was 66.89%(101 cases).The best cutoff values of albumin(ALB),prealbumin(PA),lymphocyte(LYM),PNI,body mass index(BMI)and C-reactive protein(CRP)in predicting the prognosis of patients were 36.45 g/L,206.0 mg/L and 1.85×10^(9)/L,46.9,21.45 kg/m^(2)and 8.55 mg/L,respectively,with areas under the curve of 0.885,0.683,0.867,0.955,0.635 and 0.646,respectively.Univariate analysis showed that World Health Organization(WHO)tumor grading for central nervous system(short for WHO grading),operation mode,preoperative Karnofsky Performance Status(KPS)score,ALB,PA,LYM,BMI,CRP and PNI were the influencing factors of prognosis in glioma patients(P<0.05).COX multivariate analysis showed that PNI≥46.9,preoperative KPS score≥60 and WHO gradeⅡandⅢ(compared with gradeⅣ)are the protective factors for the prognosis of patients with glioma(HR=0.925,0.964,0.122 and 0.577 respectively,P<0.05).The one-year survival rates of patients with gradeⅡ,ⅢandⅣof WHO were 85.37%,50.75 and 16.28%respectively,and the one-year survival rates of patients with PNI<46.9 and≥46.9 were 34.38%and 87.27%respectively.The one-year survival rates of patients with preoperative KPS score<60 and≥60 were 30.23%and 62.96%,respectively.Conclusion The clinical prognosis of glioma is poor.PNI,preoperative KPS score and WHO grade are related to the clinical outcome of patients with glioma.