术前营养炎症指标对胃癌患者生存的预后价值分析

Prognostic Value of Preoperative Nutritional Inflammation Index for Survival of Gastric Cancer Patients

目的:探索术前营养炎症指标(预后营养指数PNI、系统免疫炎症指数SII、血小板与淋巴细胞比值PLR、中性粒细胞与淋巴细胞比值NLR、体质指数BMI)对胃癌患者生存状态的影响,为胃癌的防治提供科学依据。方法:回顾性分析2016年1—12月在山西省肿瘤医院初次诊断的胃癌患者的临床资料,计算患者术前PNI、SII、PLR、NLR、BMI。单因素生存分析采用Log-rank检验,多因素生存分析采用COX回归分析。结果:共有928例患者符合纳入标准。年龄最小者32岁,最大者88岁,平均年龄(63.69±9.27)岁。男性731例、女性197例。R语言“survminer”包确定各变量最佳截断值:年龄65岁、中性粒细胞3×10^(9)/L、淋巴细胞2×10^(9)/L、血小板314×10^(9)/L、白蛋白(ALB)41g/L、PNI 46、SII 531、PLR 187、NLR 2、BMI 20 kg/m^(2)。单因素生存分析显示,年龄、中性粒细胞、淋巴细胞、血小板、ALB、PNI、SII、PLR、NLR、BMI有统计学意义。将这些变量纳入多因素COX回归模型后,结果显示,年龄(HR:0.778,95%CI:0.644~0.941)、ALB(0.762,95%CI:0.599~0.969)、PNI(HR:0.729,95%CI:0.540~0.984)、SII(HR:1.376,95%CI:1.131~1.676)、BMI(HR:0.724,95%CI:0.576~0.909)是胃癌患者生存的影响因素。结论:术前BMI、SII、PNI、ALB对胃癌患者生存有预测价值。术前营养状况会影响胃癌根治术后患者的5年生存状态。

Objective To explore the influence of preoperative nutritional inflammatory index(PNI,SII,PLR,NLR,BMI)on the survival status of patients with gastric cancer,and provide basis for the prevention and treatment of gastric cancer.Method The clinical data of gastric cancer patients who were first diagnosed in Shanxi Provincial Cancer Hospital from January to December 2016 were retrospectively analyzed,and the preoperative PNI,SII,PLR,NLR and BMI were calculated Log-rank test was used for univariate survival analysis,and COX regression analysis was used for multivariate survival analysis.Result A total of 928 patients met the inclusion criteria.The minimum age was 32 years old,the maximum age was 88 years old,and the average age was(63.69±9.27)years old.There were 731 males and 197 females.R language"survminer"package determined the best cutoff value of each variable:age 65,Neutrophils 3×10^(9)/L,Lymphocytes 2×10^(9)/L,Platelet 314×10^(9)/L,ALB 41 g/L,PNI 46,SII 531,PLR 187,NLR 2,BMI 20kg/m^(2)。Univariate survival analysis showed that age,neutrophils,lymphocytes,platelets,ALB,PNI,SII,PLR,NLR,BMI were statistically significant.After incorporating these variables into the multivariate COX regression model,the results showed that age(HR:0.778,95%CI:0.644—0.941),ALB(0.762,95%CI:0.599—0.969),PNI(HR:0.729,95%CI:0.540—0.984),SII(HR:1.376,95%CI:1.131—1.676)and BMI(HR:0.724,95%CI:0.576—0.909)were the factors that affected the survival of gastric cancer patients.Conclusion Preoperative BMI,SII,PNI and ALB have predictive value for survival of gastric cancer patients.Preoperative nutritional status will affect the five-year survival status of patients with gastric cancer after radical surgery.