营养风险指数在幽门狭窄胃癌患者的营养状况及预后评估中的应用

Nutritional risk index predicts the prognosis and nutritional status of patients with gastric cancer with pyloric stenosis before surgery

目的探讨术前幽门狭窄胃癌患者的营养状况及营养风险指数(NRI)对预后的预测能力。方法连续收集2016年1月至2021年12月在内江市第二人民医院接受手术治疗的215例伴有幽门狭窄的胃癌患者和324例无幽门狭窄胃癌患者。通过受试者工作特征(ROC)曲线计算NRI的最佳临界值,并通过生存分析找到预后因素,构建列线图来预测胃癌患者的生存概率。结果幽门狭窄胃癌患者的病理特征和血液参数均较差。NRI低的患者总生存期(OS)较短(56.37个月vs.63.47个月,P<0.001)。同时,在幽门狭窄的患者中,低NRI的OS也较短。多因素分析发现幽门狭窄和NRI都是OS的独立预后指标。分层分析还发现,低NRI与接受根治性切除患者的生存时间较短显著相关(P=0.046)。预测胃癌患者生存概率的列线图的C指数为0.676。结论NRI可以预测术前幽门狭窄胃癌患者的预后。

Objective To investigate the nutritional status of gastric cancer patients with pyloric stricture before surgery and the predictive ability of nutritional risk index(NRI)for prognosis.Methods This study continuously collected 215 gastric cancer patients with pyloric stenosis and 324 cases with non-pyloric stenosis in this institution from January 2016 to December 2021.The optimal threshold of NRI was calculated by receiver operating characteristic(ROC)curve and prognostic factors were identified by survival analysis.Finally,a column graph was constructed to predict the survival probability of patients with gastric cancer.Results The pathological characteristics and blood parameters of gastric cancer patients with pyloric stenosis were poor.Patients with low NRI had poorer overall survival(OS,56.37 months vs.63.47 months,P<0.001).At the same time,in patients with pyloric stenosis,the OS with low NRI was shorter.Multivariate analysis showed that pyloric stenosis and NRI were independent prognostic indicators of OS.In addition,the stratified analysis found that low NRI was significantly associated with poor survival time in patients with radical resection(P=0.046).The C index of the column graph predicting the survival probability of gastric cancer patients is 0.676.Conclusion NRI can predict the prognosis of gastric cancer patients with pyloric stricture before surgery.