基于CONUT、WPCBAL、PNI评分对终末期肺癌患者生存预测的比较分析

Prognostic Value of CONUT,WPCBAL and PNI Scores in End-stage Lung Cancer

目的:探索控制营养状况(Controlling Nutritional Status,CONUT)评分、WPCBAL评分、预后营养指数(Prognostic Nutritional Index,PNI)等3种预后评分系统对晚期肺癌患者生存时间的预测效能。方法:收集2018年12月—2021年12月在山东省第一医科大学附属肿瘤医院住院期间发生死亡,且具有评估所需全部数据的138例晚期肺癌患者的相关资料,进行回顾性分析。3个评分系统不同组别人群生存期差异的比较采用Log-rank检验,评估系统对终末期肺癌患者2周生存期的预测效能用受试者工作特征(ROC)曲线进行评价。结果:138例终末期肺癌患者的中位年龄为63.5岁,末次入院的中位生存时间为14 d,2周死亡率为51.4%。Log-rank检验结果显示,CONUT≥5分组的生存时间比CONUT<5分组更短,差异有统计学意义(11 d vs 16 d,P=0.046);WPCBAL≥5分组的生存时间比WPCBAL<5分组更短,差异有统计学意义(8 d vs 16 d,P=0.002)。ROC曲线显示,CONUT、WPCBAL对晚期肺癌患者2周生存状态的预测有一定价值,ROC曲线下面积分别为0.613、0.677。CONUT评分以5为截点时,预测晚期肺癌患者2周生存期的灵敏度、特异度分别为0.61、0.54;WPCBAL评分以5为截点时,预测晚期肺癌患者2周生存期的灵敏度、特异度分别为0.76、0.54。结论:CONUT评分、WPCBAL评分对预测晚期肺癌患者短期生存状态有一定价值,但特异度相对较低,仍需进一步研究。

Objective To evaluate the prognostic value of Prognostic Nutritional Index(PNI),Controlling Nutritional Status(CONUT)score,and WPCBAL score in end-stage lung cancer patients.Method Clinical data of 138 patients discharged dead from medical administration of the affiliated cancer hospital of Shandong first medical university between December 2018 to December 2021 were retrospectively analyzed.The log-rank test was used to compare the differences in survival time among prognostic tools.The receiver operating characteristic(ROC)curve was used to evaluate the predictive values of various prognostic tools for 2-week mortality.Result The median survival age and the median survival time were 63.5 years and 14 days,respectively.The 2-week mortality rate was 51.4%.Compared with the CONUT score<5 group,Log-rank test showed that the survival time of the CONUT score≥5 group was shorter(11 d vs.16 d,P=0.046).WPCBAL score≥5 had a shorter survival time than WPCBAL score<5 group(8 d vs 16 d,P=0.0018).ROC analysis showed that the area under the ROC(AUC)of CONUT score and WPCBAL score in predicting 2 week survival of patients with end-stage lung cancer were 0.613 and 0.677.When CONUT takes 5 as the critical value,the sensitivity and specificity for predicting the 2-week survival status of patients with end-stage lung cancer are 0.61 and 0.54 respectively.When WPCBAL takes 5 as the critical value,the sensitivity and specificity for predicting the 2-week survival status of patients with end-stage lung cancer are were 0.76 and 0.54,respectively.Conclusion CONUT and WPCBAL score are valuable in predicting the short-term survival status of patients with end-stage lung cancer,but the specificity is relatively low,and further research is needed.