预后营养指数和中性粒细胞与淋巴细胞比值在骨肉瘤患者预后预测中的应用价值

Application value of prognostic nutritional index andneutrophil-to-lymphocyte ratio in predicting prognosisof patients with osteosarcoma

目的 探讨预后营养指数(PNI)和中性粒细胞与淋巴细胞比值(NLR)对骨肉瘤患者预后预测的价值。方法 收集2000—2018年宜宾市2所综合医院92例骨肉瘤患者的病历资料,随访患者临床结局。采用受试者工作特征(ROC)曲线分析PNI和NLR预测患者预后的截断值;采用Kaplan-Meier法绘制生存曲线;采用Log-rank检验和Cox回归模型分析预后的影响因素。结果 92例患者平均随访时间58个月,平均生存时间50(23, 61)个月;随访期内发生死亡47例(51.09%),患者5年生存率为51.09%。PNI和NLR的ROC曲线的曲线下面积分别为0.957和0.788,最佳截断值为46.35和2.10。Cox回归模型显示,诊断时有转移和PNI<46.35是患者预后的危险因素,其风险比及其95%置信区间[HR(95%CI)]分别为4.361(2.021~9.410)和15.361(5.797~46.118);NLR<2.10是患者预后的保护因素,其HR(95%CI)为0.781(0.631~0.967)。诊断时有转移和无转移的患者5年生存率分别为10.26%和81.13%;PNI<46.35和≥46.35的患者5年生存率分别为11.11%和89.36%;NLR<2.10和≥2.10的患者5年生存率分别为87.10%和32.79%。结论 骨肉瘤患者PNI、NLR和诊断时转移情况与预后有关。

Objective To explore the value of prognostic nutritional index(PNI)and neutrophil-to-lymphocyte ratio(NLR)in predicting the prognosis of patients with osteosarcoma.Methods From 2000 to 2018,medical records of 92 patients with osteosarcoma were collected from two comprehensive hospitals in Yibin city and clinical outcomes of patients were followed up.Receiver operating characteristic(ROC)curve was used to analyze the cut-off values of PNI and NLR for prognosis prediction;the Kaplan-Meier method was used to draw survival curve;the Log-rank test and Cox regression model were used to analyze the influencing factors of prognosis.Results The average follow-up time of 92 patients was 58 months,with an average survival time of 50(23,61)months;during the follow-up period,47 patients(51.09%)died,with a 5-year survival rate of 51.09%.The areas under the curve of ROC curves for PNI and NLR were 0.957 and 0.788 respectively,with the optimal cut-off values of 46.35 and 2.10.Cox regression model showed that metastasis at diagnosis and PNI<46.35 were the risk factors for prognosis,with hazard ratio and its 95%confidence interval[HR(95%CI)of 4.361(2.021 to 9.410)and 15.361(5.797 to 46.118)]respectively;NLR<2.10 was a protective factor for prognosis,with HR(95%CI)of 0.781(0.631 to 0.967).The 5-year survival rates of patients with and without metastasis at diagnosis were 10.26% and 81.13% respectively;the 5-yearsurvival rates of patients with PNI<46.35 and ≥46.35 were 11.11% and 89.36% respectively;the 5-year survivalrates of patients with NLR<2.10 and ≥2.10 were 87.10% and 32.79% respectively . Conclusion PNI, NLR andstatus of metastasis at diagnosis are associated with prognosis of patients with osteosarcoma.