放疗前Glasgow预后评分及相关指标对鼻咽癌放化疗患者预后预测的价值

Value of Glasgow prognostic score and related indexes before radiotherapy in predicting the prognosis of nasopharyngeal carcinoma patients

目的研究放疗前格拉斯哥预后评分(Glasgow prognostic score,GPS)及相关指标与鼻咽癌(nasopharyngeal carcinoma,NPC)放化疗患者临床预后的关系。方法2010年1月至2016年6月于宜宾市第三人民医院、宜宾市中医医院和核工业四一六医院放化疗的NPC患者183例,回顾患者病历资料并随访至2022年6月30日,采用Kaplan-Meier法绘制生存曲线,Log-rank检验和Cox回归分析患者预后的影响因素。结果中位随访时间87个月,随访期内死亡42例(23.0%),患者3年和5年总生存率分别为91.8%和61.2%。采用受试者工作特征(ROC)曲线分析发现白蛋白(ALB)、淋巴细胞计数(LYM)、体重指数(BMI)和C反应蛋白(CRP)4项指标对预测患者生存状况有统计学意义(P<0.05),最佳截断值(optimal cut-off)分别为34.85 g/L、1.65×10^(9)/L、22.25 kg/m^(2)和8.0 mg/L。单因素分析:肿瘤分期、T分级、N分级、ALB、LYM、BMI、CRP、NRS 2002评分及GPS等9个指标与患者总生存率有关(P<0.05),Cox回归分析发现:GPS(1分、2分)和肿瘤分期(Ⅱ期、Ⅲ期)是患者预后的危险因素,其HR及95%CI分别为2.473(1.111~5.500:1分)、5.536(1.839~16.652:2分)、1.907(1.218~2.989:Ⅱ期)和4.392(1.844~10.468:Ⅲ期)(P<0.05)。结论放疗前营养、炎症和免疫状况与NPC患者临床预后有关,GPS和肿瘤分期可以作为患者预后的独立预测因子。

Objective To study the correlation of Glasgow prognostic score(GPS)and related indexes and the prognosis of nasopharyngeal carcinoma(NPC)patients undergoing radiotherapy.Methods From January 2010 to June 2016,183 NPC patients received radiotherapy in our hospitals were retrospectively collected with patient data and followed up until June 30,2022.Kaplan-Meier method was used to draw the survival curve.Log-rank test and Cox regression were used to analyze the prognostic factors of NPC patients.Results The median follow-up time was 87 months.42 patients died during the follow-up period(23.0%).The 3-year and 5-year overall survival rates of patients were 91.8%and 61.2%,respectively.The analysis of ROC showed that albumin(ALB),lymphocyte count(LYM),body mass index(BMI)and C-reactive protein(CRP)could predict the survival of patients with the optimal cut-off values at 34.85 g/L,1.65×10^(9)/L,22.25 kg/m^(2)and 8.0 mg/L,respectively(P<0.05).Univariate analysis showed that tumor stage,T stage,N stage,ALB,LYM,BMI,CRP,NRS 2002 score and GPS were related with the prognosis of NPC patients(P<0.05).Cox regression analysis showed that GPS(1 point,2 points)and tumor stage(stageⅡand stageⅢ)were the risk factors for the prognosis of patients,with HR and 95%CI at 2.473(1.111-5.500:1 point),5.536(1.839-16.652:2 points),1.907(1.218-2.989:stageⅡ)and 4.392(1.844-0.468:stageⅢ),respectively(P<0.05).Conclusions The nutritional,inflammatory and immune status before radiotherapy are associated with the clinical prognosis of NPC patients.GPS score and tumor stage can be used as independent predictors of the prognosis of patients.