术前老年营养风险指数联合内生肌酐清除率对老年肾透明细胞癌患者的预后价值

Prognostic value of preoperative geriatric nutritional risk index combined with endogenous creatinine clearance in elderly patients with renal clear cell carcinoma

目的探讨术前老年营养风险指数(GNRI)联合内生肌酐清除率(Ccr)对老年肾透明细胞癌患者的预后价值。方法选取2016年1月至2017年12月广西医科大学第一附属医院泌尿外科收治住院的老年肾透明细胞癌患者148例,根据随访状况将患者分为存活组122例和死亡组26例。采用采用单因素和多因素Cox回归分析老年肾透明细胞癌患者预后的影响因素。采用Kaplan-Meier分析GNRI和Ccr与老年肾透明细胞癌患者总生存时间的相关性。绘制受试者工作特征曲线分析预测效能。结果两组患者一般资料中,性别、M分期、T分期、肿瘤坏死、白蛋白、GNRI差异有统计学意义(P<0.05);两组患者血清指标中,碱性磷酸酶、前白蛋白、Ccr差异有统计学意义(P<0.05)。Cox回归分析显示,GNRI升高(HR:0.803,95%CI:0.686~0.939)与Ccr升高(HR:0.971,95%CI:0.943~0.999)是老年肾透明细胞癌患者预后的保护因素(P<0.05),肿瘤M分期为M 1期(HR:5.132,95%CI:1.021~25.787)、T分期为T 3、T 4期(HR:5.179,95%CI:1.249~21.473)是老年肾透明细胞癌患者预后的危险因素(P<0.05)。Kaplan-Meier生存曲线显示,高GNRI组5年生存率高于低GNRI组(χ^(2)=15.446,P<0.001),高Ccr组5年生存率高于低Ccr组(χ^(2)=11.959,P=0.001)。受试者工作特征曲线曲线显示,GNRI联合Ccr对患者术后1年及3年预后不良预测效果好(曲线下面积分别为0.909、0.755)。结论术前GNRI和Ccr的降低与老年肾透明细胞癌患者预后不良密切相关,GNRI联合Ccr预测老年肾透明细胞癌患者疗效更佳。

Objective To investigate the prognostic value of preoperative geriatric nutritional risk index(GNRI)combined with endogenous creatinine clearance(Ccr)in elderly patients with renal clear cell carcinoma.Methods From January 2016 to December 2017,a total of 148 elderly patients with renal clear cell carcinoma were admitted to the Department of Urology,the First Affiliated Hospital of Guangxi Medical University.Based on the follow-up status,the patients were divided into a survival group(122 cases)and a death group(26 cases).Univariate and multivariate Cox regression analyses were used to explore the prognostic factors of elderly patients with renal clear cell carcinoma.Kaplan-Meier was performed to access the correlation between GNRI,Ccr and overall survival time in elderly patients with renal clear cell carcinoma.Receiver operating characteristic curve analysis was conducted to evaluated the predictive performance.Results There were statistically significant differences in general data between the two groups,including gender,M stage,T stage,tumor necrosis,albumin and GNRI(P<0.05).There were statistically significant differences in serum index between the two groups,including alkaline phosphatase,prealbumin and Ccr(P<0.05).Cox regression analysis demonstrated that the increase of GNRI(HR:0.803,95%CI:0.686-0.939),and Ccr(HR:0.971,95%CI:0.943-0.999)were the protective factors in the prognosis of the elderly patients with renal clear cell carcinoma.M 1 stage(HR:5.132,95%CI:1.021-25.787),T stage and T 3,T 4 stage(HR:5.179,95%CI:1.249-21.473)tumors were risk factors affecting the prognosis(P<0.05).Kaplan-Meier survival curve showed that the 5-year survival rate of high GNRI group was higher than that of low GNRI group(χ^(2)=15.446,P<0.001),and the 5-year survival rate of high Ccr group was higher than that of low Ccr group(χ^(2)=11.959,P=0.001).The ROC curve indicated the combination of GNRI and Ccr had a good predictive effect on poor prognosis of patients at one year and three years after operation(AUC=0.909,0.755).Conclusions Preoperative decreases in GNRI and Ccr are associated with poor prognosis in elderly patients with renal clear cell carcinoma,and the combination of GNRI and Ccr provides better prediction of treatment efficacy.