术前预后营养指数在上尿路上皮癌根治性手术患者中的临床应用价值

Clinical application value of preoperative prognostic nutritional index in patients with upper tract urothelial carcinoma undergoing radical surgery

目的探讨术前预后营养指数(PNI)在上尿路上皮癌(UTUC)根治性手术患者中的临床应用价值。方法回顾性分析2012年1月至2021年6月就诊于我院并接受根治性手术的所有UTUC患者的临床资料。根据受试者工作特征曲线(ROC)下最大约登指数确定PNI的最佳截点,比较不同PNI UTUC患者的临床病理特征;分析UTUC患者术后总生存期(OS)的影响因素及生存情况。结果术前PNI预测UTUC患者5年OS的曲线下面积(AUC)为0.672(95%CI:0.586~0.750),最佳截点值为47.63。在纳入研究的136例患者中,59例(43.38%)患者的PNI<47.63(低PNI组),77例(56.62%)患者的PNI≥47.63(高PNI组);两组的年龄、病理T分期及病理N分期比较,差异具有统计学意义(P<0.05)。Cox回归分析显示,术前病理分期为T3~T4期、N1期及PNI<47.63是UTUC患者术后OS的独立危险因素(P<0.05);Kaplan-Meier生存曲线结果提示,高PNI组患者的术后5年生存率为81.82%,显著高于低PNI组的44.07%(P<0.05)。结论术前PNI可有效地评估UTUC根治性手术患者的预后,其值越低表明患者的预后越差。

Objective To explore clinical application value of preoperative prognostic nutritional index(PNI)in patients with upper tract urothelial carcinoma(UTUC)undergoing radical surgery.Methods The clinical data of all UTUC patients who underwent radical surgery in our hospital from January 2012 to June 2021 were retrospectively analyzed.The optimal cut-off point of PNI was determined according to the maximum Youden index under the receiver operating characteristic curve(ROC);the clinic opathological features of UTUC patients with different PNI were compared;the influencing factors of postoperative overall survival(OS)and survival in UTUC patients were analyzed.Results The area under the curve(AUC)of preoperative PNI for predicting 5-years OS in UTUC patients was 0.672(95%CI:0.586-0.750),and the optimal cut-off value was 47.63.Of the 136 patients included in the study,59 cases(43.38%)had PNI<47.63(low PNI group)and 77 cases(56.62%)had PNI≥47.63(high PNI group);there were significant differences in age,pathological T stage and pathological N stage between the two groups(P<0.05).Cox regression analysis showed that preoperative pathological stage of T3-T4,N1 and PNI<47.63 were independent risk factors for postoperative OS in patients with UTUC(P<0.05);Kaplan-Meier survival curve result showed that the 5-years survival rate of patients in the high PNI group was 81.82%,which was significantly higher than 44.07% in the low PNI group(P<0.05).Conclusion Preoperative PNI can effectively evaluate the prognosis of UTUC patients undergoing radical surgery,and the lower the PNI value,the worse the prognosis of patients.