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中华普通外科学文献(电子版)

中华普通外科学文献(电子版) ›› 2020, Vol. 14 ›› Issue (04) : 261 -265. doi: 10.3877/cma.j.issn.1674-0793.2020.04.006

所属专题： 文献；

论著

术前预后营养指数对结直肠癌根治术后生存的预测价值研究
陈天文1, 温贺新1, 刘牧林1,†()   
  1. 1. 233004　蚌埠医学院第一附属医院胃肠外科
  • 收稿日期:2020-06-17 出版日期:2020-08-01
  • 通信作者: 刘牧林
  • 基金资助:
    安徽省高校学科（专业）拔尖人才学术资助重点项目(gxbjZD2016070); 安徽省高校自然科学研究项目(KJ2017A219)

Value of preoperative prognostic nutrition index in postoperative survival of colorectal cancer after radical resection

Tianwen Chen1, Hexin Wen1, Mulin Liu1,†()   

  1. 1. Department of Gastrointestinal Surgery, the First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, China
  • Received:2020-06-17 Published:2020-08-01
  • Corresponding author: Mulin Liu
  • About author:
    Corresponding author: Liu Mulin, Email:
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引用本文：

陈天文, 温贺新, 刘牧林. 术前预后营养指数对结直肠癌根治术后生存的预测价值研究[J/OL]. 中华普通外科学文献(电子版), 2020, 14(04): 261-265.

Tianwen Chen, Hexin Wen, Mulin Liu. Value of preoperative prognostic nutrition index in postoperative survival of colorectal cancer after radical resection[J/OL]. Chinese Archives of General Surgery(Electronic Edition), 2020, 14(04): 261-265.

目的

探讨术前预后营养指数（PNI）对结直肠癌根治术后患者预后的评估价值。

方法

回顾性分析2011年1月至2014年1月在蚌埠医学院第一附属医院行结直肠癌根治术的182例结直肠癌患者临床资料和随访资料。根据入院首次采血检查结果，计算PNI、中性粒细胞-淋巴细胞比（NLR）和淋巴细胞-单核细胞比（LMR）。采用受试者工作特征曲线（receiver operating characteristic curve, ROC）曲线获取PNI、NLR和LMR指标最佳截断值。采用Kaplan-Meier生存曲线进行生存分析，Cox比例风险模型分析术前PNI与患者预后的关联性。

结果

患者术前PNI为22.03~71.06（47.62±9.88），最佳截断值为45.61。高PNI组（≥45.61，115例）患者的5年总生存率明显高于低PNI组（<45.61，67例）（χ2=19.706，P<0.001）。术前PNI与体质指数、肿瘤大小、T分期、N分期、癌胚抗原、CA19-9、NLR和LMR有关。PNI是影响结直肠癌根治术后5年生存的独立危险因素（HR=1.835，95% CI：1.067~3.157，P=0.028）。

结论

术前PNI是影响结直肠癌患者根治术后生存的独立危险因素，对结直肠癌的预后评估有一定的临床应用价值。

关键词: 结直肠癌, 预后营养指数, 炎症指数, 生存分析, 预后
Objective

To explore the prognostic value of preoperative prognostic nutritional index (PNI) for patients with colorectal cancer after radical resection.

Methods

The clinical data and follow-up data of 182 patients with colorectal cancer undergoing radical colorectal cancer surgery in the First Affiliated Hospital of Bengbu Medical College from January 2011 to January 2014 were retrospectively analyzed. Preoperative PNI, neutrophil-lymphocyte ratio (NLR) and lymphocyte-monocyte ratio (LMR) were calculated, according to the results of the first blood sampling before operation. Receiver operating characteristic curve (ROC) curve was used to obtain the best cut-off value of PNI index, NLR and LMR. Kaplan-Meier survival curve and Cox proportional hazard model were used to analyze the correlation between preoperative PNI and patients’ prognosis.

Results

The preoperative PNI was 22.03-71.06 (47.62±9.88), with the best cut-off value of 45.61. The 5-year survival rate of patients in the high PNI group (≥45.61, 115 cases) was significantly higher than that in the low PNI group (<45.61, 67 cases), the difference was statistically significant (χ2=19.706, P<0.001). Preoperative PNI was associated with body mass index, tumor size, T stage, N stage, CEA, CA19-9, NLR and LMR, pointing out to be an independent risk factor for 5-year survival after radical resection of colorectal cancer (HR=1.835, 95% CI: 1.067-3.157, P=0.028).

Conclusion

Preoperative PNI is an independent risk factor that affects the survival of patients after colorectal cancer radical surgery, which has a certain clinical value for the prognosis evaluation of colorectal cancer.

Key words: Colorectal cancer, Prognostic nutrition index, Inflammation index, Survival analysis, Prognosis
图1 中性粒细胞-淋巴细胞比（NLR）、淋巴细胞-单核细胞比（LMR）和预后营养指数（PNI）的ROC曲线
表1 PNI、NLR和LMR的ROC曲线结果
指标 曲线下面积 95% CI Cut-off 敏感度(%) 特异度(%) P值
PNI 0.709 0.630~0.787 45.61 70.43 68.66 <0.001
NLR 0.630 0.544~0.717 3.38 72.17 52.24 0.003
LMR 0.624 0.541~0.707 4.66 72.17 47.76 0.005
表2 术前PNI与结直肠癌患者临床病理资料间关系(例)
因素 低PNI组 高PNI组 χ2值 P值
例数 67 115 ? ?
性别 ? ? 0.961 0.327
? 男 37 72 ? ?
? 女 30 43 ? ?
年龄(岁) ? ? 2.530 0.112
? <60 42 85 ? ?
? ≥60 25 30 ? ?
体质指数(kg/m2) ? ? 5.339 0.021
? <18.5 13 9 ? ?
? ≥18.5 54 106 ? ?
组织学分型 ? ? 1.531 0.216
? 腺癌 45 87 ? ?
? 其他 22 28 ? ?
肿瘤部位 ? ? 0.314 0.575
? 结肠 35 65 ? ?
? 直肠 32 50 ? ?
肿瘤大小(cm) ? ? 5.470 0.019
? <5 27 67 ? ?
? ≥5 40 48 ? ?
T分期 ? ? 5.315 0.021
? T1~T2 26 65 ? ?
? T3~T4 41 50 ? ?
N分期 ? ? 16.867 <0.001
? N0~N1 22 74 ? ?
? N2 45 41 ? ?
TNM分期 ? ? 1.393 0.238
? Ⅰ~Ⅱ 44 85 ? ?
? Ⅲ 23 30 ? ?
CEA（μg/L） ? ? 4.722 0.030
? <5 46 95 ? ?
? ≥5 21 20 ? ?
CA19-9（U/ml） ? ? 10.588 0.001
? <37 40 94 ? ?
? ≥37 27 21 ? ?
NLR ? ? 9.202 0.002
? <3.38 24 68 ? ?
? ≥3.38 43 47 ? ?
LMR ? ? 14.736 <0.001
? <4.66 46 45 ? ?
? ≥4.66 21 70 ? ?
图2 高PNI组和低PNI组结直肠癌患者根治术后生存的Kaplan-Meier曲线
表3 影响结直肠癌术后生存的单因素和多因素分析
因素 单因素分析 多因素分析
HR 95% CI P值 HR 95% CI P值
性别(女) 1.124 0.692~1.827 0.637 - - -
年龄(≥60岁) 2.206 1.359~3.579 0.001 1.977 1.204~3.246 0.007
体质指数(≥18.5 kg/m2) 0.685 0.350~1.341 0.270 - - -
组织学分型(腺癌) 1.112 0.641~1.928 0.705 - - -
肿瘤部位(直肠) 1.517 0.939~2.450 0.089 - - -
肿瘤大小(≥5 cm) 1.22 0.755~1.971 0.416 - - -
T分期(T3~T4) 1.688 1.036~2.750 0.036 1.690 1.030~2.775 0.038
N分期(N2) 2.379 1.449~3.907 0.001 1.848 1.098~3.110 0.021
TNM分期(Ⅲ) 1.591 0.965~2.622 0.069 - - -
癌胚抗原(≥5 μg/L) 1.468 0.862~2.497 0.157 - - -
CA19-9(≥37 U/ml) 1.351 0.806~2.264 0.254 - - -
NLR(≥3.38) 1.667 1.023~2.717 0.040 1.327 0.796~2.214 0.278
LMR(<4.66) 1.858 1.132~3.051 0.014 0.726 0.430~1.225 0.230
PNI(<45.61) 2.833 1.748~4.593 <0.001 1.835 1.067~3.157 0.028
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