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

doi:10.3877/cma.j.issn.1674-0793.2020.04.006

Abstract

Abstract:

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

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

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References 21

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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

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

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	?	?

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	?	?

因素	单因素分析			多因素分析
因素	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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