术前预后营养指数在评价肝细胞癌患者术后生存预后中的价值  

Value of preoperative prognostic nutritional index in postoperative survival prognosis of hepatocellular carcinoma patients

作　　者：华赟鹏[1] 吉斐 付顺军[2] 沈顺利[1] 李绍强[1] 梁力建[1] 彭宝岗[1] 

机构地区：[1]中山大学附属第一医院肝胆外科,广州510080 [2]中山大学附属第一医院器官移植中心,广州510080

出　　处：《中华肝脏外科手术学电子杂志》2015年第6期363-367,共5页Chinese Journal of Hepatic Surgery(Electronic Edition)

基　　金：国家自然科学基金(81201918);教育部留学回国人员科研启动基金[教外司留(2015)311号];广东省科技计划项目(2012B031800099)

摘　　要：目的 探讨术前预后营养指数（PNI）在肝细胞癌（肝癌）患者术后生存预后中的价值.方法 回顾性分析2006 年1 月至2009 年12 月在中山大学附属第一医院行根治性切除的322 例肝癌患者临床资料.其中男286 例,女36 例;年龄21～79 岁,中位年龄51 岁.所有患者均签署知情同意书,符合医学伦理学规定.根据患者术前1 周检查结果计算PNI 值,将患者分为高PNI 组（253 例）和低PNI 组（69 例）,观察PNI 与肝癌患者术后生存时间的关系,分析术前PNI 在生存预后中的价值.采用Kaplan-Meier 法和Log-rank 检验进行生存分析.多因素分析采用Cox 比例风险模型.结果 高PNI 组1、3、5 年无瘤生存率分别为48.0%、34.9%、31.3%,低PNI 组相应为33.3%、15.8%、11.7%,高PNI 组无瘤生存明显优于低PNI 组（χ^2=9.990,P〈0.05）.高PNI 组1、3、5 年总体生存率分别为72.3%、49.0% 、42.6%,低PNI 组相应为65.2%、36.2%、25.9%,高PNI 组总体生存明显优于低PNI 组（χ^2=8.172,P〈0.05）.多因素分析结果显示,AFP、肿瘤数量、肿瘤直径、门静脉癌栓（PVTT）和PNI 是患者无瘤生存率的独立危险因素（HR=1.355、0.783、2.295、1.920、0.710;P〈0.05）;肿瘤数量、肿瘤直径、PVTT 和PNI 是总体生存率的独立危险因素（HR=0.780、2.340、2.013、0.653;P〈0.05）.结论 术前PNI 是肝癌患者术后生存预后的独立危险因素,可作为预测肝癌患者术后生存预后的常用指标.ObjectiveTo investigate the value of preoperative prognostic nutritional index (PNI) in postoperative survival prognosis of hepatocellular carcinoma (HCC) patients.Methods Clinical data of 322 HCC patients undergoing radical resection in the First Affiliated Hospital of Sun Yat-sen University between January 2006 and December 2009 were retrospectively studied. Among the 322 patients, 286 were males and 36 were females with the age ranging from 21 to 79 years old and the median age of 51 years old. The informed consents of all patients were obtained and the local ethical committee approval had been received. PNI value was calculated according to the examination results 1 week before surgery, then the patients were divided into the high PNI group (n=253) and low PNI group (n=69). The relationship between PNI and postoperative survival time was observed, and the value of preoperative PNI in postoperative survival prognosis was analyzed. The survival analysis was conducted using Kaplan-Meier method and Log-rank test, and the multivariate analysis was conducted using Cox proportional hazards model.ResultsThe 1-, 3-, 5-year disease free survival rate was respectively 48.0%, 34.9% and 31.3% in high PNI group, and 33.3%, 15.8% and 11.7% in low PNI group. The disease free survival in high PNI group was significantly better than that in low PNI group (χ2=9.990,P<0.05). The 1-, 3-, 5-year overall survival rate was respectively 72.3%, 49.0% and 42.6% in high PNI group, and 65.2%, 36.2% and 25.9% in low PNI group. The overall survival in high PNI group was significantly better than that in low PNI group (χ2=8.172,P<0.05). The results of the multivariate analysis showed that AFP, tumor number, tumor diameter, portal vein tumor thrombus (PVTT) and PNI were the independent risk factors for disease free survival rate (HR=1.355, 0.783, 2.295, 1.920, 0.710;P<0.05), and tumor number, tumor diameter, PVTT and PNI were the independent risk factors for overall survival rate (HR=0.780, 2.340, 2.013, 0.653;P<0.05).ConclusionsPreoperati

关 键 词：肝细胞癌 营养预后指数 病理学 临床 预后 

分 类 号：R735.7[医药卫生—肿瘤]