小野寺营养预后指数在胃癌患者预后评估中的价值  

Value of prognostic nutritional index in prognostic evaluation of gastric cancer patients

作　　者：方军[1] 余阳[1] 许涛[1] 张应天[1] 

机构地区：[1]江汉大学附属医院普外科(武汉市第六医院),武汉430015

出　　处：《临床外科杂志》2016年第11期831-834,共4页Journal of Clinical Surgery

摘　　要：目的：探讨应用小野寺营养预后指数（Onodera′s prognostic nutritional index，Onodera′s PNI）评估胃癌患者预后的价值。方法2000年1月~2014年1月收治的胃癌患者386例，收集患者术前血液检查结果（包括血清白蛋白水平、外周血总淋巴细胞计数），计算每一例患者术前 On-odera’s PNI。根据 PNI 分为营养较好组（201例，PNI≥48）和营养较差组（185例，PNI ＜48）。分析PNI 与临床病理特征、术后并发症及预后的相关性，并通过 Cox 回归模型筛选影响胃癌患者的预后因素。结果386例患者术前平均 PNI 为50.6±5.7。年龄≥65岁者平均 PNI 为48.5±5.7，＜65岁者为51.8±5.4，两组比较差异有统计学意义（P ＜0.01）；pT3/ T4期及有淋巴结转移者与pT1/ T2期及无淋巴结转移者比较平均 PNI 均明显降低（P ＜0.01）。两组患者术后总体并发症发生率分别为6.5%（13/201）和15.6%（29/185），差异有统计学意义（P ＜0.01）。有并发症组平均 PNI 值为（49.2±5.4），无并发症组为（51.6±5.3），两组比较差异有统计学意义（P ＜0.05）。相关分析显示，PNI 与患者年龄、肿瘤侵润深度、淋巴结转移状况、术后总体并发症率具有相关性（P ＜0.05）。营养较好组和营养较差组术后5年总体生存（OS）率及无瘤生存（DFS）率分别为86.2%比52.1%（χ2=9.28，P ＜0.01）及83.5%比53.7%（χ2=9.36，P ＜0.01）。多因素 Cox 回归分析证实，营养预后指数是影响胃癌患者预后的独立预测因素（HR =2.16，95% CI：1.57-3.26，P ＜0.01）。结论小野寺营养预后指数能较好地反映胃癌患者的营养状态、手术风险及预后，是独立于 TNM 分期的一种胃癌患者长期结果的预测指标，其获得简单方便。Objective To study the value of Onodera′s prognostic nutritional index（Onodera′s PNI）in patients with gastric cancer. Methods The clinical data of 386 cases of gastric cancer between January 2000 and January 2014 were analyzed retrospectively. Preoperative blood test results,including the level of serum albumin and total lymphocyte count in the peripheral blood,were collected. Then,Onodera′s PNI of every patient was calculated according to the test results. According to the Onodera index,these pa-tients were divided into better-nourished group（PNI≥48,n = 201）and under-nourished group（PNI 〈48,n = 185）. Relationship among PNI,clinicopathological feature,postoperative complication and progno-sis were analyzed. Cox proportional hazards model was also established to identify the independent prog-nostic factors for prognosis of patients with gastric cancer. Results The mean PNI of 386 patients before the operation was 50. 6 ± 5. 7. The mean PNI in patients aged 65 years or older was significantly lower than that in patients younger than 65 years（48. 5 ± 5. 7 vs 51. 8 ± 5. 4,P 〈 0. 001）. The mean PNI in pa-tients with T3 / T4 tumors and lymph node metastasis was significantly lower（P 〈 0. 001）. Patients in bet-ter-nourished group had significantly lower postoperative complication rate[6. 5% vs 15. 6% ,P 〈0. 001]. The patients with postoperative complications had a significantly lower mean PNI than those with-out complications（49. 2 ± 5. 4 vs 51. 6 ± 5. 3,P = 0. 024）. PNI was found to be related to age,tumor depth,lymph node involvement and postoperative complication rate（P 〈 0. 05）. Better-nourished group had significantly better 5-year overall survival（OS）rate（86. 2% vs 52. 1% ,χ2 = 9. 28,P 〈 0. 001）and better 5-year disease free survival rate（83. 5% vs 53. 7% ,χ2 = 9. 36,P 〈 0. 001）than under-nourished group. The multivariate analysis demonstrated that the PNI was an independent prognostic factor for pa-tients with gastric cancer（HR = 2. 16,95% CI�

关 键 词：小野寺营养预后指数 胃癌 预后 

分 类 号：R735.2[医药卫生—肿瘤]