预后营养指数评估75岁及以上胃癌患者手术风险和预后的价值  

Prognostic nutrition index for evaluation of surgical risk and prognosis in elderly patients with gastric cancer

作　　者：赵刚[1] 曹祥龙[1] 安琦[1] 余涛[1] 杨华[1] 潘宏达 崔健 肖刚[1] Zhao Gang;Cao Xianglong;An Qi;Yu Tao;Yang Hua;Pan Hongda;Cui Jian;Xiao Gang(Department of General Surgery,Beifing Hospital,National Center of Gerontology,Beijing 100730,China)

机构地区：[1]国家老年医学中心北京医院胃肠外科,100730

出　　处：《中华全科医师杂志》2018年第9期703-708,共6页Chinese Journal of General Practitioners

基　　金：北京市东城区人才资助项目支持

摘　　要：目的探讨预后营养指数（PNI）与高龄胃癌患者临床病理特征、手术风险及预后的关系。方法回顾性分析2004年1月至2016年12月北京医院胃肠外科行根治手术治疗的205例高龄（／〉75岁）胃癌患者的临床资料，计算PNI值，采用受试者工作特征曲线（ROC）计算Youden指数，得mPNI的最佳界值为44．9，以低于此值的72例（35．1％）为低PNI组，高于此值的133例（64．9％）为高PNI组，分析两组患者的临床病理特征、术后并发症及预后。结果205例患者的PNI平均值为47．3±5．5。当PNI值为44．9时，Youden指数最大，敏感度为0．86，特异度为0．47。两组患者的年龄（t=-2．16，P=0．032）、BMI（t=4．88，P=0．000）、Charlson合并症评分（CCS）（χ^2=7．77，P=0．005）、胃切除范围（χ^2=8．63，P=0．003）、术后并发症（χ^2：9．46，P=0．002）等差异有统计学意义。高PNI组并发症发生率为24．8％（33／133），低于低PNI组的45．8％（33／72），差异有统计学意义（χ^2=9．46，P：0．002）。多因素logistic回归分析显示，年龄（P=0．032）、CCS（P=0．042）、PNI〈44．9（P=0．027）是术后并发症的独立危险因素。多因素预后分析显示，PNI〈44．9（P：0．001）、胃切除范围（P=0．011）、淋巴结清扫范围（P=0．000）、肿瘤分化程度（P=0．001）和肿瘤TNM分期（P=0．000）是影响本组高龄胃癌患者的独立预后因素。结论PNI能较好地反映高龄胃癌患者的营养状态、手术风险及预后，对高龄胃癌术前评估及预后分析有参考价值。Objective To assess the application of preoperative prognostic nutritional index （PNI） in evaluation the surgical risk and long-term prognosis for elderly patients with gastric cancer. Methods The clinical data of 205 patients aged ≥75 years with gastric cancer undergoing radical resection from January 2004 to December 2016 were analyzed retrospectively. The PNI value was calculated by serum albumin （ g/ L） ＋5 ×lymphocyte count （×109/L）. The receiver operating characteristic （ROC） curve and Youden＇s index was used to determine the value of PNI in surgical risk and prognosis of patients. Patients were divided into low PNI group and high PNI group based on the cut-off value, the clinieopathological characteristics, postoperative complications and long-term survival were compared between two groups. Results The average PNI value of 205 patients was 47.3± 5.5. When 44.9 was set as the cut-off value with the maximal Youden＇s index, the sensitivity and specificity of PNI were 0. 86 and 0.47, respectively. There were statistically significant differences between the two groups of patients in age （t = -2. 16, P = 0. 032 ） , BMI （ t = 4. 88,P = 0. 000） , Charlson comorbidity score （ χ^2 = 7.77, P = 0. 005 ） , gastric resection range （ χ^2 = 8.63,P = 0. 003 ） , postoperative complications （ χ^2 = 9. 46, P = 0. 002）. The incidence of complications in the high PNI group was 24.8% （33/133）, which was lower than that in the low PNI group （45.8% , 33/ 72 ; χ^2 = 9.46, P = 0. 002 ）. Multivariate logistic analysis showed that age （ P = 0. 032 ） , Charlson coplications scal （ CCS ） （ P = 0. 042 ） and PNI 〈 44. 9 （ P = 0. 027 ） were independent risk factors for postoperative complications ; PNI 〈 44.9 （ P = 0. 001 ）, gastreetomy （ P = 0.011 ）, lymph node dissection （ P =0.000 ） , tumor differentiation （ P = 0. 001 ） and TNM stage （ P = 0. 000 ） were independent prognostic factors for elderly patients with gastric cancer. Conclusions P

关 键 词：胃肿瘤 营养评价 预后 

分 类 号：R735.2[医药卫生—肿瘤]