动态观察预后营养指数对局部进展期食管鳞癌放化疗患者预后评估的价值  

Value of dynamic prognostic nutritional index in evaluating prognosis of locally advanced esophageal squamous cell carcinoma patients undergoing radiotherapy and chemotherapy

作　　者：林贵山[1] 骆华春[2] LIN Guishan;LUO Huachun(Department of Medical Oncology,Fujian Province Hospital,Provincial Clinic College of Fujian Medical University,Fuzhou 350001,China)

机构地区：[1]福建医科大学省立临床学院福建省立医院肿瘤内科,福州350001 [2]福建医科大学福州总院临床学院 福州总医院放疗科,350007

出　　处：《临床肿瘤学杂志》2019年第1期38-43,共6页Chinese Clinical Oncology

基　　金：福建省卫计委医学创新课题资助项目(2018-CX-3)

摘　　要：目的探讨动态观察预后营养指数(PNI)在局部进展期食管鳞癌同步放化疗患者预后评估中的临床意义。方法收集2012年4月至2016年3月81例局部进展期食管鳞癌同步放化疗患者的病历资料,包括性别、年龄、BMI、肿瘤位置、分化程度、TNM分期、治疗前PNI(PNI1)和治疗后PNI(PNI2)。采用RECIST 1. 1版标准评价近期疗效;生存分析采用Kap-lan Meier法并行Log-rank检验;采用Cox风险比例回归模型分析影响预后的因素。结果 81例患者均可评价疗效,获CR 24例、PR 47例、SD 10例。全组患者中位无进展生存时间(PFS)为22. 71个月(13. 80～45. 15个月),中位总生存时间(OS)为27. 47个月(17. 66～57. 02个月)。单因素分析显示,肿瘤位置胸下段、TNM分期Ⅳ期、PNI1≤45和PNI2≤45与患者较短的PFS、OS有关(P <0. 05)。多因素Cox风险比例回归模型分析显示,Ⅳ期和PNI1≤45是影响PFS、OS的独立危险因素。PNI均> 45、治疗前后PNI变化不一致和PNI均≤45组患者的PFS和OS差异均有统计学意义(P <0. 05),PNI均> 45患者的PFS和OS最佳。治疗前后PNI变化不一致患者中,PNI2好转组与恶化组的PFS和OS差异均无统计学意义(P> 0. 05)。结论PNI是个简单、方便、有效的营养-免疫指标,临床上可用于预测肿瘤治疗疗效。动态观察治疗前后的PNI或许能更好地预测局部进展期食管鳞癌放化疗的远期疗效。Objective To investigate the clinical significance of dynamic prognostic nutrition index(PNI)in evaluating the prognosis of patients with locally advanced esophageal squamous cell carcinoma after concurrent radiotherapy and chemotherapy.Methods Data of 81 patients with locally advanced esophageal squamous cell carcinoma treated with concurrent radiotherapy and chemotherapy from April 2012 to March 2016 were collected,including gender,age,BMI,tumor location,differentiation,TNM stage,pre-treatment PNI(PNI 1)and post-treatment PNI(PNI 2).RECIST 1.1 standard was used to evaluate the short-term efficacy,and Kaplan Meier method and Log-rank test were used for survival analysis.Cox proportional-hazards regression model was used to analyze the factors affecting the prognosis.Results The short-term efficacy was evaluated in all 81 patients,including 24 cases of CR,47 cases of PR and 10 cases of SD.The median progression free survival(PFS)was 22.71 months(13.80-45.15 months)and the median overall survival(OS)was 27.47 months(17.66-57.02 months).Univariate analysis showed that lower thoracic segment,stageⅣ,PNI 1≤45 and PNI 2≤45 were associated with short PFS and OS.Multivariate Cox proportional-hazards regression model analysis showed that stageⅣand PNI 1≤45 were independent risk factors for PFS and OS.There were significant differences in PFS and OS among groups with PNI >45,inconsistent changes of PNI before and after treatment and those with PNI≤45(P<0.05).PFS and OS in PNI >45 group were the best.The patients with inconsistent of PNI were divided into two groups:the PNI 2 improvement group and the PNI 2 deterioration group.There was no significant difference in PFS and OS between the two groups(P >0.05).Conclusion PNI is a simple,convenient and effective nutrition-immunity index,which can be used to predict the therapeutic effect of cancer in clinic.Dynamic observation of PNI before and after treatment may better predict the long-term efficacy of radiotherapy and chemotherapy for locally advanced esophageal

关 键 词：食管鳞癌 预后营养指数 放化疗 Cox风险比例回归模型 

分 类 号：R735.1[医药卫生—肿瘤]