预后营养指数评估弥漫性大B细胞淋巴瘤患者预后的临床价值  

The prognostic value of prognostic nutritional index in patients with diffuse large Bcell lymphoma

作　　者：宋腾[1] 张亚瑞[1] 赵可 李书苹 常智[1] 柳凤亭 王华庆[1] Teng Song;Yarui Zhang;Ke Zhao;Shuping Li;Zhi Chang;Fengting Liu;Huaqing Wang(Department of Oncology,Tianjin Union Medical Center,Tianjin Cancer Institute of Integrated Traditional Chinese and Western Medicine,Tianjin 300121,China)

机构地区：[1]天津市人民医院肿瘤科天津市中西医结合肿瘤研究所

出　　处：《中国肿瘤临床》2019年第17期903-908,共6页Chinese Journal of Clinical Oncology

基　　金：天津市卫生行业重点攻关项目（编号：2015KG111）资助~~

摘　　要：目的:探讨预后营养指数(prognostic nutritional index,PNI)与弥漫性大B细胞淋巴瘤(diffuse large B-cell lymphoma,DLBCL)患者临床特征及预后之间的关系。方法:回顾性收集2010年6月至2016年6月于天津市人民医院收治的82例初治DLBCL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,获取PNI最佳分界值,分析不同PNI水平与患者临床特征、治疗疗效及预后的关系。结果:全组患者PNI均值为43.93±5.86,当PNI值为44.15时,Youden指数最大,敏感度为74.6%,特异度为67.2%。低PNI组(<44.15)和高PNI组(≥44.15)患者分别占38例(46.3%)和44例(53.7%),PNI水平与患者的ECOG PS评分、Ann Arbor分期、IPI评分、LDH水平等均有相关性(均P<0.05)。低PNI组患者化疗总有效率低于高PNI组(65.8%vs.86.4%),且差异具有统计学意义(χ^2=4.848,P=0.028)。全组患者3年生存率为69.1%,低PNI组1、2、3年生存率分别为86.8%、67.8%和56.9%,均低于高PNI组96.7%、89.5%和80.2%,差异具有统计学意义(χ^2=9.421,P=0.002)。单因素分析显示患者PNI值<44.15、ECOG PS评分≥2分、IPI评分>2分、分期Ⅲ~Ⅳ期、外周血淋巴细胞计数<1.0×10^9/L对预后有影响(均P<0.05),多因素分析显示PNI值<44.15和Ⅲ/Ⅳ期为影响该组患者的独立预后不良因素(P=0.006,0.011)。结论:PNI值可作为DLBCL患者简便可行的临床预后指标。Objective:To investigate the prognostic value of prognostic nutritional index(PNI)in patients with diffuse large B-cell lymphoma(DLBCL).Methods:We retrospectively reviewed the medical records of 82 patients with DLBCL treated at Tianjin Union Medical Center between June 2010 and June 2016.The optimal cutoff value of PNI was determined using a receiver operating characteristic(ROC)curve and the Youden index.The relationship of high and low PNI with the clinical characteristics of the patients,therapeutic efficacy,and prognosis were analyzed.Results:Overall,mean PNI of the patients was 46.17±8.8.When the PNI was 44.15,the Youden index was found to be maximal,with a sensitivity of 74.6%and specificity of 67.2%.There were 38 patients(46.3%)in the low PNI group(<44.15)and 44 patients(53.7%)in the high PNI group(≥44.15).Data analysis showed that PNI was correlated with Eastern Cooperative Oncology Group performance status(ECOG PS),Ann Arbor stage,international prognostic index(IPI)score,and lactic acid dehydrogenase(LDH)level(P<0.05).The total effective rate of the low PNI group was significantly lower than that of the high PNI group(65.8%vs.86.4%;χ^2=4.848;P=0.028).The 3-year overall survival(OS)rate of the entire group of patients was 69.1%.The 1-,2-,and 3-year OS rates of the low PNI group(86.8%,67.8%,and 56.9%,respectively)were significantly lower than that of the high PNI group(96.7%,89.5%,and 80.2%,respectively;χ^2=9.421,P=0.002).Univariate analysis showed that PNI<44.15,ECOG PS≥2,IPI>2,stageⅢ/Ⅳ,and lymphocyte count<1.0×10^9/L had a significant impact on predicting OS(P<0.05).Multivariate analysis showed that PNI<44.15(P=0.006)and stageⅢ/Ⅳ(P=0.011)were independent factors for predicting OS.Conclusions:PNI might be used as a simple and feasible clinical prognostic indicator in patients with DLBCL.

关 键 词：弥漫大B细胞淋巴瘤 预后营养指数 预后 化疗 

分 类 号：R73[医药卫生—肿瘤]