115例食管胃结合部腺癌术后发生吻合口瘘患者预后营养指数与预后相关性分析  

The Clinical Value of Prognostic Nutritional Index in Esophagogastric Junctional Adenocarcinoma Patients with Anastomotic Leakage after Surgery and Its Correlation with Prognosis:One Hundred and Fifteen Cases Report

作　　者：王岩[1] 曹玉[2] 刘俊峰[1] 殷金环[1] WANG Yan;CAO Yu;LIU Jun-feng;YIN Jin-huan(The Fourth Hospital of Hebei Medical University,Shijiazhuang 050011,China;The Fourth Hospital of Hebei Medical University,Hebei Tumor Research Institute,Shijiazhuang 050011,China)

机构地区：[1]河北医科大学第四医院,河北石家庄050011 [2]河北医科大学第四医院,河北省肿瘤研究所,河北石家庄050011

出　　处：《中国肿瘤》2020年第5期391-395,共5页China Cancer

基　　金：河北省医学科学研究重点课题(20160178)。

摘　　要：[目的]研究食管胃结合部腺癌术后发生吻合口瘘的患者预后营养指数(PNI)与临床病理因素的关系,以及PNI对预测术后发生吻合口瘘的患者生存期的临床意义。[方法]回顾性分析2004年1月1日至2013年12月31日在河北医科大学第四医院胸外科行食管胃结合部腺癌根治术的115例术后发生吻合口瘘患者的临床病理资料和随访资料。计算PNI值[PNI=淋巴细胞绝对值(109/L)×5+血清白蛋白(g/L)],根据PNI均值进行分组,分析PNI与患者性别、年龄、肿瘤大小、肿瘤分化程度、肿瘤分期、肿瘤位置、淋巴结转移情况的关系。同时对患者进行生存分析,采用Log-rank法进行单因素分析,Cox法进行多因素分析。[结果]发生吻合口瘘患者PNI均值为48.51 (43.25~56.25)。PNI≤48.51组患者5年生存率为58.9%,PNI>48.51组患者5年生存率为59.3%,两组比较差异无统计学意义(χ~2=0.127,P=0.722)。单因素、多因素分析显示,PNI≤48.51组患者中,N分期是影响发生吻合口瘘的食管胃结合部腺癌患者预后的独立危险因素。PNI>48.51组患者中,是否给予术后辅助治疗是发生吻合口瘘的食管胃结合部腺癌患者预后的独立影响因素。PNI与治疗方式存在交互作用(P=0.037)。[结论 ] N分期和术后是否给予辅助治疗分别是PNI低值组(PNI≤48.51)和高值组(PNI>48.51)发生吻合口瘘的食管胃结合部腺癌患者生存的独立影响因素。对于发生吻合口瘘的食管胃结合部腺癌患者,应回顾术前预后营养指数这一指标,以指导选择适宜的后续治疗方式。[Objective] To study the relationship between prognostic nutritional index(PNI) and clinicopathological factors in gastroesophageal junction cancer patients with postoperative anastomotic leakage,as well as the clinical significance of PNI in predicting the survival of patients with postoperative anastomotic leakage. [Methods] Clinicopathological and follow-up data of 115 gastroesophageal junction cancer patients with anastomotic leakage after radical surgery in the Department of Thoracic Surgery,the Fourth Hospital of Hebei Medical University from January 1st 2004 to December 31 th 2013 were retrospectively analyzed. PNI values were calculated [PNI = absolute lymphocyte count(109/L)×5 + serum albumin(g/L)],and were grouped according to the PNI mean value. Relationship of PNI with patient’sgender,age,tumor stage,tumor differentiation,tumor location,lymph node metastasis were analyzed. For survival analysis,log-rank method was used for univariate analysis,and Cox method was used for multivariate analysis.[Results] The mean PNI of patients with anastomotic leakage was 48.51(43.25~56.25). The 5-year survival rate of patients with PNI≤48.51 was 58.9%,and 59.3% for patients with PNI>48.51. There was no significant difference between the two groups( χ~2=0.127, P =0.722). Univariate and multivariate analysis showed that N stage was an independent risk factor for the prognosis of patients with PNI≤48.51. Postoperative adjuvant treatment was an independent risk factor for the survival of patients with PNI>48.51. P for interaction between PNI and treatment modality was 0.037. [Conclusion] N stage and adjuvant treatment(PNI ≤48.51 and PNI >48.51 group,respectively) are two independent prognostic factors of patients with esophagogastric junction adenocarcinoma combined with anastomotic leakage. For patients who have esophagogastric junction adenocarcinoma combined with anastomotic leakage,PNI is an important factor for guidingthe selection of appropriate postoperative treatment.

关 键 词：食管胃结合部腺癌 吻合口瘘 预后营养指数 生存分析 

分 类 号：R735.2[医药卫生—肿瘤]