术前预后营养指数对首次行根治性手术的口腔鳞状细胞癌患者预后的预测价值  

Value of preoperative prognostic nutrition index in predicting prognosis of oral squamous cell carcinoma patients initially undergoing radical operation

作　　者：夏晓芳 张文颖[1] 袁海花[1] 刘峰[1] 姜斌[1] XIA Xiaofang;ZHANG Wenying;YUAN Haihua;LIU Feng;JIANG Bin(Department of Oncology,The Ninth People′s Hospital Affiliated to Medical School of Shanghai Jiaotong University,Shanghai,200001)

机构地区：[1]上海交通大学医学院附属第九人民医院肿瘤科,上海200001

出　　处：《实用临床医药杂志》2021年第8期6-10,共5页Journal of Clinical Medicine in Practice

基　　金：国家自然科学基金资助项目(81871862)。

摘　　要：目的探讨术前预后营养指数(PNI)对首次行根治性手术的口腔鳞状细胞癌(OSCC)患者预后的预测价值。方法回顾性分析2015年1月—2017年10月上海交通大学医学院附属第九人民医院首次行根治性手术的437例OSCC患者的临床和随访资料。根据术前1周的血常规检查结果计算PNI。通过受试者工作特征(ROC)曲线计算约登(Youden)指数,将Youden指数最大值所对应的PNI作为预测OSCC预后的最佳临界值。分析术前PNI与临床病理特征的关系。采用KaplanMeier生存曲线和Cox回归模型分析PNI对OSCC患者预后的影响。结果患者术前PNI的平均值为(49.93±5.60),最佳临界值为46.23。术前PNI与年龄(P <0.001)、T分期(P <0.001)、TNM分期(P=0.013)有相关性。高PNI组患者3年总生存率为84.7%,高于低PNI组的57.3%,差异有统计学意义(P <0.001)。多因素分析结果显示,年龄> 60岁(HR=2.211,95%CI为1.390~3.518,P=0.001)、TNM分期为Ⅲ期和Ⅳ期(HR=3.911,95%CI为2.561~6.221,P <0.001)、PNI≤46.23(HR=2.554,95%CI为1.707~3.821,P <0.001)是OSCC患者术后预后较差的独立危险因素。结论术前低PNI是影响OSCC患者预后的独立危险因素,对OSCC的预后评估具有一定的指导意义。Objective To investigate the value of postoperative prognostic nutritional index(PNI)in predicting prognosis of oral squamous cell carcinoma(OSCC)patients initially undergoing radical operation.Methods Clinical and follow-up materials of 437 OSCC patients initially undergoing radical operation in the Ninth People′s Hospital Affiliated to Medical School of Shanghai Jiaotong University from January 2015 to OctobeR2017 were retrospectively analyzed.PNI was calculated according to the blood routine results one week before surgery.The Youden index was calculated by receiver operating characteristic(ROC)curve,and PNI with the maximum Youden index was selected as the optimal critical value for predicting the prognosis of OSCC.The relationship between preoperative PNI and clinical characteristics was analyzed.Kaplan-Meier survival analysis and Cox regression analysis were conducted to analyze the influence of PNI on prognosis of patients with OSCC.Results The mean value of preoperative PNI was(49.93±5.60)and the optimal critical value of PNI was 46.23.Preoperative PNI was associated with age(P<0.001),T staging(P<0.001)and TNM staging(P=0.013).The 3-year survival rate of patients in the high PNI group was 84.7%,which was significantly higher than 57.3%in the low PNI group(P<0.001).Multivariate analysis showed that aged over60 years old(HR=2.211,95%CI,1.390 to 3.518,P=0.001),stageⅢandⅣof TNM(HR=3.911,95%CI,2.561 to 6.221,P<0.001)and PNI≤46.23(HR=2.554,95%CI,1.707 to 3.821,P<0.001)were the independent risk factors of prognosis in patients with OSCC.Conclusion Preoperative low PNI is an independent risk factor for the prognosis of patients with OSCC,which has a certain guiding significance for the prognosis evaluation of OSCC.

关 键 词：预后营养指数 口腔鳞状细胞癌 受试者工作特征 预后 病理特征 

分 类 号：R739.85[医药卫生—肿瘤] R782.05[医药卫生—临床医学]