术前PNI、SII、SIM和白蛋白对牙龈癌患者术后生存的预测价值  

Predictive value of preoperative PNI,SII,SIM and albumin in postoperative survival of patients with gingival carcinoma

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 Shanghai Jiao Tong University School of Medicine,Shanghai 200000,China)

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200000

出　　处：《现代肿瘤医学》2022年第12期2156-2163,共8页Journal of Modern Oncology

基　　金：上海市科学技术项目(编号:18DZ1910107)。

摘　　要：目的:探讨术前预后营养指数(prognostic nutritional index,PNI)、炎症指数(system inflammation index,SII)、系统炎性标志物(systemic inflammatory marker,SIM)和白蛋白与牙龈癌患者预后的关系。方法:回顾性分析2014年12月至2017年11月在我院首次接受根治性手术切除的200例牙龈癌患者的临床和随访资料。通过受试者工作特征(receiver operating characteristic curve,ROC)曲线确定PNI、SII、SIM和白蛋白预测牙龈癌预后的最佳临界值。采用χ^(2)检验分析术前PNI、SII、SIM和白蛋白与临床特征的关系。采用Kaplan-Meier法和Cox回归模型对牙龈癌患者预后影响因素进行单因素和多因素分析。结果:通过ROC曲线确定PNI、SII和SIM和白蛋白预测生存的最佳临界点分别为46.03、478.37、1.02和40.5 g/L。Cox多因素分析提示较晚的TNM分期(HR 2.873;95%CI 1.598~5.166;P<0.0001)、较低的PNI值(HR 0.414;95%CI 0.223~0.770;P=0.005)、较高的SIM值(HR 2.391;95%CI 1.329~4.299;P=0.004)以及低水平的白蛋白(HR 0.425;95%CI 0.203~0.888;P=0.023)是牙龈癌患者术后3年总生存期的独立危险因素,而较晚的TNM分期(HR 3.324;95%CI 2.055~5.089;P<0.0001)和低PNI值(HR 0.457;95%CI 0.296~0.705;P<0.0001)是术后3年无复发生存期(recurrence-free survival,RFS)的独立危险因素。结论:仅低水平的PNI是影响牙龈癌患者3年总生存期和3年无复发生存期的独立危险因素,对患者个体化治疗和随访具有指导意义。Objective:To investigate the relationship between preoperative prognostic nutritional index(PNI),systemic immune-inflammation index(SII),systemic inflammatory marker(SIM)and albumin and prognosis in patients with gingival carcinoma.Methods:We retrospectively collected the clinical and follow-up data of 200 patients with gingival cancer who underwent radical surgical resection in our hospital from December 2014 to November 2017.The optimal cut-off points for PNI,SII,SIM and albumin to predict the prognosis of gingival cancer were determined by the receiver operating characteristic(ROC)curve.The relationship between preoperative PNI,SII and SIM and clinical characteristics was performed byχ^(2) test.Kaplan-Meier survival analysis and Cox regression analysis were conducted to analyze the prognostic factors of gingival carcinoma.Results:By ROC analysis,the optimal cut-off points for predicting survival of PNI,SII,SIM and albumin were 46.03,478.37,1.02 and 40.5 g/L,respectively.Cox regression multivariate analysis suggested advanced TNM stage(HR 2.873,95%CI 1.598~5.166,P<0.0001),low level of PNI(HR 0.414,95%CI 0.223~0.770,P=0.005),high level of SIM(HR 2.391,95%CI 1.329~4.299,P=0.004)and low level of albumin(HR 0.425,95%CI 0.203~0.888,P=0.023)were independent risk factors for the 3 year overall survival(OS),but advanced TNM stage(HR 3.324,95%CI 2.055~5.089,P<0.0001)and low level of PNI(HR 0.457,95%CI 0.296~0.705,P<0.0001)were independent risk factors for 3 year recurrence-free survival(RFS).Conclusion:Only a low level of PNI was an independent factor for 3 year OS and 3 year RFS of patients with gingival carcinoma,which could be helpful for the individual treatment and follow-up of patients.

关 键 词：预后营养指数 炎症指数 系统炎性标志物 白蛋白 牙龈癌 预后 

分 类 号：R739.8[医药卫生—肿瘤]