术前预后营养指数、淋巴细胞与单核细胞比值对高危子宫内膜癌预后的评估价值  

Value of Preoperative PNI and LMR in Evaluating the Prognosis of High-Risk Endometrial Cancer

作　　者：黄蓓 张国楠 王登凤 余健 徐世强 Huang Bei;Zhang Guonan;Wang Dengfeng;Yu Jian;Xu Shiqiang(Department of Oncology,the Affiliated Hospital of Southwest Medical University,Luzhou 646000,Sichuan,China;Gynecologic Oncology Center,Sichuan Cancer Hospital&Institute,Sichuan Cancer Center,School of Medicine,University of Electronic Science and Technology of China,Chengdu 610041,Sichuan,China)

机构地区：[1]西南医科大学附属医院肿瘤科,四川泸州646000 [2]四川省肿瘤医院·研究所四川省癌症防治中心电子科技大学医学院妇科肿瘤中心,成都610041

出　　处：《肿瘤预防与治疗》2022年第5期419-426,共8页Journal of Cancer Control And Treatment

基　　金：四川省医学重点学科建设项目(编号:川卫办发[2007]407号)。

摘　　要：目的:探讨术前预后营养指数(prognostic nutritional index,PNI)、淋巴细胞与单核细胞比值(lymphocyte to monocyte ratio,LMR)与高危子宫内膜癌患者预后的相关性,并明确PNI、LMR的最佳临界值。方法:收集2012年至2017年期间于四川省肿瘤医院妇瘤中心初次接受治疗的FIGO IA期~IIIC期高危子宫内膜癌患者156例,采用中国子宫内膜癌诊断与治疗指南确定风险组。收集患者术前1周内测定的血常规、血清白蛋白,计算PNI和LMR值,通过ROC曲线、约登指数找出以总生存期(overall survival,OS)为结局事件的最佳临界值。通过单、多因素分析PNI和LMR与高危子宫内膜癌预后的相关性,并探讨PNI、LMR对OS、无病生存期(disease free survival,DFS)预测性能的优劣。结果:Cox单因素分析提示年龄、PNI、LMR、淋巴血管间隙侵犯(lymphovascalar space invasion,LVSI)、中性粒细胞数与淋巴细胞数比值(neutrophil to lymphocyte,NLR)、治疗方式是OS和DFS的预后影响因素;Cox多因素分析提示年龄、PNI、LMR、LVSI是高危子宫内膜癌OS和DFS的独立预后因素。PNI、LMR对高危子宫内膜癌患者出现复发或转移、死亡事件的预测性能不具有差异。结论:术前PNI、LMR值能预测高危子宫内膜癌患者预后。低PNI、低LMR是高危子宫内膜癌预后不良的独立预测因素。Objective:To investigate the relation of preoperative prognostic nutrition index(PNI) and lymphocyte-to-monocyte ratio(LMR) to the prognosis of high-risk endometrial cancer patients,and determine the cut-off values of PNI and LMR.Methods:156 high-risk endometrial cancer patients(FIGO stage:IA-IIIC) initially treated in the gynecologic cancer center in Sichuan Cancer Hospital from 2012 to 2017 were included.And we determined risk groups according to Chinese Guidelines for Endometrial Cancer Diagnosis and Treatment.After collecting routine blood test and serum albumin 1 week before operation,we calculated PNI and LMR values,and found out the best cut-off value with OS as the outcome event through ROC curve and Youden index.By means of univariate and multivariate analyses,we acquired the correlation between PNI/LMR and the prognosis of high-risk endometrial cancer,then compared PNI and LMR in predicting OS and DFS.Results:Univariate Cox analysis indicated that age,PNI,LMR,lymphovascular space invasion(LVSI),neutrophil-to-lymphocyte ratio(NLR) and therapy were prognostic factors for OS and DFS;multivariate Cox analysis indicated that age,PNI,LMR and LVSI were the independent prognostic factors for OS and DFS of high-risk endometrial cancer patients.There was no difference between PNI and LMR in predicting the recurrence,metastasis or death events in patients with high-risk endometrial cancer.Conclusion:Preoperative PNI and LMR values can predict the prognosis of patients with high-risk endometrial cancer.Low PNI and LMR are independent predictors of poor prognosis of high-risk endometrial cancer patients.

关 键 词：高危子宫内膜癌 PNI LMR 预后 

分 类 号：R730.7[医药卫生—肿瘤] R737.33[医药卫生—临床医学]