辅助化疗前基于老年营养风险指数预测老年胃癌患者预后的研究  

Prognosis prediction of elderly patients with gastric cancer based on geriatric nutrition risk index before adjuvant chemotherapy

作　　者：马亚辉 苗祥[1] 朱洪波[1] 刘冬良 孙刚 Yahui Ma;Xiang Miao;Hongbo Zhu;Dongliang Liu;Gang Sun(Department of General Surgery,Lianyungang Oriental Hospital,Lianyungang 222042,China)

机构地区：[1]连云港市东方医院普外科,江苏省连云港市222042

出　　处：《中国肿瘤临床》2023年第6期319-324,共6页Chinese Journal of Clinical Oncology

摘　　要：目的:探讨辅助化疗前老年营养风险指数(geriatric nutrition risk index,GNRI)评估老年胃癌患者的复发率和死亡率。方法:收集2013年1月至2017年1月连云港市东方医院162例接受根治性手术并行规范化疗的老年胃癌患者的临床资料,计算术前和化疗前GNRI,绘制其预测患者预后的ROC曲线,比较两者的诊断精度,分析化疗前GNRI不同水平患者的临床病理特征和预后。结果:化疗前GNRI的AUC值均大于术前GNRI,差异有统计学意义(均P<0.05)。根据最佳截断值将化疗前GNRI分为高GNRI组和低GNRI组。通过Kaplan-Meier分析,高GNRI组患者5年生存率和无病生存率均高于低GNRI组患者(均P<0.05)。根据pTNM分期分层分析,在pTNMⅡ期患者中,高GNRI组患者5年生存率高于低GNRI组患者(P<0.05)。高GNRI组和低GNRI组患者的5年无病生存率无显著性差异(P>0.05)。在pTNMⅢ期患者中,高GNRI组患者5年生存率和无病生存率均高于低GNRI组患者(均P<0.05)。多因素Cox回归分析,低GNRI和肿瘤中低分化是患者死亡和复发的独立危险因素。结论:化疗前GNRI是评估老年胃癌患者预后的独立因素,低GNRI的老年胃癌患者死亡和复发风险高,预后差。Objective:To investigate the recurrence and mortality rates of elderly patients with gastric cancer using the geriatric nutrition risk index(GNRI)before adjuvant chemotherapy.Methods:Clinical data from 162 elderly patients with gastric cancer who underwent radical surgery and standardized chemotherapy at Lianyungang Oriental Hospital from January 2013 to January 2017 were collected.Preoperative and pre-chemotherapy GNRI scores were calculated,and receiver operating characteristic(ROC)curve analysis was used to predict patient prognosis and compare diagnostic accuracy between the two.Additionally,the clinicopathological characteristics and prognosis of patients with different pre-chemotherapy GNRI scores were analyzed.Results:The area under the ROC curve for pre-chemotherapy GNRI was greater than for preoperative GNRI,and the difference was statistically significant(P<0.05).Pre-chemotherapy GNRI scores were divided into high and low GNRI groups according to an optimal cut-off value.Kaplan–Meier analysis revealed that the 5-year and disease-free survival(DFS)rates of patients with high GNRI were higher than those with low GNRI scores(all P<0.05).According to a hierarchical analysis of pTNM stage,among patients of pTNMⅡstage,the 5-year survival rate of patients with high GNRI was higher than that in those with low GNRI scores(P<0.05).There was no significant difference in 5-year DFS rate between the high and low GNRI groups(P>0.05).Among patients with pTNMⅢ,the 5-year and DFS rates of patients with high GNRI were higher than those in patients with low GNRI scores(all P<0.05).Multivariate Cox regression analysis revealed that low GNRI score and low tumor differentiation were independent risk factors for patient mortality and recurrence.Conclusions:Pre-chemotherapy GNRI score was an independent prognostic factor in elderly patients with gastric cancer.Elderly patients of gastric cancer with low GNRI score exhibited a higher risk for mortality and recurrence,the prognosis is poor.

关 键 词：胃癌 化疗 老年营养风险指数 预后 

分 类 号：R735.2[医药卫生—肿瘤]