老年营养风险指数对新辅助治疗后行直肠癌根治术患者术后短期预后的预测价值  

Predictive value of nutritional risk index in elderly patients undergoing radical resection of rectal cancer after neoadjuvant therapy

作　　者：付维波 张磊[1] 吴晨曦 佘军军[1] FU Weibo;ZHANG Lei;WU Chenxi;SHE Junjun(Department of General Surgery,the First Affiliated Hospital of Xi'an Jiaotong University,Shaanxi Xi'an 710061,China)

机构地区：[1]西安交通大学第一附属医院普通外科,陕西西安710061

出　　处：《现代肿瘤医学》2023年第11期2063-2068,共6页Journal of Modern Oncology

基　　金：西安交通大学第一附属医院临床研究课题(编号:XJTU1AF2020LSL-004)。

摘　　要：目的:评估老年营养风险指数(geriatric nutritional risk index,GNRI)对新辅助治疗后行直肠癌根治术患者术后短期预后的预测价值。方法:回顾性收集2018年01月至2021年12月我院收治的符合纳入排除标准的393例新辅助治疗后行直肠癌根治术患者的临床病例资料。将393例患者按照术前GNRI水平分为正常GNRI水平组和低GNRI水平组。采用倾向评分匹配法(propensity scores match,PSM)对两组患者基线资料进行1∶1匹配。比较匹配后两组患者的术后短期预后。采用单因素和多因素logistic回归分析新辅助治疗后行直肠癌根治术患者发生术后并发症(Clavien-Dindo分级≥Ⅱ级)的独立危险因素。结果:经过PSM,两组各114例纳入配对研究。术前低GNRI水平组患者的术后并发症发生率显著高于术前正常GNRI组(31.6%vs 17.5%,P=0.014)。术前低GNRI水平组患者的术后住院总花费显著高于术前正常GNRI组(8.4万元vs 7.4万元,P=0.031)。多因素logistic回归分析中,术前GNRI水平(<93.7,OR=3.580,95%CI:1.546~8.293,P=0.003)、cT分期(T_(3-4),OR=2.615,95%CI:1.264~5.409,P=0.010)、ASA分级(Ⅲ、Ⅳ级,OR=1.533,95%CI:1.068~2.201,P=0.021)以及开腹手术(OR=6.589,95%CI:2.466~17.602,P<0.001)是新辅助治疗后行直肠癌根治术患者发生术后并发症的独立危险因素。结论:术前GNRI水平可用于评估新辅助治疗后行直肠癌根治术患者的短期预后,有助于为临床诊疗工作提供参考,及时干预,改善患者短期预后。Objective:To evaluate the predictive value of geriatric nutritional risk index(GNRI)in postoperative short-term outcomes of patients undergoing radical resection of rectal cancer after neoadjuvant therapy.Methods:The clinicopathologic data of 393 patients with rectal cancer underwent radical resection after neoadjuvant therapy admitted in our hospital from January 2018 to December 2021 who met the inclusion and exclusion criteria were retrospectively collected.393 patients were divided into normal GNRI group and low GNRI group according to preoperative GNRI level.Baseline data of the two groups were matched 1∶1 by propensity scores match(PSM).The short-term outcomes of the two matched groups was compared.Univariate and multivariate logistic regression were used to analyze the independent risk factors for postoperative complications(Clavien-Dindo grade≥Ⅱ)in patients undergoing radical resection of rectal cancer after neoadjuvant therapy.Results:After PSM,114 cases in each of the two groups were included in the matching study.The incidence of postoperative complications was significantly higher in the low preoperative GNRI group than in the normal preoperative GNRI group(31.6%vs 17.5%,P=0.014).The total cost of postoperative hospitalization in the low preoperative GNRI group was significantly higher than that in the normal preoperative GNRI group(84000 yuan vs 74000 yuan,P=0.031).In multivariate logistic regression analysis,preoperative GNRI level(<93.7,OR=3.580,95%CI:1.546~8.293,P=0.003),cT stage(T_(3-4),OR=2.615,95%CI:1.264~5.409,P=0.010),ASA grading(level Ⅲ or Ⅳ,OR=1.533,95%CI:1.068~2.201,P=0.021),and open surgery(OR=6.589,95%CI:2.466~17.602,P<0.001)were the independent risk factors for postoperative complications in patients undergoing radical resection of rectal cancer after neoadjuvant therapy.Conclusion:Preoperative GNRI level can be used to evaluate the short-term prognosis of patients undergoing radical resection of rectal cancer after neoadjuvant therapy,which is helpful to provide reference for

关 键 词：老年营养风险指数 新辅助治疗 直肠肿瘤 术后并发症 短期预后 

分 类 号：R735.3[医药卫生—肿瘤]