基于炎症营养参数的评分系统预测胃上部癌新辅助化疗效果的研究  

VALUE OF A SCORING SYSTEM BASED ON INFLAMMATORY AND NUTRITIONAL INDICATORS IN PREDICTING THE EFFICACY OF NEOADJUVANT CHEMOTHERAPY FOR UPPER GASTRIC CANCER

作　　者：朱红苹 刘睿清 张宪祥[1] 张茂申[1] 王东升[1] 卢云[1] ZHU Hongping;LIU Ruiqing;ZHANG Xianxiang;ZHANG Maoshen;WANG Dongsheng;LU Yun(Gastrointestinal Surgery,The Affiliated Hospital of Qingdao University,Qingdao 266555,China)

机构地区：[1]青岛大学附属医院胃肠外科,山东青岛266555

出　　处：《精准医学杂志》2023年第5期427-430,435,共5页Journal of Precision Medicine

摘　　要：目的探讨局部进展期胃上部癌患者新辅助化疗(NACT)前后炎症营养指标与NACT疗效的关系,并建立临床预测模型。方法选取2013年4月—2022年1月于我院胃肠外科接受NACT的胃上部癌患者117例,根据化疗结果分为有效组与无效组,收集患者的年龄、性别、吸烟史、饮酒史、首发症状、肿瘤部位、肿瘤分化程度、肿瘤临床分期、肿瘤病理类型、NACT前1周内及NACT后1周内的血常规结果等临床资料,经单因素及多因素分析后筛选出影响NACT疗效的因素,进一步构建列线图模型并验证该模型的性能。结果多因素分析结果显示,患者NACT前后的血浆中性粒细胞与淋巴细胞比值(NLR)差值(△NLR)(OR=2.043,95%CI=1.334~3.127,P<0.05)、血浆血小板与淋巴细胞比值(PLR)差值(△PLR)(OR=1.007,95%CI=1.000~1.014,P<0.05)、血清白蛋白(Alb)差值(△Alb)(OR=0.936,95%CI=0.878~0.997,P<0.05)以及T分期(OR=4.044,95%CI=1.128~14.501,P<0.05)均为影响NACT疗效的独立危险因素。基于多因素分析结果构建胃上部癌NACT疗效列线图预测模型,该模型受试者特征曲线下面积为0.877,绘制的校准曲线及临床决策曲线显示校准度较好且与实际结果较一致。结论胃上部癌患者△NLR、△PLR、△Alb及T分期为影响NACT疗效的独立危险因素,胃上部癌NACT疗效预测模型具有良好的预测性能和临床应用价值。Objective To investigate the association of inflammatory and nutritional indicators with the efficacy of neoadjuvant chemotherapy(NACT)in patients with upper gastric cancer before and after NACT,and to establish a clinical predictive model.Methods A total of 117 patients with upper gastric cancer who underwent NACT in Department of Gastroenterology in our hospital from April 2013 to January 2022 were enrolled,and according to the efficacy of chemotherapy,they were divided into effective group and ineffective group.Related clinical data were collected,such as age,sex,smoking history,drinking history,initial symptoms,tumor location,degree of tumor differentiation,tumor stage,tumor pathological type,and routine blood test results within one week before NACT and within one week after NACT.Univariate and multivariate analyses were performed to identify the influencing factors for the efficacy of NACT,and then a nomogram model was established and validated.Results The multivariate analysis showed that the difference in plasma neutrophil-to-lymphocyte ratio before and after NACT(△NLR)(OR=2.043,95%CI=1.334-3.127,P<0.05),the difference in plasma platelet-to-lymphocyte ratio before and after NACT(△PLR)(OR=1.007,95%CI=1.000-1.014,P<0.05),the difference in serum albumin before and after NACT(△Alb)(OR=0.936,95%CI=0.878-0.997,P<0.05),and T stage(OR=4.044,95%CI=1.128-14.501,P<0.05)were independent risk factors for the efficacy of NACT.A nomogram predictive model for the efficacy of NACT in upper gastric cancer was constructed based on the results of the multivariate analysis,with an area under the ROC curve of 0.877,and the calibration curve and the clinical decision curve showed that the model had good calibration and consistency with the actual results.Conclusion△NLR,△PLR,△Alb,and T stage are independent independent risk factors for the efficacy of NACT in patients with upper gastric cancer,and the predictive model for the efficacy of NACT for upper gastric cancer has good predictive performance and clinical appli

关 键 词：胃肿瘤 慢性病指标 营养评价 化学疗法 肿瘤 局部灌注 危险因素 回归分析 

分 类 号：R735.2[医药卫生—肿瘤]