那不勒斯预后评分对行胆囊癌根治术病人预后的预测价值  

Predictive value of Naples prognostic score in gallbladder cancer patients undergoing radical surgery

作　　者：邱朋 王剑明[1,2] Qiu Peng;Wang Jianming(Department of Biliary-Pancreatic Surgery,Affiliated Tongji Hospital,Tongji Medical College,Huazhong University of Science&Technology,Hubei Wuhan 430030,China;Department of Hepatobiliary Surgery,Affiliated Tianyou Hospital,Wuhan University of Science&Technology,Hubei Wuhan 430064,China)

机构地区：[1]华中科技大学同济医学院附属同济医院胆胰外科,湖北武汉430030 [2]武汉科技大学附属天佑医院肝胆外科,湖北武汉430064

出　　处：《腹部外科》2023年第4期269-274,280,共7页Journal of Abdominal Surgery

基　　金：国家自然科学基金(8207103888,81874062,82072730)。

摘　　要：目的探讨术前那不勒斯预后评分(Naples prognostic score,NPS)对行根治性手术的胆囊癌病人远期预后的预测效能。方法选择2016年1月至2021年12月华中科技大学同济医学院附属同济医院胆胰外科行胆囊癌根治术的病人102例,根据NPS分为NPS1组(0分)19例、NPS2(1分或2分)组46例和NPS3组(3分或4分)37例。比较三组病人的一般临床病理资料,运用Cox回归及预后Kaplan-Meier(K-M)曲线分析病人的生存资料,构建列线图预测模型并用预后校正曲线进一步验证。建立时间依赖的受试者工作特征(receiver operating characteristic,ROC)曲线来评估各预后评分系统的区分能力。结果NPS与T分期、肿瘤分化程度、肝脏侵犯、糖类抗原(CA)19-9显著相关(P<0.05)。K-M曲线显示高NPS的胆囊癌病人预后更差(P<0.001)。NPS、年龄、N分期、肝脏侵犯、CA19-9和癌胚抗原(CEA)是影响行胆囊癌根治术病人总生存期的独立预后因素。构建包含以上独立危险因素的列线图预测模型,校正曲线提示该模型有较好的预测能力。ROC曲线显示NPS相比于其他炎症预后评分有更好的预后性能(曲线下面积为0.766)。结论NPS对行胆囊癌根治术病人的预后有良好预测价值,该评分系统对于生存预后的评估比其他的营养及炎症预后评分更加可靠。Objective To explore the predictive value of preoperative Naples prognostic score(NPS)on the prognosis of patients with gallbladder cancer(GC)undergoing radical surgery.Methods A total of 102 patients undergoing radical surgery for GC were recruited from Tongji Hospital between January 2016 and December 2021.They were assigned into three groups of NPS1(n=19),NPS2(n=46)and NPS3(n=37).Clinicopathological data of three groups were compared.Univariate and multivariate Cox analyses and Kaplan-Meier(K-M)survival curve were employed for examining the survival data.A line plot prediction model was constructed and prognostic calibration curve for further validating the model.Time-dependent receiver operating characteristic(ROC)curves were plotted for evaluating the discriminative capabilities of various prognostic scoring systems.Results NPS was significantly correlated with T stage,tumor differentiation,liver invasion and CA19-9.K-M curve indicated that patients with a higher NPS had a worse prognosis.NPS,age,N stage,liver invasion,CA19-9 and carcinoembryonic antigen(CEA)were independent prognostic factors affecting overall survival(OS).A line plot prediction model was constructed from the above independent risk factors.Calibration curve revealed an excellent predictive capability of the model.ROC curve indicated that NPS had better a prognostic performance than other inflammation prognostic scores.Conclusion Preoperative NPS has a great predictive value for GC patients undergoing radical surgery.This scoring system is more reliable than other nutritional and inflammatory prognostic scores for GC patients.

关 键 词：那不勒斯预后评分 胆囊癌 根治术 预后 列线图预测模型 

分 类 号：R735.7[医药卫生—肿瘤]