中性粒细胞与白蛋白比值在转移性胰腺癌患者中的预后价值及预测模型构建  

Prognostic value of neutrophil/albumin ratio in patients with metastatic pancreatic cancer and construction of a predictive model

作　　者：龙夏薇 黎倩[1] 李永强[1] 廖小莉[1] Long Xiawei;Li Qian;Li Yongqiang;Liao Xiaoli(Department of First Chemotherapy,Guangxi Medical University Cancer Hospital,Nanning 530021,China)

机构地区：[1]广西医科大学附属肿瘤医院化疗一科,南宁530021

出　　处：《广西医科大学学报》2023年第8期1313-1320,共8页Journal of Guangxi Medical University

基　　金：广西医疗卫生适宜技术开发与推广应用项目(No.S2020100);广西医疗卫生重点学科建设项目(No.2022-1号)。

摘　　要：目的:探讨中性粒细胞与白蛋白比值(NAR)在转移性胰腺癌(mPC)患者中的预后价值,并构建预后预测模型。方法:回顾性分析2013年10月至2022年4月在广西医科大学附属肿瘤医院就诊的223例mPC患者的临床资料,按2∶1的比例将患者随机分为训练集和验证集。采用X-tile对NAR取最佳截断值并进行分组。采用Kaplan-Meier法绘制生存曲线,并进行logrank检验。采用多因素Cox比例风险回归模型分析mPC患者预后的影响因素,并基于此构建列线图模型。通过受试者工作特征(ROC)曲线下面积(AUC)、校准图和临床决策曲线(DCA)来评估列线图的性能。用X-tile分为高危组与低危组,采用Kaplan-Meier法和log-rank检验评估两组患者的生存差异。结果:NAR的最佳截断值为0.13。低NAR组中位总生存期(OS)长于高NAR组(P=0.003)。Cox模型分析结果显示,高NAR是影响mPC预后的独立危险因素(HR=1.455,95%CI:1.065~1.988,P=0.018)。训练集和验证集的ROC曲线、校准图和DCA均体现了基于NAR构建的列线图模型具有良好的区分能力、校准能力和临床实用性。根据列线图模型评分可以有效地将高低风险人群进行分层。结论:高NAR(NAR>0.13)是mPC患者预后的独立危险因素,基于NAR构建的列线图模型可以协助预测mPC患者的预后。Objective:To investigate the prognostic value of neutrophil/albumin ratio(NAR)in patients with metastatic pancreatic cancer(mPC)and construct a prediction model.Methods:The clinical data of 223 patients with mPC treated in the Guangxi Medical University Cancer Hospital from October 2013 to April 2022 were retrospectively collected.The patients were randomly divided into the training cohort and the validation cohort in a ratio of 2:1.The optimal cutoff value for NAR was obtained by X-tile and grouped.Kaplan-Meier method was used to draw the survival curves,and log-rank tests were performed.Multivariate Cox proportional hazard regression model was used to analyze the factors affecting the prognosis of mPC patients,and a nomogram model was constructed based on this.The performance of nomogram was evaluated by the area under receiver operating characteristic(ROC)curve(AUC),calibration plots and decision curve analysis(DCA).X-tile was used to divide the patients into high-risk group and low-risk group.Kaplan-Meier and log-rank tests were used to evaluate the survival differences between the two groups.Results:The optimal cutoff value for NAR was 0.13.The median overall survival(OS)was longer in the low NAR group than in the high NAR group(P=0.003).Multivariate Cox analysis results showed that high NAR was an independent risk factor for mPC prognosis(HR=1.455,95%CI:1.065-1.988,P=0.018).ROC curve,calibration plots and DCA of training cohort and validation cohort all reflected that the nomogram model built based on NAR exhibited good discrimination ability,calibration abilityand clinical practicability.The nomogram model scores could effectively distinguish high and low risk groups.Conclusion:High NAR(NAR>0.13)is an independent risk factor for the prognosis of mPC patients,and the nomogram model built based on NAR can assist in predicting the prognosis of mPC patients.

关 键 词：转移性胰腺癌 中性粒细胞与白蛋白比值 系统免疫炎性指数 列线图 预后 

分 类 号：R735.9[医药卫生—肿瘤]