术前预后营养指数对远端胆管癌根治术后生存的预测价值  

Predictive value of preoperative prognostic nutritional index in patients with distal cholangiocarci-noma after radical resection

作　　者：马右维 黄金灿 李禹林 姜涛[1] 潘飞[1] 吕少诚[1] 郎韧[1] Ma Youwei;Huang Jincan;Li Yulin;Jiang Tao;Pan Fei;Lyu Shaocheng;Lang Ren(Department of Hepatobiliary Surgery,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China)

机构地区：[1]首都医科大学附属北京朝阳医院肝胆外科,北京100020

出　　处：《中华肝胆外科杂志》2023年第10期737-741,共5页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的评估预后营养指数(PNI)对远端胆管癌患者根治性切除术后生存的预测价值。方法回顾性分析2011年9月至2022年3月首都医科大学附属北京朝阳医院肝胆外科收治的行根治性胰十二指肠切除手术的160例远端胆管癌患者的临床资料,其中男性97例,女性63例,年龄(65.58±9.22)岁。通过受试者工作特征曲线确定PNI预测术后生存的最佳截断值为42.275,将患者分为两组:PNI<42.275为低PNI组(n=79);PNI≥42.275为高PNI组(n=81)。术后采用门诊复查及电话随访相结合的方式随访患者的生存状态。采用Kaplan-Meier法进行生存分析,生存率比较采用log-rank检验。将单因素分析中P<0.1的因素纳入Cox比例风险模型进行多因素分析,筛选预后的影响因素。结果低PNI组和高PNI组患者的术前白蛋白、术前淋巴细胞及术前总胆红素间差异有统计学意义(均P<0.05)。低PNI组术后中位生存时间为17个月,术后1年、3年、5年的累积生存率分别为62.0%、25.0%、16.2%,高PNI组术后中位生存时间为23个月,术后1年、3年、5年的累积生存率分别为84.0%、46.4%、40.4%,两组比较,差异有统计学意义(P<0.001)。PNI评分<42.275(HR=1.040,95%CI:1.011~1.071,P=0.008)、肿瘤糖类抗原19-9>37 U/ml(HR=1.620,95%CI:1.046~2.509,P=0.031)、静脉侵犯(HR=1.809,95%CI:1.013~3.230,P=0.045)、淋巴结转移(HR=1.956,95%CI:1.300~2.969,P=0.001)、肿瘤长径>2 cm(HR=1.534,95%CI:1.011~2.328,P=0.044)、无术后化疗(HR=2.828,95%CI:1.291~6.195,P=0.009)的远端胆管癌患者根治性切除术后生存不良的风险更大(均P<0.05)。结论术前PNI评分是远端胆管癌患者根治性切除术后生存的影响因素,可以用于预测患者的术后生存。Objective To evaluate the predictive value of prognostic nutritional index(PNI)for survival after radical resection in patients with distal cholangiocarcinoma.Methods The clinical data of 160 patients with distal cholangiocarcinoma undergoing radical pancreatoduodenectomy in Beijing Chaoyang Hospital Affiliated to Capital Medical University from September 2011 to March 2022 were retrospectively analyzed,including 97 males and 63 females,aged(65.58±9.22)years old.The optimal cut-off value of PNI for predicting postoperative survival was 42.275 determined by the receiver operating characteristic curve.Patients were divided into the low PNI group(n=79,PNI<42.275)and high PNI group(n=81,PNI≥42.275).The survival status of patients were followed up by outpatient clinic or telephone review.Survival analysis was performed using the Kaplan-Meier method and the log-rank test.Factors with P<0.1 in the univariate analysis were included in the Cox proportional hazards model for multivariate analysis to screen the prognostic factors.Results There were statistically significant differences in the preoperative albumin,total bilirubin,lymphocytes counts between the two group(all P<0.05).The postoperative median survival time of the low PNI group was 17 months,with cumulative 1,3 and 5-year survival rates of 62.0%,25.0%and 16.2%,respectively.The postoperative median survival time of the high PNI group was 23 months,with cumulative 1,3 and 5-year survival rates of 84.0%,46.4%and 40.4%,respectively.There was a significant difference between the two groups(P<0.001).PNI score<42.275(HR=1.040,95%CI:1.011-1.071,P=0.008),CA19-9>37 U/ml(HR=1.620,95%CI:1.046-2.509,P=0.031),venous invasion(HR=1.809,95%CI:1.013-3.230,P=0.045),lymph node metastasis(HR=1.956,95%CI:1.300-2.969,P=0.001),tumor diameter>2 cm(HR=1.534,95%CI:1.011-2.328,P=0.044),without postoperative adjuvant chemotherapy(HR=2.828,95%CI:1.291-6.195,P=0.009)had a greater risk of poor survival after radical resection.Conclusion PNI score could be an influencing factor and serve as

关 键 词：胆管肿瘤 预后营养指数 外科手术 预后 

分 类 号：R735.8[医药卫生—肿瘤]