不同术前营养评分系统在肝细胞癌切除术预后评估中的意义  

Significance of different preoperative nutritional scoring systems in prognosis evaluation of radical resection of hepatocellular carcinoma

作　　者：陆明 胡孔旺[2] 涂从银 LU Ming;HU Kong-wang;TU Cong-yin(Department of General Surgery,West District of the First Affiliated Hospital of University of Science and Technology of China,Hefei Anhui 230031,China;Department of General Surgery,the First Affiliated Hospital of Anhui Medical University,Hefei Anhui 230022,China)

机构地区：[1]中国科学技术大学附属第一医院西区普外科,安徽合肥230031 [2]安徽医科大学第一附属医院普外科,安徽合肥230022

出　　处：《局解手术学杂志》2023年第12期1054-1058,共5页Journal of Regional Anatomy and Operative Surgery

基　　金：安徽省科技厅重点研究与开发项目(202004j07020036)。

摘　　要：目的评估术前预后营养指数(PNI)、控制营养状态评分(CONUT)、那不勒斯预后评分(NPS)3种营养评分系统与肝细胞癌切除术患者临床病理特征及预后的关系。方法回顾性分析2016年1月至2019年12月在中国科学技术大学附属第一医院行肝细胞癌根治性切除术的122例原发性肝细胞癌患者的临床病理资料,分析术前PNI、CONUT和NPS与临床病理特征及预后之间的关系。采用Kaplan-Meier法绘制生存曲线;Cox比例风险模型进行单因素及多因素分析肝细胞癌患者总生存期的影响因素。受试者工作特征(ROC)曲线下面积(AUC)比较各评分系统的预测价值。结果术前PNI与肿瘤分化程度、微血管侵犯(MVI)、肝硬化、术前血红蛋白水平有关(P<0.05);术前CONUT与肿瘤分化程度、肝硬化、术前血红蛋白水平有关(P<0.05);术前NPS与肝硬化、术前血红蛋白水平有关(P<0.05)。低PNI组、高CONUT组、高NPS组分别相较于高PNI组、低CONUT组、低NPS组的术后住院时间更长、术后并发症发生率更高,差异均具有统计学意义(P<0.05)。Cox比例风险模型得出术前PNI、CONUT、NPS与肝细胞癌患者的预后相关(P<0.05);但只有术前NPS是影响肝细胞癌患者预后的独立危险因素(P<0.05)。ROC曲线结果显示,NPS的AUC高于PNI、CONUT。结论术前PNI、CONUT和NPS 3种营养评分系统均与行肝细胞癌切除术患者的预后有关,其中术前NPS的预测价值高于术前PNI和CONUT。Objective To evaluate the relationship between preoperative prognostic nutritional index(PNI),controlling nutritional status(CONUT)and Naples prognostic score(NPS)and the clinicopathological characteristics and prognosis of patients with radical resection of hepatocellular carcinoma.Methods The clinicopathological data of 122 patients with hepatocellular carcinoma who underwent radical resection in the first affiliated hospital of university of science and technology of China from January 2016 to December 2019 were retrospectively analyzed,and the relationship between preoperative PNI,CONUT and NPS and the clinicopathological characteristics and prognosis was analyzed.The survival curve was drawn by Kaplan-Meier method.Cox proportional-hazards regression model was used to analyze the influencing factors of the overall survival of hepatocellular carcinoma patients.The area under the receiver operating characteristic(ROC)curve(AUC)was used to compare the predictive value of each scoring system.Results Preoperative PNI was related to the tumor differentiation,microvascular invasion(MVI),cirrhosis and preoperative hemoglobin level(P<0.05).The preoperative CONUT was related to the tumor differentiation,cirrhosis and preoperative hemoglobin level(P<0.05).The preoperative NPS was related to the cirrhosis and preoperative hemoglobin level(P<0.05).The low PNI group,high CONUT group and high NPS group had longer postoperative hospital stay and higher postoperative complications rate compared with the high PNI group,low CONUT group and low NPS group,respectively,and the differences were statistically significant(P<0.05).Cox proportional-hazards regression model showed that preoperative PNI,CONUT and NPS were associated with the prognosis of patients with hepatocellular carcinoma(P<0.05);However,only preoperative NPS was the independent risk factor for prognosis of patients with hepatocellular carcinoma(P<0.05).The ROC curve results showed that the AUC of NPS was higher than those of PNI and CONUT.Conclusion preoperative PNI

关 键 词：肝细胞癌 预后营养指数 控制营养状态 那不勒斯预后评分 预后 

分 类 号：R657.3[医药卫生—外科学]