老年营养风险指数对新辅助化疗后胃癌患者疗效的预测价值  

Prognostic value of geriatric nutritional risk index during neoadjuvant chemotherapy in elderly patients with gastric cancer

作　　者：段颖欣 霍俊杰[1] DUAN Yingxin;HUO Junjie(Department of Radiotherapy and Chemotherapy,the Second Affiliated Hospital of Xingtai Medical College,Hebei Xingtai 054000,China)

机构地区：[1]邢台医学高等专科学校第二附属医院放化疗科,河北邢台054000

出　　处：《现代肿瘤医学》2024年第2期289-296,共8页Journal of Modern Oncology

基　　金：河北省邢台市重点研发计划项目(编号:2020ZC382)。

摘　　要：目的:探讨老年营养风险指数(geriatric nutritional risk index,GNRI)对接受新辅助化疗的老年胃癌患者近远期疗效的临床价值。方法:回顾性分析2014年1月至2019年12月期间在我院接受新辅助化疗后行腹腔镜胃癌根治术的230例老年胃癌患者的临床病理资料,应用受试者工作特征(receiver operating characteristic,ROC)曲线评估新辅助化疗前后GNRI对患者近远期疗效的预测效能,分别应用Logistic回归模型和Cox回归模型分析近远期疗效的影响因素。构建各因素和GNRI的交互项并计算交互项检验P值,分析GNRI在各亚组人群中的远期预后价值。结果:与新辅助前GNRI、新辅助前后GNRI变化值相比,新辅助后GNRI预测术后并发症、3年总体生存和3年无病生存的AUC值均最高,分别为0.692、0.703和0.702;与高GNRI组的患者相比,低GNRI组的患者首次下床时间、首次排气时间、首次进食时间、术后住院天数均明显延长,且并发症发生率明显升高(33.6%vs 20.5%),差异均具有统计学意义(P<0.05)。多因素分析结果显示,低GNRI是术后并发症发生和远期预后不良的独立危险因素(P<0.05)。另外,亚组分析结果显示,GNRI在ypI-II期的患者中具体更加显著的远期生存价值(交互性P<0.05)。结论:新辅助化疗后GNRI是影响老年胃癌患者术后近远期疗效的独立预后因素,GNRI较高的患者术后并发症少、恢复快、且具有更长的生存期。Objective:To investigate the prognostic value of geriatric nutritional risk index(GNRI)during neoadjuvant chemotherapy in predicting short-and long-term prognosis of elderly patients with gastric cancer(GC).Methods:The clinicopathological data of 230 elderly GC patients who underwent neoadjuvant chemotherapy combined with radical gastrectomy at our institution between January 2014 and December 2019 were retrospectively reviewed.The receiver operating characteristic(ROC)curves were used to evaluate the predictive ability of the GNRI on short-and long-term efficacy.The Logistic and Cox regression models were used to identify the independent risk factors for short-and long-term prognosis.The interaction terms between the GNRI and clinicopathological factors were constructed and P values for interaction were calculated.The long-term prognostic value of GNRI in subgroups was analyzed.Results:Compared with the GNRI before neoadjuvant chemotherapy and the change of GNRI during neoadjuvant chemotherapy,the GNRI after neoadjuvant chemotherapy(post-GNRI)had the highest predictive abilities in predicting postoperative complications,3-year overall survival(OS),and 3-year disease-free survival(DFS),with the AUC values of 0.692,0.703,and 0.702,respectively.Compared with the patients with a higher post-GNRI,the patients with a lower post-GNRI had significantly longer time to ambulation,time to first flatus,time to first diet,and postoperative hospital stay,as well as a significantly higher rate of postoperative complications(33.6%vs 20.5%)(all P<0.05).Multivariate analysis showed that a low post-GNRI was an independent risk factor for postoperative complications and poor long-term prognosis(all P<0.05).Moreover,subgroup analysis showed that the post-GNRI exhibited a better prognostic value in patients with yp stage I-II disease.Conclusion:The GNRI after neoadjuvant chemotherapy was an independent predictor of both short-and long-term prognosis.Patients with a higher GNRI had fewer postoperative complications,faster recovery,and

关 键 词：胃癌 新辅助化疗 老年营养风险指数 近远期疗效 

分 类 号：R735.2[医药卫生—肿瘤]