预后营养指数对交界可切除胰腺癌患者术后预后的预测价值  

Predictive value of prognostic nutritional index for postoperative prognosis in patients with borderline resectable pancreatic cancer

作　　者：黄金灿 王迪 崔松平 陈晴 吕少诚[1] 贺强[1] 郎韧[1] Huang Jincan;Wang Di;Cui Songping;Chen Qing;Lyu Shaocheng;He Qiang;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,100020

出　　处：《中华肝脏外科手术学电子杂志》2024年第1期51-56,共6页Chinese Journal of Hepatic Surgery(Electronic Edition)

摘　　要：目的探讨预后营养指数(PNI)对交界可切除胰腺癌患者术后预后的预测价值。方法回顾性分析2013年3月至2021年12月首都医科大学附属北京朝阳医院行手术治疗的77例交界可切除胰腺癌患者临床资料。患者均签署知情同意书,符合医学伦理学规定。其中男34例,女43例;平均年龄(61±11)岁。根治性胰十二指肠切除术61例,根治性全胰十二指肠切除术16例。根据术前血清ALB和外周血淋巴细胞计数,计算术前PNI为45±5,以45为界值,将患者分为低PNI组(39例)和高PNI组(38例)。生存分析采用Kaplan-Meier法和Log-rank检验,采用Cox多因素分析筛选影响患者远期预后的危险因素。结果两组患者均顺利完成手术,术后并发症发生率为30%(23/77)。低PNI组和高PNI组患者中位生存时间分别为8.0、15.5个月,患者术后6个月、1年、2年总体生存率分别为76.7%、40.1%、17.2%和91.8%、65.3%、49.8%,差异有统计学意义(χ^(2)=5.826,P<0.05)。Cox多因素分析显示,低PNI(HR=1.864,95%CI:1.089~3.190,P=0.023)、肿瘤低分化(HR=2.166,95%CI:1.225~3.828,P=0.008)是影响术后远期生存的独立危险因素。结论PNI可作为预测交界可切除胰腺癌患者总体生存期的有效指标,低PNI患者预后较差。Objective To evaluate the predictive value of prognostic nutritional index(PNI)for prognosis of patients with borderline resectable pancreatic cancer.Methods Clinical data of 77 patients with borderline resectable pancreatic cancer who underwent surgical treatment in Beijing Chaoyang Hospital,Capital Medical University from March 2013 to December 2021 were retrospectively analyzed.The informed consents of all patients were obtained and the local ethical committee approval was received.Among them,34 patients were male and 43 female,aged(61±11)years on average.61 patients underwent radical pancreaticoduodenectomy and 16 cases of radical total pancreaticoduodenectomy.According to preoperative serum ALB and peripheral blood lymphocyte count,preoperative PNI was calculated as 45±5.All patients were divided into low(n=39)and high PNI groups(n=38)with PNI of 45 as the cut-off value.Survival analysis was performed by Kaplan-Meier analysis and Log-rank test.The risk factors affecting the long-term prognosis of patients were screened by multivariate Cox's model.Results All patients successfully completed the surgery.The incidence of postoperative complications was 30%(23/77).The median survival of patients in the low and high PNI groups was 8.0 and 15.5 months.The postoperative 6-month,1-year and 2-year overall survival rates in two groups were 76.7%,40.1%,17.2%and 91.8%,65.3%,49.8%,and the differences were statistically significant(χ^(2)=5.826,P<0.05).Multivariate Cox's model showed that low PNI(HR=1.864,95%CI:1.089-3.190,P=0.023)and low degree of tumor differentiation(HR=2.166,95%CI:1.225-3.828,P=0.008)were the independent risk factors for postoperative long-term survival.Conclusions PNI can be utilized as an effective index to predict the overall survival of patients with borderline resectable pancreatic cancer.Patients with low PNI obtain poor prognosis.

关 键 词：胰腺肿瘤 交界可切除胰腺癌 营养评估 预后营养指数(PNI) 预后 

分 类 号：R735.9[医药卫生—肿瘤]