患者主观整体状况评估在结直肠癌中的预后价值及其列线图模型的构建  

Prognostic value of patient-generated subjective global assessment for colorectal cancer patients and construction of a nomogram

作　　者：赵东 许健华 季佩东 明志祥 Zhao Dong;Xu Jianhua;Ji Peidong;Ming Zhitiang(Department of General Surgery,Nartong Affiliated Hospital of Nanjing University of Chinese Medicine,Nantong 226007,Jiangsu,China)

机构地区：[1]南京中医药大学南通附属医院普外科,江苏南通226007

出　　处：《肿瘤代谢与营养电子杂志》2024年第3期367-374,共8页Electronic Journal of Metabolism and Nutrition of Cancer

基　　金：2021年度南通市市级科技计划项目(MSZ19056)。

摘　　要：目的探讨患者主观整体评估(PG-SGA)在结直肠癌中的预后价值,并构建一个联合患者营养状况与临床病理参数的列线图模型。方法选取2016年1月至2020年1月期间于南京中医药大学南通附属医院接受根治性手术的202例结直肠癌患者进行回顾性分析,使用PG-SGA量表评估患者术前营养状况,评估其对患者总生存(OS)率的影响。通过单、多变量Cox回归分析确定结直肠癌患者的独立预后因素,并构建列线图模型,C指数和校准曲线用于评价模型的预测能力。结果根据PG-SGA量表,33.7%的患者存在中度营养不良,26.7%为严重营养不良。严重营养不良患者肿瘤直径更大(P=0.044),术后接受辅助化疗的比例明显更低(P=0.029)。营养良好、中度营养不良及严重营养不良患者的5年OS率分别为81.6%、63.2%和46.5%,组间差异均有统计学意义(P<0.05)。肿瘤大小(P=0.046)、pT分期(P=0.002)、淋巴结转移(P=0.001)、脉管侵犯(P<0.001)与PG-SGA量表评估结果(P<0.001)是结直肠癌患者的独立预后因素。基于上述预后参数构建列线图模型,C指数为0.781(95%CI=0.671~0.890),校准曲线显示模型预测概率与实际生存概率具有良好一致性。结论PG-SGA量表评分是结直肠癌患者一项有用的生存预测工具,联合临床病理参数可进一步优化患者的预后风险分层。Objective To investigate the prognostic value of patient-generated subjective global assessment(PG-SGA)for colorectal cancer patients,and construct a nutrition-related nomogram integrated with nutritional status with clinicopathologic parameters for survival prediction.Method A retrospective analysis was conducted on 202 colorectal cancer patients who underwent curative resection in Nantong Affiliated Hospital of Nanjing University of Chinese Medicine from January 2016 to January 2020.Preoperative nutritional status was evaluated by PG-SGA and its impact on overall survival(OS)of colorectal cancer patients was analyzed.The univariate and multivariate Cox regression analysis was used to determine independent prognostic factors.A nomogram model was constructed and its predictive performance was tested by the consistency index(C-index)and calibration plots.Result According to the PG-SGA,33.7%of patients had moderate malnutrition and 26.7%were severely malnourished.Patients with severe malnutrition had a larger tumor diameter(P=0.044)and a lower proportion of adjuvant chemotherapy following the surgery(P=0.029)than other patients.The 5-year OS rates of patients with well nutrition,moderate malnutrition,and severe malnutrition were 81.6%,63.2%,and 46.5%,respectively.There were significant survival differences between the groups(P<0.05).Tumor size(P=0.046),p T stage(P=0.002),lymph node metastasis(P=0.001),vascular invasion(P<0.001),and PG-SGA(P<0.001)were independent prognostic factors for colorectal cancer patients.A nomogram model was developed according to the above prognostic parameters,and its C-index was 0.781(95%CI=0.671-0.890).The calibration plots showed a good consistency between the predicted survival probability and actual survival probability.Conclusion PG-SGA is a useful tool for survival prediction of colorectal cancer patients,and it might further optimize the prognostic risk stratification of patients along with clinicopathologic parameters.

关 键 词：结直肠癌 患者主观营养状况评价 列线图 预后 预测 

分 类 号：R735.34[医药卫生—肿瘤]