那不勒斯预后评分对肝内胆管癌患者根治性切除术后预后的预测价值  

Predictive value of the Naples prognostic score for patients with intrahepatic cholangiocarcinoma after radical resection

作　　者：凌帅波 李路豪 刘兆臣 李素新[1] 李林[1] 党晓卫[1] Ling Shuaibo;Li Luhao;Liu Zhaochen;Li Suxin;Li Lin;Dang Xiaowei(Department of Hepatopancreatobiliary Surgery,the First Affiliated Hospital of Zhengzhou University,Key Laboratory of Precision Diagnosis and Treatment in General Surgical(Hepatobiliary and Pancreatic)Diseases of Health Commission of Henan Province,Henan Province Engineering Research Center of Minimally Invasive Diagnosis and Treatment of Hepatobiliary and Pancreatic Diseases,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院肝胆胰外科,河南省卫生健康委员会普通外科(肝胆胰)疾病精准诊疗重点实验室,河南省肝胆胰疾病微创诊治工程研究中心,郑州450052

出　　处：《中华肝胆外科杂志》2024年第8期586-591,共6页Chinese Journal of Hepatobiliary Surgery

基　　金：河南省自然科学基金(232300420232)。

摘　　要：目的探讨那不勒斯预后评分(NPS)评估肝内胆管癌(ICC)患者根治性切除术后预后的临床价值,建立列线图预测模型。方法回顾性收集2018年1月至2022年12月在郑州大学第一附属医院首次行根治性肝切除术的77例ICC患者的临床资料,其中男性46例,女性31例,年龄(58.9±11.0)岁。NPS预测ICC患者根治性肝切除术后死亡的受试者工作特征曲线下面积为0.673,根据约登指数计算NPS的最佳截断值为2.5。依据NPS的最佳截断值,将77例ICC患者分为两组:NPS≤2.5的患者纳入低NPS组(n=37);NPS>2.5的患者纳入高NPS组(n=40)。比较两组患者的手术切除范围、输血情况、肿瘤分化、脉管癌栓、淋巴结转移、术后并发症等临床资料。采用门诊复查或电话沟通的方式进行随访。采用Kaplan-Meier法进行生存分析,生存率比较采用log-rank检验。Cox比例风险回归分析影响术后生存的危险因素。构建列线图并评价其预测效能。结果与低NPS组相比,高NPS组中肿瘤长径≥5 cm、脉管癌栓、淋巴结转移、肿瘤糖类抗原19-9≥37 U/ml患者的比例及中性粒细胞计数与淋巴细胞计数比值水平均增加,而白蛋白≥40 g/L患者的比例降低,差异均具有统计学意义(均P<0.05)。高NPS组患者术后累积生存率低于低NPS组,差异具有统计学意义(P=0.001)。多因素Cox分析结果显示,有脉管癌栓、淋巴结转移、NPS>2.5的ICC患者,术后生存时间短的风险高(均P<0.05)。基于NPS构建的列线图模型具有良好的预测能力。结论术前NPS>2.5提示ICC患者根治性切除术后预后不良,基于NPS建立的列线图模型可预测ICC患者根治性切除术后的预后。ObjectiveTo study the clinical value of the Naples prognostic score(NPS)in predicting the prognosis of patients with intrahepatic cholangiocarcinoma(ICC)after radical resection and establish a nomogram prediction model.MethodsClinical data of 77 patients with ICC undergoing radical hepatectomy for the first time in the First Affiliated Hospital of Zhengzhou University from January 2018 to December 2022 were retrospectively collected,including 46 males and 31 females,aged(58.9±11.0)years old.The area under the receiver operating characteristic curve for NPS to predict the death after radical hepatectomy in ICC patients was 0.673,and the optimal cut-off value for NPS based on the Youden's index was 2.5.According to the optimal cut-off value of NPS,patients were divided into two groups:the low NPS group(patients with NPS≤2.5,n=37)and high NPS group(patients with NPS>2.5,n=40).The clinicopathological data including resection extent,blood transfusion,tumor differentiation,lymphovascular invasion,lymph node metastasis and postoperative complications were compared between the groups.Follow-ups were conducted via outpatient or telephone reviews.Kaplan-Meier method was used for survival analysis,and log-rank test was used for survival comparison.Cox proportional hazards regression was used to analyze the risk factors affecting postoperative survival.A prediction nomogram was established and evaluated.ResultsCompared to the low NPS group,the proportion of patients with tumor length≥5 cm,lymphovascular invasion,lymph node metastasis,tumor carbohydrate antigen 19-9≥37 U/ml and the level of neutrophil to lymphocyte ratio were increased in the high NPS group,while the proportion of patients with serum albumin≥40 g/L was decreased(all P<0.05).The cumulative survival rate of patients in the high NPS group was lower than that of the low NPS group(P=0.001).Multivariate Cox analysis showed that ICC patients with lymphovascular invasion,lymph node metastasis,and NPS>2.5 had a higher risk of short survival after surgery(all

关 键 词：胆管上皮癌 那不勒斯预后评分 根治性切除术 预后 

分 类 号：R735.8[医药卫生—肿瘤]