预后营养指数联合炎症指标预测局部晚期胃癌辅助同步放化疗疗效的临床意义  

Significance of prognostic nutritional index combined with inflammatory index in predicting prognosis of locally advanced gastric cancer with concurrent chemoradiotherapy

作　　者：要雪品 段颖欣 霍俊杰[1] YAO Xuepin;DUAN Yingxin;HUO Junjie(Department of Chemoradiotherapy,the Second Affiliated Hospital of Xingtai Medical College,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：《临床肿瘤学杂志》2024年第8期758-763,共6页Chinese Clinical Oncology

基　　金：河北省邢台市重点研发计划资助项目(2020ZC382)。

摘　　要：目的探讨局部晚期胃癌(LAGC)患者辅助同步放化疗(CCRT)前预后营养指数(PNI)和全身炎症指标在疗效预测中的意义。方法回顾性分析2019年1月至2020年12月接受D 2根治术和辅助CCRT的120例局部晚期胃或胃食管交界癌患者的病历资料。受试者工作特征(ROC)曲线确定相关指标预测复发和死亡的最佳截断值。Kaplan-Meier法绘制生存曲线,生存差异行Log-rank检验。Cox比例风险回归模型分析影响胃癌患者总生存时间(OS)和无复发生存时间(RFS)的因素。结果全组患者中位OS为22.1个月,RFS为14.9个月。复发78例,死亡64例。与复发或死亡患者比较,未复发或存活患者的临床分期以及全身炎症指标,包括SII、SIRI、PIV、PLR、NLR显著降低;而PNI显著升高(P<0.05)。根据ROC曲线,SII、SIRI、PLR、NLR预测LAGC复发的截断值分别为350.580、1.738、112.125、3.018,预测死亡的截断值分别为355.758、1.076、149.125、2.505。另外,PNI、PIV预测复发和死亡的截断值均为51.255、170.781。多因素Cox回归分析显示,临床分期、PNI、NLR为影响LAGC患者复发和死亡的独立因素(P<0.05)。PNI≥51.255患者的RFS和OS更长(P<0.05);NLR≥3.018患者的RFS和NLR≥2.505患者的OS更短(P<0.05)。结论PNI和术后全身炎症指标(尤其是NLR)是影响LAGC患者D 2根治性切除和辅助CCRT疗效的独立因素。Objective To investigate the significance of prognostic nutritional index(PNI)and systemic inflammatory index before concurrent chemoradiotherapy(CCRT)in patients with locally advanced gastric cancer(LAGC).Methods The medical records of 120 patients with locally advanced gastric or gastroesophageal borderline carcinoma who received D 2 radical resection and auxiliary CCRT from January 2019 to December 2020 were retrospectively analyzed.Receiver operating characteristics(ROC)determined the best cut-off values for relevant indicators to predict recurrence and death.Survival curve was drawn by Kaplan-Meier method,and survival difference was tested by Log-rank.Multivariate Cox proportional risk model was used to analyze the factors affecting overall survival(OS)and relapse-free survival(RFS)in patients with gastric cancer.Results The median OS and RFS of LAGC patients were 22.1 months and 14.9 months.There were 78 recurrences and 64 deaths.Clinical stage and systemic inflammatory markers,including SII,SIRI,PIV,PLR,and NLR,were significantly lower in patients who did not relapse or survived compared with patients who relapsed or died.PNI was significantly higher(P<0.05).According to ROC curve,the cut-off values of SII,SIRI,PLR and NLR for predicting LAGC recurrence were 350.580,1.738,112.125 and 3.018,and the cut-off values for predicting death were 355.758,1.076,149.125 and 2.505.In addition,the cut-off values of PNI and PIV for predicting recurrence and death were both 51.255 and 170.781.Multivariate Cox regression analysis showed that clinical stage,PNI and NLR were independent influencing factors for recurrence and death in LAGC patients(P<0.05).RFS and OS were longer in patients with PNI≥51.255(P<0.05).Patients with NLR≥3.018 had shorter RFS and patients with NLR≥2.505 had shorter OS(P<0.05).Conclusion PNI and postoperative systemic inflammatory markers(especially NLR)are independent prognostic factors for D 2 radical resection and adjuvant concurrent chemoradiothergpy in LAGC patients.

关 键 词：局部晚期胃癌 辅助同步放化疗 炎症指标 预后营养指数 预后 

分 类 号：R735.2[医药卫生—肿瘤]