预后营养指数在晚期NSCLC伴恶性胸腔积液患者预后和胸膜自发固定中的预测价值  

Predictive Value of Prognostic Nutritional Index in Prognosis and Spontaneous Pleurodesis of Patients with Advanced Non-small Cell Lung Cancer and Malignant Pleural Effusion

作　　者：谈思含 李为民[1] 田攀文[1] Sihan TAN;Weimin LI;Panwen TIAN(Department of Pulmonary and Critical Care Medicine/Lung Cancer Institute,State Key Laboratory of Respiratory Health and Multimorbidity,Precision Medicine Key Laboratory of Sichuan Province,West China Hospital,Sichuan University,Chengdu 610041,China)

机构地区：[1]四川大学华西医院呼吸与危重症医学科/肺癌中心,呼吸和共病全国重点实验室,精准医学四川省重点实验室,成都610041

出　　处：《中国肺癌杂志》2024年第12期931-939,共9页Chinese Journal of Lung Cancer

基　　金：国家自然科学基金项目(No.82473213、No.92159302)资助。

摘　　要：背景与目的 基于营养状况和炎症的预后营养指数(prognostic nutritional index, PNI)已被开发并证明与恶性肿瘤不良预后密切相关。然而,PNI在恶性胸腔积液(malignant pleural effusion, MPE)患者中的预测作用仍不确定。本研究旨在探究PNI在MPE患者预后和胸膜自发固定中的预测价值。方法 回顾性分析2015年1月至2022年12月于四川大学华西医院诊断为晚期非小细胞肺癌(non-small cell lung cancer, NSCLC)伴MPE患者病例资料,并将患者随机分配到训练集(60%)和验证集(40%)。收集患者的临床数据和外周血炎症指标并计算全身炎症系数,使用Cox比例风险模型、Kaplan-Meier法、Nelson-Aalen累积风险曲线分析PNI对MPE患者预后和胸膜自发固定的影响。结果 本研究最终纳入261例晚期NSCLC伴MPE患者(训练集157例,验证集104例),其中年龄<65岁占58.2%,男性患者占53.6%,腺癌占95.8%。PNI的二分类截断值为44.1,与PNI较低(PNI<44.1)的患者相比,PNI高(PNI≥44.1)的患者中位生存期明显延长(36.5 vs 24.3个月,P=0.02),胸膜自发固定发生率更高(P=0.009)。多因素Cox分析发现,较高的PNI是患者良好预后和胸膜自发固定的独立影响因素(P<0.05)。根据Cox回归分析结果确定PNI-预后和PNI-胸膜自发固定预测模型,绘制受试者工作特征(receiver operating characteristic, ROC)曲线,训练集的曲线下面积(area under the curve, AUC)分别为0.694(95%CI:0.620-0.776)和0.673(95%CI:0.590-0.737)。结论 PNI是衡量MPE患者预后和胸膜自发固定的可靠生物标志物,关注患者的营养状况和免疫状态可能会改善患者的预后和胸腔积液的控制。Background and objective A prognostic nutritional index(PNI)developed by nutritional status and inflammation are closely associated with poor prognosis in malignant tumors.However,the predictive impact of PNI in patients with malignant pleural effusion(MPE)remains inconclusive.The study aimed to determine the predictive value of PNI in prognosis and spontaneous pleurodesis among patients with MPE.Methods The patients diagnosed with advanced non-small cell lung cancer(NSCLC)with MPE in West China Hospital between January 2015 and December 2022 were reviewed and allocated randomly to development set(60%)and validation set(40%).After collecting clinical data,peripheral blood inflamma-tion indices and calculating systemic inflammation indices,the effects of PNI on prognosis and spontaneous pleurodesis have been evaluated by Cox proportional hazards models,Kaplan-Meier method and Nelson-Aalen cumulative risk curve.Results In total,261 patients diagnosed NSCLC with MPE were selected(development set:n=157;validation set:n=104),of whom 58.2%were aged<65 years,53.6%were male and 95.8%were diagnosed with adenocarcinoma.The dichotomous cut-off value for PNI was 44.1,respectively.Compared with lower PNI(PNI<44.1)cases,patients with higher PNI(PNI≥44.1)showed significantly longer overall survival(36.5 vs 24.3 mon,P=0.02)and higher incidence of spontaneous pleurodesis(P=0.009).According to the multivariate Cox analysis,higher PNI was associated with good prognosis and successful spontaneous pleurodesis(P<0.05).According to the results of Cox regression analysis,the PNI-prognosis and PNI-spontaneous pleurodesis models are determined,the receiver operating characteristic(ROC)curves are drawn,and the area under the curves(AUC)value of development set are 0.694(95%CI:0.620-0.776)and 0.673(95%CI:0.590-0.737).Conclusion PNI is a reliable biomarker of prognosis and spontaneous pleurodesis in patients with MPE.Attention to the patient's nutritional status and inflammation may improve the prognosis and efficacy of pleural effusion.

关 键 词：肺肿瘤 恶性胸腔积液 预后营养指数 预后 胸膜自发固定 

分 类 号：R73[医药卫生—肿瘤]