术前预后营养指数及骨骼肌面积与胃癌胃全切除术患者预后的相关性  

comPrognostic correlation between preoperative nutritional index and skeletal muscle area and prognosis of patients with gastric cancer undergoing total gastrectomy

作　　者：明芳 余燕子 余阳 Ming Fang;Yu Yanzi;Yu Yang(Department of General Surgery,the Sixth Hospital of Wuhan,Affiliated Hospital of Jianghan University,Wuhan 430014,Hubei,China;Department of Gastrointestinal Surgery,the Sixth Hospital of Wuhan,Affiliated Hospital of Jianghan University,Wuhan 430014,Hubei,China)

机构地区：[1]江汉大学附属医院/武汉市第六医院普外科,湖北武汉430014 [2]江汉大学附属医院/武汉市第六医院胃肠外科,湖北武汉430014

出　　处：《肿瘤代谢与营养电子杂志》2025年第1期52-59,共8页Electronic Journal of Metabolism and Nutrition of Cancer

基　　金：湖北省卫健委西医类项目(WJ2023M136)。

摘　　要：目的探讨术前预后营养指数(PNI)及骨骼肌面积(SMA)与胃癌胃全切除术患者预后的相关性。方法选取2019年3月至2020年12月于江汉大学附属医院/武汉市第六医院接受胃癌胃全切除术治疗且随访至2023年12月的胃癌患者109例作为研究对象,设立为胃癌组,另选取54例健康体检者设立为健康对照组,比较两组PNI、SMA变化,并观察PNI、SMA在胃癌患者不同病理特征中的表达;采用Spearman法分析PNI、SMA与胃癌患者临床特征的相关性;采用Cox比例风险模型分析PNI、SMA对胃癌患者3年随访期中无进展生存及总生存的影响;绘制受试者操作特征(ROC)曲线分析SMA预测胃癌患者预后的曲线下面积(AUC)、敏感度及特异度。结果胃癌组的PNI、SMA均低于健康对照组(P<0.05)。临床分期为Ⅲ期、低分化、T3~T4浸润、存在淋巴结转移和脉管浸润的胃癌患者PNI、SMA低于临床分期Ⅰ~Ⅱ期、中-高分化、T1~T2浸润、无淋巴结转移和脉管浸润的胃癌患者(P<0.05)。相关性分析显示,PNI、SMA与临床分期、分化程度、浸润深度、淋巴结转移、脉管浸润呈负相关(P<0.05)。Cox比例风险模型分析显示,SMA下降为胃癌胃全切除术患者3年无进展生存的独立影响因素(P<0.05)。ROC曲线分析显示,SMA预测胃癌胃全切除术患者3年无进展生存的AUC、敏感度、特异度分别为0.797、69.90%、83.30%。结论PNI、SMA在胃癌患者中呈明显下降趋势,其水平会随患者病情程度而发生改变,并影响预后,动态监测其变化有利于为临床治疗和预后评估提供指导。SMA下降为胃癌胃全切除术患者无进展生存的独立影响因素。Objective To investigate the correlation between preoperative prognostic nutritional index(PNI)and skeletal muscle area(SMA)and prognosis of patients with gastric cancer after total gastrectomy.Method A total of 109 patients with gastric cancer who received total gastectomy in the Affiliated Hospital of Jianghan University/Wuhan Sixth Hospital from March 2019 to December 2020 and were followed up to December 2023 were selected as the study subjects and set as the gastric cancer group,and 54 healthy subjects were selected as the healthy control group.The changes of PNI and SMA between the two groups were compared.The expressions of PNI andSMA in different pathological features of gastric cancer patients were observed.Spearman method was used to analyze the correlation between PNI,SMAand clinical features of gastric cancer patients.Cox proportional risk model was used to analyze the effects of PNIand SMA on 3-year progression-free survival and overall survival of gastric cancer patients.Receiver operating characteristic(ROC)curve were drawn to analyze the area under the curve(AUC),sensitivity and specificity of SMA in predicting the prognosis of patients with gastric cancer.ResultPNIand SMA in gastric cancer group were lower than those in healthy control group(P<0.05).The PNIand SMA of gastric cancer patients with stage Ⅲ,low differentiation,T3-T4 infiltration,lymph node metastasis and vascular invasion were lower than those with stage Ⅰ to Ⅱ,medium to high differentiation,T1-T2 infiltration,and no lymph node metastasis and vascular invasion(P<0.05).Correlation analysis showed that PNIand SMA were negatively correlated with clinical stage,differentiation degree,depth of invasion,lymph node metastasis and vascular invasion(P<0.05).Cox proportional risk model multivariate analysis showed that the decrease of SMA was an independent factor for 3-year progression-free survival in patients with total gastrectomy for gastric cancer(P<0.05).ROC curve analysis showed that the AUC,sensitivity and specificity of SMA in

关 键 词：预后营养指数 骨骼肌面积 胃癌胃全切除术 无进展生存 淋巴结转移 临床分期 脉管浸润 浸润深度 

分 类 号：R73[医药卫生—肿瘤]