预后营养指数与胃癌术后临床特征及预后关系

目的：探讨预后营养指数（prognostic nutritional index ，PNI）与胃癌术后患者的临床特征、辅助化疗后不良反应及预后的关系。方法：回顾性分析148 例经病理确诊为胃癌并行胃癌根治切除术患者的临床随访病例资料。根据术前1 周内化验结果计算PNI 值。PNI 通过血清白蛋白（A，g/L）和总淋巴细胞计数（TLC ，× 10⁹/L ）的公式（PNI=A+5 ×TLC）计算出。通过对受试者工作特征曲线（receiver operating characteristic curve，ROC ）的分析得出PNI 的cut-off 值。采用Kaplan-Meier 生存曲线和Cox 比例风险模型研究PNI 对胃癌术后患者预后的影响。结果：年龄<65岁的胃癌患者的PNI 值明显高于年龄≥65岁的患者（P<0.01）。术后病理提示T1、T2 期（P<0.01）及淋巴结转移阴性（P=0.013）的患者的PNI 平均值均显著高于对照组。未发生术后并发症（P<0.01）及术后辅助化疗不良反应≤2 级的患者，PNI 值显著高于对照组（P<0.01）。 采用5 年生存作为终点绘制PNI 值的ROC 曲线，当PNI 值为52.08时，Youden指数最大，敏感度为66.7％，特异度为34.3％。PNI 高值组累积5 年总生存率显著高于PNI 低值组（P<0.01）。 单因素及多因素生存分析显示：术前CEA 值（P=0.018）、侵犯深度（P=0.010）、脉管癌栓（P=0.010）、初次化疗距手术天数（P=0.034）和PNI 值（P=0.015）是胃癌术后患者总生存时间的独立预后因素。结论：PNI 值作为一项便捷且有效的指标，可用于初步判断胃癌术后患者辅助化疗的不良反应发生率及预后状况。

Correlation analysis between prognostic nutritional index and clin-ical features and prognosis of resectable gastric cancer

Objective:To investigate the correlation among prognostic nutritional index (PNI), clinical features, and adverse reac -tions after adjuvant chemotherapy of gastric cancer patients who underwent radical gastrectomy. Furthermore, this study aimed to clari -fy the predictive and prognostic significance of PNI in patients who underwent gastrectomy for gastric cancer. Methods:This study re-viewed the medical records of148 patients with gastric cancer who underwent gastrectomy. The PNI value was calculated by serum al-bumin concentration (g/L) + 5 × lymphocyte count (×109/L). The receiver operating characteristic (ROC) curve and Youden index were used to determine the cut-off value of the PNI. Survival curves were described by Kaplan-Meier method and compared by Log-rank test. The univariate and multivariate analyses were performed with the Cox proportional hazard model to identify the prognostic factors.Re-sults: The mean values of the PNI in <65years old patients ( P<0.01), T 1 and T2 stages of tumor ( P<0.01), and negative lymph node ( P=0.013) were significantly higher than those without such factors. Patients with higher PNI had significantly lower rates of postoperative complication and adjuvant chemotherapy adverse reactions than those with lower PNI (P<0.01). When the PNI value was 52.08, the Youden index was maximal, with a sensitivity of 66.7% and a specificity of 34.3%. The overall survival rate in the high PNI group was higher than that in the low PNI group (P<0.01). The univariate and multivariate analyses showed that preoperative carcinoembryonic antigen level ( P=0.018), tumor depth ( P=0.010), intravascular cancer embolus ( P=0.010), time to initiation of chemotherapy after sur -gery (P=0.034), and the PNI value ( P=0.015) were independent factors in predicting overall survival rate. Conclusion:The PNI value was a simple and useful tool to predict the prognosis and the incidence of adjuvant chemotherapy adverse reactions of gastric cancer pa-tients after radical gastrectomy.