王 巖,陶仁海,曹 玉,高 峰,殷金環(huán),張立敏,周 軍,劉俊峰
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·論著·
預(yù)后營(yíng)養(yǎng)指數(shù)在食管腺癌患者預(yù)后評(píng)估中的價(jià)值研究
王 巖,陶仁海,曹 玉,高 峰,殷金環(huán),張立敏,周 軍,劉俊峰
目的探討預(yù)后營(yíng)養(yǎng)指數(shù)(PNI)在食管腺癌患者預(yù)后評(píng)估中的影響。方法選取2008—2010年就診于河北醫(yī)科大學(xué)第四醫(yī)院的食管腺癌患者128例。收集患者人口學(xué)和臨床病理資料,包括性別、年齡、組織學(xué)分化程度、腫瘤位置、腫瘤大小、淋巴結(jié)轉(zhuǎn)移、TNM分期、術(shù)后排氣時(shí)間、術(shù)后排便時(shí)間、有無(wú)殘端受侵、有無(wú)脈管瘤栓。收集患者術(shù)前1周內(nèi)血清蛋白和外周血淋巴細(xì)胞計(jì)數(shù)資料,計(jì)算PNI。以手術(shù)日期為觀察起點(diǎn),隨訪至2015-12-31,隨訪終點(diǎn)為死亡或截至隨訪日期。采用Kaplan-Meier法計(jì)算生存率,Log-rank檢驗(yàn)比較生存率,Cox比例風(fēng)險(xiǎn)回歸模型分析影響食管腺癌患者預(yù)后的因素。結(jié)果128例患者完成隨訪120例,隨訪率為93.8%。以患者平均PNI(40.82)為界,分為高PNI組(n=41)和低PNI組(n=79)。高PNI組和低PNI組患者腫瘤大小、淋巴結(jié)轉(zhuǎn)移、TNM分期、術(shù)后排氣時(shí)間比較,差異均有統(tǒng)計(jì)學(xué)意義(P<0.001)。單因素分析結(jié)果顯示,不同腫瘤大小、淋巴結(jié)轉(zhuǎn)移、TNM分期、術(shù)后排氣時(shí)間、術(shù)后排便時(shí)間、PNI水平者預(yù)后比較,差異均有統(tǒng)計(jì)學(xué)意義(P<0.05)。Cox比例風(fēng)險(xiǎn)回歸模型結(jié)果顯示,TNM分期、PNI為影響食管腺癌患者預(yù)后的獨(dú)立因素(P<0.05)。以患者平均年齡(61.5歲)為界值,<61.5歲為中青年組(n=63),≥61.5歲為老年組(n=57)。單因素分析結(jié)果顯示,中青年組中,不同性別、腫瘤大小、淋巴結(jié)轉(zhuǎn)移、TNM分期、術(shù)后排氣時(shí)間、術(shù)后排便時(shí)間、PNI水平者預(yù)后比較,差異均有統(tǒng)計(jì)學(xué)意義(P<0.05)。老年組中,不同性別、腫瘤大小、TNM分期、術(shù)后排便時(shí)間、PNI水平者預(yù)后比較,差異均有統(tǒng)計(jì)學(xué)意義(P<0.05)。Cox比例風(fēng)險(xiǎn)回歸模型結(jié)果顯示,TNM分期、術(shù)后排氣時(shí)間、PNI為影響中青年食管腺癌患者預(yù)后的獨(dú)立因素(P<0.05);PNI為影響老年食管腺癌患者預(yù)后的獨(dú)立因素(P<0.05)。結(jié)論P(yáng)NI能較好地評(píng)估食管腺癌患者的手術(shù)風(fēng)險(xiǎn),是一項(xiàng)較有價(jià)值的術(shù)前評(píng)估和分析預(yù)后的指標(biāo)。
食管腫瘤;營(yíng)養(yǎng)評(píng)價(jià);預(yù)后
王巖,陶仁海,曹玉,等.預(yù)后營(yíng)養(yǎng)指數(shù)在食管腺癌患者預(yù)后評(píng)估中的價(jià)值研究[J].中國(guó)全科醫(yī)學(xué),2016,19(28):3428-3433.[www.chinagp.net]
WANG Y,TAO R H,CAO Y,et al.Investigation in prognostic value of prognostic nutritional index in patients with esophageal adenocarcinoma[J].Chinese General Practice,2016,19(28):3428-3433.
近年來,惡性腫瘤患者的免疫-營(yíng)養(yǎng)學(xué)指標(biāo)與預(yù)后的關(guān)系成為研究熱點(diǎn)。預(yù)后營(yíng)養(yǎng)指數(shù)(prognostic nutritional index,PNI)通過結(jié)合血清蛋白和外周血淋巴細(xì)胞計(jì)數(shù)兩項(xiàng)指標(biāo),可綜合反映患者的營(yíng)養(yǎng)水平和免疫狀態(tài)[1]。多項(xiàng)臨床研究認(rèn)為,PNI與胃癌、結(jié)直腸癌、胰腺癌等癌癥的預(yù)后存在密切關(guān)系[2-4]。本研究分析PNI與食管腺癌患者臨床病理特征及預(yù)后的關(guān)系,探討PNI在食管腺癌患者預(yù)后評(píng)估中的價(jià)值。
1.1一般資料選取2008—2010年就診于河北醫(yī)科大學(xué)第四醫(yī)院的食管腺癌患者128例。入選標(biāo)準(zhǔn):(1)經(jīng)術(shù)后病理證實(shí)為食管腺癌;(2)術(shù)前未行新輔助治療;(3)術(shù)前1周內(nèi)獲得血清蛋白和外周血淋巴細(xì)胞計(jì)數(shù)指標(biāo);(4)術(shù)前未輸血、無(wú)血液系統(tǒng)疾病、無(wú)嚴(yán)重感染。排除標(biāo)準(zhǔn):(1)病理證實(shí)為非食管腺癌;(2)合并或既往存在其他腫瘤;(3)術(shù)前行新輔助治療;(4)術(shù)前1周內(nèi)存在明顯感染征象;(5)出現(xiàn)遠(yuǎn)處轉(zhuǎn)移。
1.2數(shù)據(jù)收集收集患者人口學(xué)和臨床病理資料,包括性別、年齡、組織學(xué)分化程度、腫瘤位置、腫瘤大小、淋巴結(jié)轉(zhuǎn)移、TNM分期、術(shù)后排氣時(shí)間、術(shù)后排便時(shí)間、有無(wú)殘端受侵、有無(wú)脈管瘤栓。收集患者入院后術(shù)前1周內(nèi)血常規(guī)和生化指標(biāo),包括血清蛋白和外周血淋巴細(xì)胞計(jì)數(shù),計(jì)算PNI,PNI=血清蛋白(g/L)+5×外周血淋巴細(xì)胞計(jì)數(shù)(×109/L)。
1.3隨訪以手術(shù)日期為觀察起點(diǎn),出院患者采取電話隨訪的方式,第1年每3個(gè)月隨訪1次,第2年開始每6個(gè)月隨訪1次,末次隨訪日期為2015-12-31。生存時(shí)間為手術(shù)日期至死亡日期或截至隨訪日期。
1.4統(tǒng)計(jì)學(xué)方法采用SPSS 20.0軟件進(jìn)行統(tǒng)計(jì)學(xué)分析,計(jì)數(shù)資料的分析采用χ2檢驗(yàn);采用Kaplan-Meier法計(jì)算生存率,生存率的比較采用Log-rank檢驗(yàn);采用多因素Cox比例風(fēng)險(xiǎn)回歸模型分析預(yù)后的獨(dú)立影響因素。以P<0.05為差異有統(tǒng)計(jì)學(xué)意義。
2.1PNI與食管腺癌患者臨床病理特征的關(guān)系128例患者完成隨訪120例,隨訪率為93.8%。120例患者年齡31~78歲,平均年齡(61.5±8.2)歲;PNI為23.15~61.10,平均(40.82±7.11)。以PNI≥40.82定義為PNI升高。結(jié)果顯示,高PNI組41例(34.2%),低PNI組79例(65.8%)。高PNI組和低PNI組患者性別、年齡、組織學(xué)分化程度、腫瘤位置、術(shù)后排便時(shí)間、殘端受侵、脈管瘤栓比較,差異均無(wú)統(tǒng)計(jì)學(xué)意義(P>0.05);兩組腫瘤大小、淋巴結(jié)轉(zhuǎn)移、TNM分期、術(shù)后排氣時(shí)間比較,差異均有統(tǒng)計(jì)學(xué)意義(P<0.05,見表1)。
2.2影響食管腺癌患者預(yù)后的單因素及多因素分析120例患者隨訪8~66個(gè)月,截至隨訪日期,28例患者生存;患者1年、3年和5年生存率分別為88.3%、46.7%和8.3%,中位生存時(shí)間32個(gè)月。單因素分析結(jié)果顯示,不同性別、年齡、組織學(xué)分化程度、腫瘤位置、殘端受侵、脈管瘤栓者預(yù)后比較,差異均無(wú)統(tǒng)計(jì)學(xué)意義(P>0.05);不同腫瘤大小、淋巴結(jié)轉(zhuǎn)移、TNM分期、術(shù)后排氣時(shí)間、術(shù)后排便時(shí)間、PNI水平者預(yù)后比較,差異均有統(tǒng)計(jì)學(xué)意義(P<0.05,見表2、圖1)。
表1高PNI組與低PNI組患者臨床病理特征比較〔n(%)〕
Table 1Comparison of clinical features between high-PNI group and low-PNI group
因素例數(shù)高PNI組(n=41)低PNI組(n=79)χ2值P值性別2.1200.145 男9429(70.7)65(82.3) 女2612(29.3)14(17.7)年齡(歲)0.3460.557 <61.56320(48.8)43(54.4) ≥61.55721(51.2)36(45.6)組織學(xué)分化程度0.0160.900 中分化8429(70.7)55(69.6) 低分化3612(29.3)24(30.4)腫瘤位置0.6530.419 下段7925(61.0)54(68.4) 其他4116(39.0)25(31.6)腫瘤大小37.490<0.001 T12722(53.4)5(6.3) T2279(22.0)18(22.8) T36610(24.6)56(70.9)淋巴結(jié)轉(zhuǎn)移19.869<0.001 N06935(85.4)34(43.0) N1354(9.8)31(39.2) N2152(4.8)13(16.5) N3101(1.3)TNM分期(期)61.701<0.001 Ⅰ3631(75.6)5(6.3) Ⅱ526(14.6)46(58.2) Ⅲ324(9.8)28(35.5)術(shù)后排氣時(shí)間(d)8.2070.004 <4.59739(95.1)58(73.4) ≥4.5232(4.9)21(26.6)術(shù)后排便時(shí)間(d)1.7940.180 <7.16325(61.0)38(48.1) ≥7.15716(39.0)41(51.9)殘端受侵0.8600.354 有61(2.4)5(6.3) 無(wú)11440(97.6)74(93.7)脈管瘤栓0.3200.571 有82(4.9)6(7.6) 無(wú)11239(95.1)73(92.4)
注:PNI=預(yù)后營(yíng)養(yǎng)指數(shù)
以患者預(yù)后(賦值:生存=0,死亡=1)為因變量,以腫瘤大小(賦值:T1=0,T2=1,T3=2)、淋巴結(jié)轉(zhuǎn)移(賦值:N0=0,N1=1,N2=2,N3=3)、TNM分期(賦值:Ⅰ期=0,Ⅱ期=1,Ⅲ期=2)、術(shù)后排氣時(shí)間(賦值:<4.5 d=0,≥4.5 d=1)、術(shù)后排便時(shí)間(賦值:<7.1 d=0,≥7.1 d=1)、PNI(賦值:<40.82
=0,≥40.82=1)為自變量代入Cox比例風(fēng)險(xiǎn)回歸模型,結(jié)果顯示,TNM分期、PNI為影響食管腺癌患者預(yù)后的獨(dú)立因素(P<0.05,見表3)。
表2影響食管腺癌患者預(yù)后的單因素分析(%)
Table 2Univariate analysis on influencing factors for prognosis of patients with esophageal adenocarcinoma
因素例數(shù)生存率1年 3年 5年χ2值P值性別1.1000.468 男9487.243.69.6 女2692.357.73.8年齡(歲)0.0860.613 <61.56393.747.69.5 ≥61.55782.545.67.0組織學(xué)分化程度0.0140.303 中分化8488.146.48.3 低分化3688.947.28.3腫瘤位置0.6800.440 下段7889.741.09.0 其他4285.757.17.1腫瘤大小68.670<0.001 T127100.096.329.6 T22796.366.77.4 T36680.318.20淋巴結(jié)轉(zhuǎn)移24.043<0.001 N06989.963.813.0 N13585.725.72.9 N21586.720.00 N31100.000TNM分期(期)92.464<0.001 Ⅰ36100.0100.027.8 Ⅱ5284.634.60 Ⅲ3281.36.30術(shù)后排氣時(shí)間(d)12.429<0.001 <4.56383.761.915.9 ≥4.55789.529.80術(shù)后排便時(shí)間(d)9.1430.003 <7.19791.847.410.3 ≥7.12373.943.50殘端受侵1.8170.065 有683.333.30 無(wú)11488.647.48.8脈管瘤栓0.6380.121 有862.537.50 無(wú)11290.247.38.9PNI水平81.302<0.001 低7982.326.60 高41100.085.424.4
注:PNI=預(yù)后營(yíng)養(yǎng)指數(shù)
圖1高PNI組與低PNI組食管腺癌患者生存曲線
Figure 1Survival curves of patients with esophageal adenocarcinoma between high-PNI group and low-PNI group
表3影響食管腺癌患者預(yù)后的Cox比例風(fēng)險(xiǎn)回歸分析
Table 3Cox proportional hazard model analysis on influencing factors for the prognosis of patients with esophageal adenocarcinoma
因素βSEWaldχ2值HR(95%CI)P值腫瘤大小0.4630.3262.0191.589(0.839,3.008)0.155淋巴結(jié)轉(zhuǎn)移-0.1230.2660.2130.884(0.525,1.491)0.645TNM分期1.1280.3816.5223.089(1.300,7.339)0.011術(shù)后排氣時(shí)間0.3390.2342.9221.491(0.943,2.357)0.087術(shù)后排便時(shí)間0.1100.2740.1621.117(0.653,1.910)0.687PNI-2.1610.38631.2980.115(0.054,0.246)<0.001
2.3影響不同年齡組食管腺癌患者預(yù)后的單因素及多因素分析以平均年齡61.5歲為界值,<61.5歲為中青年組(n=63),≥61.5歲為老年組(n=57)。單因素分析結(jié)果顯示,中青年組中,不同組織學(xué)分化程度、腫瘤位置、殘端受侵、脈管瘤栓者預(yù)后比較,差異均無(wú)統(tǒng)計(jì)學(xué)意義(P>0.05);不同性別、腫瘤大小、淋巴結(jié)轉(zhuǎn)移、TNM分期、術(shù)后排氣時(shí)間、術(shù)后排便時(shí)間、PNI水平者預(yù)后比較,差異均有統(tǒng)計(jì)學(xué)意義(P<0.05)。老年組中,不同組織學(xué)分化程度、腫瘤位置、淋巴結(jié)轉(zhuǎn)移、術(shù)后排氣時(shí)間、殘端受侵、脈管瘤栓者預(yù)后比較,差異均無(wú)統(tǒng)計(jì)學(xué)意義(P>0.05);不同性別、腫瘤大小、TNM分期、術(shù)后排便時(shí)間、PNI水平者預(yù)后比較,差異均有統(tǒng)計(jì)學(xué)意義(P<0.05,見表4、圖2~3)。中青年組多因素分析,以預(yù)后為因變量,以單因素分析有統(tǒng)計(jì)學(xué)意義的變量作為自變量(性別賦值:男=0,女=1;余指標(biāo)賦值同上)代入Cox比例風(fēng)險(xiǎn)回歸模型,結(jié)果顯示,TNM分期、術(shù)后排氣時(shí)間、PNI為影響中青年食管腺癌患者預(yù)后的獨(dú)立因素(P<0.05,見表5)。老年組多因素分析,以預(yù)后為因變量,以單因素分析有統(tǒng)計(jì)學(xué)意義的變量作為自變量代入Cox比例風(fēng)險(xiǎn)回歸模型,結(jié)果顯示,PNI為影響老年食管腺癌患者預(yù)后的獨(dú)立因素(P<0.05,見表6)。
表5影響中青年組食管腺癌患者預(yù)后的Cox比例風(fēng)險(xiǎn)回歸分析
Table 5Cox proportional hazard model analysis on influencing factors for the prognosis of patients with esophageal adenocarcinoma in young & middle-aged group
因素βSEWaldχ2值HR(95%CI)P值性別0.5950.4361.8611.813(0.771,4.261)0.172腫瘤大小0.0830.4580.0331.087(0.443,2.667)0.855淋巴結(jié)轉(zhuǎn)移-0.4410.4211.0950.644(0.282,1.469)0.295TNM分期2.0260.7108.1357.586(1.885,30.530)0.004術(shù)后排氣時(shí)間0.7800.3754.3252.181(1.046,4.547)0.038術(shù)后排便時(shí)間-0.1730.3760.2110.841(0.402,1.759)0.646PNI-1.6150.5558.4520.199(0.067,0.591)0.004
表6影響老年組食管腺癌患者預(yù)后的Cox比例風(fēng)險(xiǎn)回歸分析
Table 6Cox proportional hazard model analysis on influencing factors for the prognosis of patients with esophageal adenocarcinoma in senior group
因素βSEWaldχ2值HR(95%CI)P值性別-0.0240.4080.0030.976(0.439,2.172)0.953腫瘤大小0.8510.5202.6752.342(0.845,6.496)0.102TNM分期0.5200.6560.6301.683(0.465,6.083)0.427術(shù)后排便時(shí)間0.2690.4780.3171.309(0.513,3.340)0.573PNI-2.5430.60917.4300.079(0.024,0.259)<0.001
圖2 中青年食管腺癌患者高PNI組與低PNI組生存曲線
Figure 2Survival curves of patients with esophageal adenocarcinoma in young & middle-aged between high-PNI group and low-PNI group
表4 影響不同年齡組食管腺癌患者預(yù)后的單因素分析
近年來,隨著生活水平的提高,食管腺癌在我國(guó)的發(fā)病率有所提高[1]。因此,有必要對(duì)食管腺癌的臨床病理特征進(jìn)行總結(jié),并分析影響其預(yù)后的因素。JEMAL等[2]報(bào)道食管腺癌發(fā)病男性較女性多見,兩者比例為3~4∶1,本研究120例患者中男女比例為3.6∶1,與既往研究結(jié)果一致。本研究病例中,胸下段食管腺癌患者占65.8%,而上段和中段總和占34.2%。說明Barrett食管-食管腺癌模式是食管腺癌發(fā)生發(fā)展過程中主要因素。本研究結(jié)果顯示,PNI與腫瘤大小、淋巴結(jié)轉(zhuǎn)移有關(guān),其原因可能是隨著疾病的進(jìn)展,患者免疫狀態(tài)逐漸下降,同時(shí),由腫瘤引起的經(jīng)口進(jìn)食量的減少,導(dǎo)致患者營(yíng)養(yǎng)狀態(tài)降低;術(shù)后排氣時(shí)間反映胃腸功能在術(shù)后恢復(fù)的快慢,本研究結(jié)果亦顯示,PNI與術(shù)后排氣時(shí)間有關(guān),說明患者術(shù)前的營(yíng)養(yǎng)狀態(tài)影響術(shù)后胃腸功能的恢復(fù),進(jìn)而與患者的住院時(shí)間和住院費(fèi)用相關(guān)。然而,PNI作為預(yù)測(cè)患者住院時(shí)間和住院費(fèi)用的一項(xiàng)指標(biāo)有待進(jìn)一步研究證實(shí)。
國(guó)外多項(xiàng)臨床研究觀察到PNI是一項(xiàng)獨(dú)立于腫瘤TNM分期以外的預(yù)后指標(biāo)[4-5]。有研究表明,在胃癌和食管鱗癌患者中,低PNI組較高PNI組的預(yù)后差[2-3]。KANDA等[4]和TAKUSHIMA等[6]分別在對(duì)胰腺癌和婦科腫瘤患者中也發(fā)現(xiàn)了相似的結(jié)果。本研究結(jié)果顯示,高PNI組患者的預(yù)后優(yōu)于低PNI組,可能由于高PNI組
圖3 老年食管腺癌患者高PNI組與低PNI組生存曲線
Figure 3Survival curves of patients with esophageal adenocarcinoma in senior between high-PNI group and low-PNI group
患者處于疾病較早期且經(jīng)口進(jìn)食量受腫瘤影響較小所致,而低PNI組患者預(yù)后差,說明在術(shù)前的低免疫-營(yíng)養(yǎng)狀態(tài)減低了機(jī)體包繞腫瘤和殺傷腺癌細(xì)胞的能力,相對(duì)增強(qiáng)了癌細(xì)胞在食管腺癌患者體內(nèi)的繁殖能力和活躍程度。多因素分析結(jié)果顯示,PNI是影響食管腺癌患者預(yù)后的獨(dú)立因素,提示PNI有可能成為預(yù)測(cè)食管腺癌患者預(yù)后的新指標(biāo)。此外,多因素分析還發(fā)現(xiàn)TNM分期是影響食管腺癌患者預(yù)后的獨(dú)立因素,與目前多數(shù)研究結(jié)果一致[7-8]。
隨著人類預(yù)期壽命的延長(zhǎng),進(jìn)行外科手術(shù)治療的老年食管癌患者越來越多。有學(xué)者認(rèn)為高齡本身不能作為手術(shù)的禁忌證,然而隨著患者年齡的增加,心功能、呼吸功能、肝腎功能和內(nèi)分泌功能等減低,均使臨床對(duì)于高齡食管癌手術(shù)患者的選擇慎之又慎[9-10]。因此本研究對(duì)不同年齡組的患者生存情況進(jìn)行分層分析,結(jié)果顯示,TNM分期、術(shù)后排氣時(shí)間和PNI為影響中青年食管腺癌患者預(yù)后的獨(dú)立因素;PNI是影響老年食管腺癌患者預(yù)后的獨(dú)立因素。PNI作為中青年及老年食管腺癌患者預(yù)后的獨(dú)立影響因素,其簡(jiǎn)便廉價(jià)且不增加癌癥患者的痛苦和負(fù)擔(dān),對(duì)于食管腺癌患者判斷預(yù)后是一項(xiàng)敏感的指標(biāo),對(duì)于臨床選擇合適的手術(shù)患者及改善患者預(yù)后起到重要作用。
作者貢獻(xiàn):王巖進(jìn)行試驗(yàn)設(shè)計(jì)與實(shí)施、資料收集整理、撰寫論文、成文并對(duì)文章負(fù)責(zé);陶仁海、曹玉、高峰、殷金環(huán)、張立敏、周軍進(jìn)行試驗(yàn)實(shí)施、評(píng)估、資料收集;劉俊峰進(jìn)行質(zhì)量控制及審校。
本文無(wú)利益沖突。
本文要點(diǎn):
(1)預(yù)后營(yíng)養(yǎng)指數(shù)(PNI)通過計(jì)算外周血淋巴細(xì)胞計(jì)數(shù)和血清蛋白兩項(xiàng)客觀性指標(biāo),反映患者的營(yíng)養(yǎng)狀態(tài),對(duì)接受手術(shù)治療的癌癥患者預(yù)后進(jìn)行評(píng)估,其計(jì)算方法省時(shí)、方便。(2)食管腺癌與食管鱗癌的起源不同,病理發(fā)生機(jī)制不同,將食管腺癌作為一種獨(dú)立疾病進(jìn)行分析,可以發(fā)現(xiàn)其獨(dú)特的臨床病理特征,對(duì)于指導(dǎo)食管腺癌治療,改善預(yù)后有重要意義。(3)由于老年患者普遍存在體質(zhì)差營(yíng)養(yǎng)不良,本研究對(duì)不同年齡組進(jìn)行了分層分析,發(fā)現(xiàn)PNI是老年患者預(yù)后的獨(dú)立影響因素。
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(本文編輯:賈萌萌)
Investigation in Prognostic Value of Prognostic Nutritional Index in Patients with Esophageal Adenocarcinoma
WANGYan,TAORen-hai,CAOYu,GAOFeng,YINJin-huan,ZHANGLi-min,ZHOUJun,LIUJun-feng.
DepartmentofThoracicSurgery,F(xiàn)ourthHospitalofHebeiMedicalUniversity,Shijiazhuang050011,China
Correspondingauthor:LIUJun-feng,DepartmentofThoracicSurgery,F(xiàn)ourthHospitalofHebeiMedicalUniversity,Shijiazhuang050011,China;E-mail:13931152296@163.com
ObjectiveTo investigate the prognostic value of prognostic nutritional index in patients with esophageal adenocarcinoma.Methods128 cases of esophageal adenocarcinoma treated in Fourth Hospital of Hebei Medical University between January 1st 2008 and December 31st 2010 were retrospectively analyzed.Demographic and clinicopathological data of patients were collected,including gender,age,degree of histological differentiation,tumour location and size,lymphatic metastasis,TNM classification,postoperative exhaust time,postoperative defecation time,diagnosis of stump invasion and tumour thrombus.The calculation of PNI was based on the count data of serum albumin and peripheral blood lymphocytes collected within one week before surgery.The date of surgery was set as starting point,and the date of death or the end date of follow-up(December 31st 2015)as end point.The survival rate was calculated by Kaplan-Meier analysis;the differences between groups were compared using Log-rank test.Cox proportional hazard regression model was used to analyze the factors which may affect the prognosis of the patients.Results120 out of 128 cases completed follow-up,so that the follow-up rate was 93.8%.Patients were divided into high PNI group(n=41)and low PNI group(n=79)by the average value of PNI(40.82).The tumour size,lymphatic metastasis,TNM classification and postoperative exhaust time of the patients were compared,and all the differences had statistical significance(P<0.001).The results of single-factor analysis indicated that there were significant differences in the tumour size,lymphatic metastasis,TNM classification,postoperative exhaust time,postoperative defecation time and PNI(P<0.05).The results of Cox proportional hazard regression model showed that TNM classification and PNI were the independent factors that affected the prognosis of the patients with esophageal adenocarcinoma(P<0.05).The patients were divided into young & middle-aged group(n=63)and senior group(n=57)by the average age(61.5 years old).The results of single-factor analysis indicated that in young & middle-aged group there were significant differences in gender,tumour size,lymphatic metastasis,TNM classification,postoperative exhaust time,postoperative defecation time and PNI(P<0.05);in senior group,there were significant differences in gender,tumour size,TNM classification,postoperative defecation time and PNI(P<0.05).The results of Cox proportional hazard regression model showed that TNM classification,postoperative exhaust time and PNI were the independent factors that affected the prognosis of the young & middle-aged patients with esophageal adenocarcinoma(P<0.05);PNI was the independent factor that affected the prognosis of the senior patients with esophageal adenocarcinoma(P<0.05).ConclusionPNI is able to assess the surgical risk for patients with esophageal adenocarcinoma,and it is a valuable clinical marker of preoperative estimation as well as prognosis prediction.
Esophageal neoplasms;Nutrition assessment;Prognosis
河北省醫(yī)學(xué)科學(xué)研究重點(diǎn)課題計(jì)劃(20160178)
050011 河北省石家莊市,河北醫(yī)科大學(xué)第四醫(yī)院胸外科(王巖,高峰,殷金環(huán),張立敏,劉俊峰),手術(shù)室(陶仁海);河北省腫瘤研究所(曹玉);定州市武警8640部隊(duì)醫(yī)院(周軍)
劉俊峰,050011 河北省石家莊市,河北醫(yī)科大學(xué)第四醫(yī)院胸外科;E-mail:13931152296@163.com
R 735.1
ADOI:10.3969/j.issn.1007-9572.2016.28.009
2016-04-01;
2016-07-26)