疗前预后营养指数对老年食管鳞癌放疗预后预测价值

目的 评价预后营养指数(PNI)在老年食管鳞癌放疗中的作用。方法 回顾性分析接受根治性放疗的初治老年(>65岁)食管鳞癌患者共108 例。计算出每位患者PNI值,通过建立受试者工作特征曲线(ROC曲线)确定治疗前 PNI最佳cutoff值,并按该值分为低PNI组和高PNI组。Kaplan-Meier法计算总生存率,并Logrank检验和单因素预后分析,Cox模型多因素预后分析。结果 ROC曲线显示PNI最佳cutoff值为50.1(高PNI组52例,低PNI组56例)。两组在年龄、性别、治疗方式均相近,在TNM分期不同(P=0.022)。高PNI组有效率明显优于低PNI组(96%︰73%,P=0.001)。高PNI组1、2、3年总生存率分别为94%、69%、62%,低PNI组分别为70%、32%、27%(P<0.001)。单因素分析显示PNⅠ、T分期、N分期、TNM分期均与总生存密切相关(均P<0.01)。多因素分析结果显示N分期(RR=1.94,95%CI为1.29~2.94,P=0.002)和PNI (RR=0.83,95%CI为0.77~0.90,P<0.001)为影响总生存因素。结论 疗前PNI与患者放疗疗效及预后均有很好相关性,可作为预测老年食管鳞癌放疗获益的重要指标。

Predictive value of prognostic nutritional index for radiotherapy and prognosis of elderly patients with esophageal squamous cell carcinoma

Objective To evaluate the role of prognostic nutritional index (PNI) in the radiotherapy for elderly patients with esophageal squamous cell carcinoma. Methods Clinical data of 108 elderly patients (aged>65 years) with esophageal squamous cell carcinoma who underwent radical radiotherapy were retrospectively analyzed. The PNI value of each patient was calculated, and the optimal cutoff value of PNI before treatment was determined by establishing the receiver operating characteristic curve (ROC curve). All patients were divided into the low and high PNI value groups. The overall survival rate was calculated by Kaplan-Meier method. Log-rank test, univariate and Cox’s multivariate prognosis analyses were performed. Results The ROC curve demonstrated that the optimal cutoff value of PNI was 50.1(n=52 in high PNI group and n=56 in low PNI group). Age, gender and treatment did not significantly differ between two groups, whereas the TNM staging significantly differed (P=0.022). The effective rate of radiotherapy in the high PNI group was 96%, significantly higher than 73% in the low PNI group (P=0.001). In the high PNI group, the 1-,2-,and 3-year overall survival rates were 94%,69%,and 62%,significantly higher compared with 70%, 32% and 27% in the low PNI group (all P<0.001). Univariate analysis showed that PNI,T staging, N staging and TNM staging were significantly correlated the overall survival of patients (all P<0.01).Cox’s multivariate analysis revealed that N staging (RR=1.94,95%CI=1.29-2.94,P=0.002) and PNI (RR=0.83,95%CI=0.77-0.90,P<0.001) were independent risk factors affecting overall survival. Conclusions PNI before treatment has a good correlation with the prognosis and radiotherapy efficacy of patients, which can be used as a pivotal index to predict the clinical benefit of radiotherapy for elderly patients with esophageal squamous cell carcinoma.