小野寺营养预后指数在胃癌患者预后评估中的价值

目的探讨应用小野寺营养预后指数(Onodera's prognostic nutritional index,Onodera's PNI)评估胃癌患者预后的价值。方法 2000年1月~2014年1月收治的胃癌患者386例,收集患者术前血液检查结果(包括血清白蛋白水平、外周血总淋巴细胞计数),计算每~例患者术前Onodera's PNI。根据PNI分为营养较好组(201例,PNI≥48)和营养较差组(185例,PNI48)。分析PNI与临床病理特征、术后并发症及预后的相关性,并通过Cox回归模型筛选影响胃癌患者的预后因素。结果 386例患者术前平均PNI为50.6±5.7。年龄≥65岁者平均PNI为48.5±5.7,65岁者为51.8±5.4,两组比较差异有统计学意义(P0.01);pT3/T4期及有淋巴结转移者与pT1/T2期及无淋巴结转移者比较平均PNI均明显降低(P0.01)。两组患者术后总体并发症发生率分别为6.5%(13/201)和15.6%(29/185),差异有统计学意义(P0.01)。有并发症组平均PNI值为(49.2±5.4),无并发症组为(51.6±5.3),两组比较差异有统计学意义(P0.05)。相关分析显示,PNI与患者年龄、肿瘤侵润深度、淋巴结转移状况、术后总体并发症率具有相关性(P0.05)。营养较好组和营养较差组术后5年总体生存(OS)率及无瘤生存(DFS)率分别为86.2%比52.1%(χ~2=9.28,P0.01)及83.5%比53.7%(χ~2=9.36,P0.01)。多因素Cox回归分析证实,营养预后指数是影响胃癌患者预后的独立预测因素(HR=2.16,95%CI:1.57~3.26,P0.01)。结论小野寺营养预后指数能较好地反映胃癌患者的营养状态、手术风险及预后,是独立于TNM分期的一种胃癌患者长期结果的预测指标,其获得简单方便。

Value of prognostic nutritional index in prognostic evaluation of gastric cancer patients

Objective To study the value of Onodera′s prognostic nutritional index(Onodera′s PNI)in patients with gastric cancer. Methods The clinical data of 386 cases of gastric cancer between January 2000 and January 2014 were analyzed retrospectively. Preoperative blood test results,including the level of serum albumin and total lymphocyte count in the peripheral blood,were collected. Then,Onodera′s PNI of every patient was calculated according to the test results. According to the Onodera index,these pa-tients were divided into better-nourished group(PNI≥48,n = 201)and under-nourished group(PNI <48,n = 185). Relationship among PNI,clinicopathological feature,postoperative complication and progno-sis were analyzed. Cox proportional hazards model was also established to identify the independent prog-nostic factors for prognosis of patients with gastric cancer. Results The mean PNI of 386 patients before the operation was 50. 6 ± 5. 7. The mean PNI in patients aged 65 years or older was significantly lower than that in patients younger than 65 years(48. 5 ± 5. 7 vs 51. 8 ± 5. 4,P < 0. 001). The mean PNI in pa-tients with T3 / T4 tumors and lymph node metastasis was significantly lower(P < 0. 001). Patients in bet-ter-nourished group had significantly lower postoperative complication rate6. 5% vs 15. 6% ,P <0. 001]. The patients with postoperative complications had a significantly lower mean PNI than those with-out complications(49. 2 ± 5. 4 vs 51. 6 ± 5. 3,P = 0. 024). PNI was found to be related to age,tumor depth,lymph node involvement and postoperative complication rate(P < 0. 05). Better-nourished group had significantly better 5-year overall survival(OS)rate(86. 2% vs 52. 1% ,χ2 = 9. 28,P < 0. 001)and better 5-year disease free survival rate(83. 5% vs 53. 7% ,χ2 = 9. 36,P < 0. 001)than under-nourished group. The multivariate analysis demonstrated that the PNI was an independent prognostic factor for pa-tients with gastric cancer(HR = 2. 16,95% CI:1. 57-3. 26,P < 0. 001). Conclusion Onodera′s PNI can evaluate the nutritional state,operation risk and prognosis for patients with gastric cancer. For gastric cancer patients,it is a long-term predictor that is independent from conventional TNM classification. Onodera′s PNI can be easily obtained,which is worthy of being spread.