炎症反应标志物和营养状况对食管胃结合部腺癌患者术后预后的评估价值

目的:明确基于系统性炎症评分和营养状况对食管胃结合部腺癌（adenocarcinoma of esophagogastric junction，AEG）患者术后预后的影响。方法:回顾性收集2010年03月至2019年03月我院451例AEG手术患者的临床资料，以及炎症-营养标志物（NLR、LMR、AGR、ALI、mGPS和PNI）。根据受试者工作特征（ROC）曲线获取截断值并分组，NLR、LMR、AGR、ALI和 PNI的截断值分别为3.76、3.01、1.30、27.55、42.68；COX模型分析患者预后的影响因素；采用Kaplan-Meier方法绘制生存曲线，Log-Rank检验比较组间生存差异。结果:患者无疾病生存期（DFS）与肿瘤分化程度、肿瘤大小、脉管癌栓、T分期、N分期、pTNM分期、血红蛋白、NLR、PNI、LMR、ALI相关（P＜0.05）,总生存期（OS）与肿瘤分化程度、肿瘤大小、脉管癌栓、T分期、N分期、pTNM分期、NLR、AGR、PNI、LMR、ALI相关（P＜0.05）。在多因素分析中，脉管癌栓、pTNM分期、ALI是DFS的独立影响因素，而LMR、PNI、pTNM分期则是OS的独立影响因素。Kaplan-Meier生存曲线显示，PNI<42.68， LMR<3.01及ALI<27.55患者的DFS和OS均更短（P＜0.05）。结论:炎症反应和营养状况与术后AEG患者临床病理因素及预后相关，ALI是AEG患者无疾病生存期的独立影响因素；PNI及LMR是AEG患者总生存期的独立影响因素。

Prognostic value of markers of inflammatory response and nutritional status in patients with postoperative adenocarcinoma of esophagogastric junction

Objective:To determine the prognostic influence of systemic inflammation-based scores and nutritional status in patients with postoperative adenocarcinoma of esophagogastric junction (AEG).Methods:This study reviewed clinical data of 451 surgical AEG patients at our hospital betweed March 2010 and March 2019,and infammation-nutrition scores(NLR,LMR,AGR,ALI,mGPS and PNI) were examined.The cut-off values were obtained according to the receiver operating characteristic (ROC) curve and grouped.The cut-off values of NLR,LMR,AGR,ALI and PNI were 3.76,3.01,1.30,27.55,42.68,respectively.The prognostic factors were compared by COX model.The survival curves were drawn by Kaplan-Meier method,and the Log-Rank test was used to compare the survival differences between groups.Results:Disease-free survival (DFS) was associated with tumor differentiation,tumor size,vascular tumor thrombus,T stage,N stage,pTNM stage,hemoglobin,NLR,PNI,LMR,ALI (P＜0.05).Overall survival (OS) was associated with tumor differentiation,tumor size,vascular tumor thrombus,T stage,N stage,pTNM stage,NLR,AGR,PNI,LMR,ALI (P＜0.05).In multivariate analysis,vascular tumor thrombus,pTNM stage,ALI were independent prognostic factors of DFS,while LMR,PNI and pTNM stage were independent influencing factors of OS.Kaplan-Meier survival curves showed that patients with PNI<42.68,LMR<3.01,and ALI<27.55 had shorter DFS and OS (P＜0.05).Conclusion:Inflammatory response and nutritional status were associated with clinicopathological factors and prognosis in AEG patients.ALI was an independent factor in the DFS of AEG patients.PNI and LMR were independent factors in the OS of AEG patients.