小野寺预后营养指数对胆囊癌患者生存的影响

  目的  研究胆囊癌患者的预后危险因素，并分析小野寺预后营养指数(PNI)对患者生存的影响意义。  方法  回顾性分析2008年1月至2012年12月于中南大学肝胆肠外科研究中心诊治的63例胆囊癌患者的生存预后。通过Cox比例风险模型分析明确患者的独立预后因素，并分析PNI对患者预后的影响。  结果  单因素分析显示，淋巴结转移、PNI≤50、鳞癌、肝脏侵润及胆总管的侵犯为OS的危险因素，而多因素分析中发现只有淋巴结转移状态(HR=4.495，95%CI=2.380~8.488，P < 0.001)及PNI(HR= 0.195，95%CI=0.098~0.389，P < 0.001)仍对OS的影响差异有统计学意义。进一步分层分析发现，PNI在中青年组(年龄≤65岁)的患者中对预后的预测能力相较于在老年组中(年龄>65岁)更为显著(中青年组:P=0.011；老年组:P=0.078)。  结论  PNI对胆囊癌患者术后预后的影响差异具有统计学意义，PNI≤50的患者其预后显著差于PNI>50的患者，在中青年组患者(年龄≤65岁)中这种差别更为显著。PNI有潜能作为一个评价胆囊癌患者术后预后评估的新证据，有利于临床医生更全面地掌握患者的整体情况。 

Effects of Onodera's prognostic nutrition index (PNI)on the survival of patients with gallbladder carcinoma

  Objective  To retrospectively evaluate the prognostic risk factors of patients with gallbladder carcinoma and the effect of normal prognostic nutrition index (PNI) on the survival.  Methods  We retrospectively analyzed 63 patients with gallbladder carcinoma treated in our hospital between January 2008 and December 2012. The independent prognostic factors of the patients were calculated by the Cox proportional hazards model. The benefit of normal PNI status on the prognosis was further explored in the patients using survival analysis.  Results  Lymph node metastasis, PNI≤50, squamous carcinoma, liver invasion and choledoch invasion were the risk factors of overall survival (OS) in the univariate analysis, while only lymph node metastasis (HR=4.495, 95%CI 2.380~8.488, P < 0.001) and PNI (HR=0.195, 95%CI 0.098~0.389, P < 0.001) were the dependent influential factors of the prognosis and OS in the multivariate analysis. The effect of PNI on OS was even more statistically significant different in the younger patients (≤65y) than in the elder (>65y) (younger group: P=0.011; elder group: P=0.078).  Conclusion  The gallbladder carcinoma patients with normal PNI status (> 50) have better OS compared to the patients with PNI≤50, with statistical differences between the two. And it is more significant in the patients of the younger group (≤65y), comparing with the elder group. PNI could be taken as a potential prognostic evaluation factor for the gallbladder carcinoma patients and can provide a more comprehensive evaluation of patients' conditions to clinician.