天津医药

天津医药 ›› 2021, Vol. 49 ›› Issue (8): 861-865.doi: 10.11958/20210143

• 临床研究 • 上一篇    下一篇

预后营养指数对老年食管癌患者根治性放疗后长期生存的预测价值

闫可 1，魏菀怡 2，杜星语 1，张雪原 1，沈文斌 1，祝淑钗 1△
  

  1. 1河北医科大学第四医院放疗科（邮编050011）；2河北省人民医院神经内科
  • 收稿日期:2021-01-19 修回日期:2021-04-18 出版日期:2021-08-15 发布日期:2021-08-19
  • 通讯作者: 闫可 E-mail:yancole@126.com
  • 作者简介:闫可（1989），男，硕士，主治医师，主要从事食管癌、肺癌放射治疗方面研究。E-mail：yancole@126.com

The predictive value of prognostic nutritional index for long-term survival after radical radiotherapy in elderly patients with esophageal cancer

YAN Ke1, WEI Wan-yi2, DU Xing-yu1, ZHANG Xue-yuan1, SHEN Wen-bin1, ZHU Shu-chai1△   

  1. 1 Department of Radiation Oncology, the Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, China; 2 Department of Neurology, Hebei General Hospital △Corresponding Author E-mail: sczhu1965@163.com
  • Received:2021-01-19 Revised:2021-04-18 Published:2021-08-15 Online:2021-08-19
  • Contact: YAN Ke E-mail:yancole@126.com

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摘要： 目的 探讨预后营养指数（PNI）对接受根治性放疗或放化疗的老年食管癌患者长期生存的预测价值。方 法 对接受根治性放疗或放化疗且符合入组条件的188例老年食管癌患者进行回顾性分析。计算每例患者放疗前 PNI值［PNI=血清白蛋白值（g/L）+5×外周血淋巴细胞总数（×109/L）］，运用受试者工作特征（ROC）曲线确定其预测患 者长期生存的最佳临界值，分为高PNI组及低PNI组，并比较2组患者生存预后及急性不良反应。结果 全组患者 1、3、5年总生存率分别为74.5%、33.5%、24.9%。依据ROC曲线计算得出放疗前PNI最佳临界值为48.65，测量曲线下 面积为0.649，敏感度为60.2%，特异度为70.1%。高PNI组（≥48.65）的86例和低PNI组（＜48.65）的102例患者1、3、5 年总生存率分别为83.7%、43.0%、32.5%和66.7%、24.5%、15.7%（Log-rank χ2=11.719，P＜0.01）。TNM分期为Ⅲ期和 放疗前PNI＜48.65为影响患者生存率的独立危险因素（P＜0.05）。另外，高PNI组≥3级急性放射性食管炎发生率低 于低PNI组（χ2=4.438，P＜0.05）。结论 PNI对于老年食管癌接受根治性放疗后的长期生存具有较高的预测价值， PNI较高的患者具有相对良好的预后。

关键词: 食管肿瘤, 癌, 鳞状细胞, 老年人, 放射疗法, 调强适形, 营养评价, 预后, 预后营养指数

Abstract: Objective To investigate the predictive value of prognostic nutritional index (PNI) in the long-term survival of elderly patients with esophageal cancer after radical radiotherapy or chemoradiotherapy. Methods Data of a total of 188 elderly patients with esophageal cancer who received radical radiotherapy or chemoradiotherapy and met the eligibility criteria were retrospectively analyzed. PNI values before radiotherapy were calculated for each patient [PNI=serum albumin level (g/L)+5×absolute lymphocyte count (×109/L)]. ROC curve was used to determine the optimal cutoff value for predicting long-term survival of the patients. The patients were divided into high PNI group and low PNI group，and the survival prognosis and acute adverse reactions were compared between the two groups of patients. Results The 1-，3- and 5-year overall survival rates were 74.5%，33.5% and 24.9%，respectively. According to the ROC curve，the optimal cutoff value of PNI before treatment was 48.65，the area under curve was 0.649，the sensitivity was 60.2% and the specificity was 70.1%. The 1-, 3- and 5-year overall survival rates were 83.7%, 43.0% and 32.5% for 86 patients in the high PNI group (≥ 48.65) and 66.7%, 24.5% and 15.7% for 102 patients in the low PNI group (< 48.65, χ2=11.719，P＜0.01). TNM stage Ⅲ and pretreatment PNI＜48.65 were independent risk factors that affect the overall survival rate of patients (P＜0.05). In addition, the incidence of grade≥3 acute radiation esophagitis was significantly lower in the high PNI group than that in the low PNI group (χ2=4.438, P＜0.05). Conclusion PNI has a good predictive value for the long-term survival of the elderly patients with esophageal cancer after radical radiotherapy. Patients with high level of PNI have relatively good prognosis.

Key words: esophageal neoplasms, carcinoma, squamous cell, aged, radiotherapy, intensity-modulated, nutrition assessment, prognosis, prognostic nutritional index

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