天津医药

天津医药 ›› 2022, Vol. 50 ›› Issue (4): 408-413.doi: 10.11958/20211819

• 临床研究 • 上一篇    下一篇

那不勒斯预后评分对临床Ⅲ期食管癌患者 预后的预测价值

闫可 1，魏菀怡 2，沈文斌 1，杜星语 1，王晓斌 1，赵晗君 3，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；3河北医科大学第四医院呼吸科
  • 收稿日期:2021-08-09 修回日期:2021-11-14 出版日期:2022-04-15 发布日期:2022-04-15
  • 通讯作者: △通信作者 E-mail：sczhu1965@163.com E-mail:yancole@126.com
  • 作者简介:闫可（1989），男，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 prognostic predictive value of Naples prognostic score in esophageal cancer patients with clinical stage Ⅲ

YAN Ke1, WEI Wanyi2, SHEN Wenbin1, DU Xingyu1, WANG Xiaobin1, ZHAO Hanjun3, ZHU Shuchai1△   

  1. 1 Department of Radiation Oncology, the Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, China; Department of Neurology, Hebei General Hospital; 3 Department of Respiratory, the Fourth Hospital of Hebei Medical University △Corresponding Author E-mail: sczhu1965@163.com
  • Received:2021-08-09 Revised:2021-11-14 Published:2022-04-15 Online:2022-04-15
  • Contact: △通信作者 E-mail：sczhu1965@163.com E-mail:yancole@126.com

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摘要： 目的 探讨那不勒斯预后评分（NPS）对临床Ⅲ期食管癌患者生存预后的预测价值。方法 回顾性分析行 根治性放疗的163例临床Ⅲ期食管癌患者。根据放疗前血常规及生化结果计算每例患者NPS，然后依据NPS分值分 为低危组（0分）、中危组（1~2分）以及高危组（3~4分）并比较3组生存预后差异。应用Kaplan-Meier法及Cox比例风 险模型进行单因素和多因素预后分析，绘制受试者工作特征（ROC）曲线并计算曲线下面积（AUC），比较NPS与预后 营养指数（PNI）、中性粒细胞/淋巴细胞比值（NLR）、淋巴细胞/单核细胞比值（LMR）等其他营养及炎症指标对生存预 后的预测价值。结果 依据放疗前NPS结果，将163例患者分为低危组38例、中危组71例及高危组54例。对低、 中、高危组生存状况的分析显示，1 年总生存率分别为 89.7%、78.3%、66.9%，3 年总生存率分别为 60.1%、40.7%、 26.6%，5 年总生存率分别为 48.1%、25.2%、17.1%（Log-rank χ2=16.398，P＜0.01）；1 年无进展生存率分别为 76.7%、 52.7%、50.8%；3 年无进展生存率分别为 50.1%、25.3%、19.4%，5 年无进展生存率分别为 42.0%、21.1%、12.9%（Logrank χ2=16.852，P＜0.01）。多因素分析显示，NPS中、高危组和同期未化疗为影响患者总生存及无进展生存的独立危 险因素。NPS预测生存的AUC值（0.658）优于PNI（0.581）、NLR（0.561）、LMR（0.578），差异有统计学意义（Z分别为 1.938、2.016、1.950，P＜0.05）。结论 放疗前NPS是接受根治性放疗的临床Ⅲ期食管癌患者预后的独立影响因素， 其对生存预后的预测价值优于其他营养及炎症指标，NPS较高的患者预后相对较差。

关键词: 食管肿瘤, 放射治疗, 预后, 那不勒斯预后评分

Abstract: Objective To investigate the predictive value of Naples prognostic score (NPS) for the survival and prognosis of esophageal cancer patients with clinical stage Ⅲ. Methods A total of 163 esophageal cancer patients with clinical stage Ⅲ who received radical radiotherapy were retrospectively analyzed. According to the blood routine and biochemical test results before radiotherapy, NPS was calculated for each patient, and patients were divided into the low-risk group (NPS=0), the medium-risk group (NPS=1-2) and the high-risk group (NPS=3-4) for survival comparison. KaplanMeier method and Cox proportional risk model were used for univariate and multivariate analysis. The receiver operating characteristic curve (ROC) was plotted and the area under curve (AUC) was calculated. The predictive value of NPS for survival was compared with other nutritional and inflammatory indicators, such as the prognostic nutritional index (PNI), neutrophil/lymphocyte ratio (NLR) and lymphocyte/monocyte ratio (LMR). Results According to NPS before radiotherapy, the 163 patients were divided into the low-risk group (n=38), the medium-risk group (n=71) and the high-risk group (n=54). Analysis of survival in the three groups showed that the 1-, 3- and 5-year overall survival rates (OS) were 89.7%, 60.1%, 48.1%, 78.3%, 40.7%, 25.2% and 66.9%, 26.6%, 17.1% in the low-risk group, the medium-risk group and the high-risk group (χ2=16.398, P＜0.01), respectively. The 1-, 3- and 5-year progression-free survival rates (PFS) were 76.7%, 50.1%, 42.0%, 52.7%, 25.3%, 21.1% and 50.8%, 19.4%, 12.9% (χ2=16.852, P＜0.01), respectively. Multivariate analysis showed that NPS high-risk group and no chemotherapy were independent risk factors for OS and PFS. The AUC value of NPS (0.658) was larger than that of PNI (0.581), NLR (0.561) and LMR (0.578) (Z=1.938, 2.016, 1.950, P＜0.05). Conclusion NPS before radiotherapy is an independent prognostic factor for esophageal cancer patients with clinical stage Ⅲ, and its predictive value for survival is better than other nutritional and inflammatory indicators. Patients with high NPS have a relatively poor prognosis.

Key words: esophageal neoplasms, radiotherapy, prognosis, Naples prognostic score

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