The predictive value of Naples prognostic score and prognostic nutritional index for postoperative recurrence and survival in endometrial cancer patients

doi:10.11958/20242339

Abstract

Abstract:

Objective To investigate the impact of Naples prognostic score (NPS) and prognostic nutritional index (PNI) on postoperative recurrence and survival in patients with endometrial cancer (EC). Methods A total of 258 EC patients were selected for surgical treatment. Clinical data such as the patients' age at admission, pathological grade, depth of myometrial invasion, lymphovascular space invasion (LVSI), lymph node metastasis and clinical stage of the International Society of Gynecological Oncology (FIGO) were collected. One week before the operation, the laboratory indicators were detected in patients, and NPS and PNI were calculated. The patients were followed up and divided into the recurrence group (n=72) and the non-recurrence group (n=186) according to whether there was recurrence after the operation. The recurrence curves were plotted using Kaplan-Meier method, and the Log-rank test was used to compare the differences in recurrence curves between patients with different NPS and PNI. The Cox proportional hazards regression model was used to analyze the influencing factors of postoperative recurrence in patients with EC. The receiver operating characteristic (ROC) curve was used to evaluate the predictive efficacy of PNI and NPS scores for postoperative recurrence in patients with EC. Results The proportion of patients with high-risk NPS scores was significantly higher in the recurrence group than that in the non-recurrence group (41.7% vs. 19.4%, P<0.05). The PNI was significantly lower in the recurrence group than that in the non-recurrence group (42.1±7.6 vs. 47.2±8.9, P<0.01). Multivariate Cox regression analysis showed that advanced age, elevated serum carbohydrate antigen 125 (CA125), pathological grades G2 and G3, myometrial invasion depth >1/2, positive LVSI, FIGO stage Ⅲ-Ⅳ and medium-high risk patients with NPS score were independent risk factors for recurrence. Postoperative radiotherapy and chemotherapy and elevated PNI were independent protective factors for recurrence in patients. ROC curve analysis showed that the combined predictive value of NPS score and PNI for postoperative recurrence in patients with EC was superior to that of individual predictions. Conclusion Both NPS and PNI can be used as potential indicators to predict the prognosis of patients with endometrial cancer.

Key words: endometrial neoplasms, prognosis, nutrition assessment, naples prognostic score, survival analysis, ROC curve

CLC Number:

R737.33

Figures/Tables 7

References 19

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组别	n			年龄/ 岁		BMI/ （kg/m2）		Hb/ （g/L）			PLT/ （×10⁹/L）			WBC/ （×10⁹/L）		LYM/ （×10⁹/L）			MON/ （×10⁹/L）			LMR			Alb/ （g/L）			CRP/（mg/L）
未复发组	186			54.8±7.9		23.8±2.9		121.3±15.8			248.9±49.7			6.9±2.2		2.13±0.56			0.65±0.15			3.28±1.34			40.3±5.5			10.4±8.3
复发组	72			57.2±8.6		24.1±2.3		118.5±14.9			255.6±52.1			7.3±2.4		1.82±0.42			0.72±0.18			2.53±1.17			39.5±5.9			11.6±8.9
t或χ2				2.137^＊		0.779		1.295			0.959			1.285		4.255^＊			3.070^＊			4.172^＊			1.026			1.021
组别			病理分级/ （G1/G2/G3）				肌层浸润深度/（≤1/2/>1/2）		LVSI 阳性			淋巴结转移			FIGO分期/ （Ⅰ—Ⅱ/Ⅲ—Ⅳ）			术后放疗			术后化疗			CA125/ （U/mL）			HE4/ （pmol/L）
未复发组			79/79/28				128/58		49（26.3）			41（22.0）			149/37			160（86.0）			142（76.3）			32.8±18.5			72.3±29.6
复发组			25/38/9				38/34		29（40.2）			24（33.3）			49/23			38（52.8）			39（54.1）			45.3±22.1			88.7±35.2
t或χ2			2.225				5.820^＊		4.778^＊			3.511			4.224^＊			32.142^＊			27.142^＊			4.603^＊			3.781^＊
组别		FPG/ （mmol/L）			ALT/ （U/L）			AST/ （U/L）		Cr/ （μmol/L）			TC/ （mmol/L）				TG/ （mmol/L）			NPS评分									PNI
组别		FPG/ （mmol/L）			ALT/ （U/L）			AST/ （U/L）		Cr/ （μmol/L）			TC/ （mmol/L）				TG/ （mmol/L）			低危			中危			高危			PNI
未复发组		5.8±1.1			26.5±12.8			27.8±15.3		65.7±10.9			5.3±1.2				1.8±0.8			80（43.0）			70（37.6）			36（19.4）			47.2±8.9
复发组		6.2±1.3			28.6±15.4			31.2±17.9		68.4±12.3			4.9±1.0				1.5±0.6			12（16.6）			30（41.7）			30（41.7）			42.1±7.6
t或χ2		2.513^＊			1.112			1.525		1.719			2.526^＊				2.901^＊			20.421^＊									4.292^＊

组别	n			年龄/ 岁		BMI/ （kg/m2）		Hb/ （g/L）			PLT/ （×10⁹/L）			WBC/ （×10⁹/L）		LYM/ （×10⁹/L）			MON/ （×10⁹/L）			LMR			Alb/ （g/L）			CRP/（mg/L）
未复发组	186			54.8±7.9		23.8±2.9		121.3±15.8			248.9±49.7			6.9±2.2		2.13±0.56			0.65±0.15			3.28±1.34			40.3±5.5			10.4±8.3
复发组	72			57.2±8.6		24.1±2.3		118.5±14.9			255.6±52.1			7.3±2.4		1.82±0.42			0.72±0.18			2.53±1.17			39.5±5.9			11.6±8.9
t或χ2				2.137^＊		0.779		1.295			0.959			1.285		4.255^＊			3.070^＊			4.172^＊			1.026			1.021
组别			病理分级/ （G1/G2/G3）				肌层浸润深度/（≤1/2/>1/2）		LVSI 阳性			淋巴结转移			FIGO分期/ （Ⅰ—Ⅱ/Ⅲ—Ⅳ）			术后放疗			术后化疗			CA125/ （U/mL）			HE4/ （pmol/L）
未复发组			79/79/28				128/58		49（26.3）			41（22.0）			149/37			160（86.0）			142（76.3）			32.8±18.5			72.3±29.6
复发组			25/38/9				38/34		29（40.2）			24（33.3）			49/23			38（52.8）			39（54.1）			45.3±22.1			88.7±35.2
t或χ2			2.225				5.820^＊		4.778^＊			3.511			4.224^＊			32.142^＊			27.142^＊			4.603^＊			3.781^＊
组别		FPG/ （mmol/L）			ALT/ （U/L）			AST/ （U/L）		Cr/ （μmol/L）			TC/ （mmol/L）				TG/ （mmol/L）			NPS评分									PNI
组别		FPG/ （mmol/L）			ALT/ （U/L）			AST/ （U/L）		Cr/ （μmol/L）			TC/ （mmol/L）				TG/ （mmol/L）			低危			中危			高危			PNI
未复发组		5.8±1.1			26.5±12.8			27.8±15.3		65.7±10.9			5.3±1.2				1.8±0.8			80（43.0）			70（37.6）			36（19.4）			47.2±8.9
复发组		6.2±1.3			28.6±15.4			31.2±17.9		68.4±12.3			4.9±1.0				1.5±0.6			12（16.6）			30（41.7）			30（41.7）			42.1±7.6
t或χ2		2.513^＊			1.112			1.525		1.719			2.526^＊				2.901^＊			20.421^＊									4.292^＊

组别	n	中位复发时间/月	Log-rank χ²
NPS评分
低危组	92	-	16.831^＊
中危组	100	49
高危组	66	46
PNI
<43.8	81	40	29.487^＊
≥43.8	177	-	29.487^＊

组别	n	中位复发时间/月	Log-rank χ²
NPS评分
低危组	92	-	16.831^＊
中危组	100	49
高危组	66	46
PNI
<43.8	81	40	29.487^＊
≥43.8	177	-	29.487^＊

指标	β	SE	Wald χ²	P	HR（95%CI）
年龄	0.074	0.029	6.551	0.011	1.077（1.017~1.140）
LMR	-0.268	0.079	11.508	0.001	0.765（0.655~0.893）
CA125	0.027	0.013	4.314	0.038	1.027（1.003~1.055）
HE4	0.224	0.084	7.111	0.008	1.251（1.061~1.475）
FPG	0.124	0.083	2.232	0.135	1.132（0.962~1.332）
TC	-0.167	0.132	1.601	0.206	0.846（0.653~1.096）
TG	0.181	0.104	3.029	0.082	1.198（0.977~1.469）
病理分级			18.368	<0.001
G2级	0.852	0.323	6.958	0.008	2.339（1.248~4.419）
G3级	1.588	0.417	14.502	<0.001	4.895（2.161~11.078）
肌层浸润深度	0.684	0.313	4.776	0.018	1.974（1.073~3.660）
LVSI	1.012	0.367	7.604	0.006	2.746（1.340~5.648）
FIGO分期	1.734	0.341	25.858	<0.001	5.663（2.903~11.049）
术后放疗	-0.684	0.267	6.563	0.010	0.505（0.299~0.582）
术后化疗	-0.536	0.233	5.292	0.021	0.585（0.371~0.924）
NPS评分			21.682	<0.001
中危	0.256	0.091	7.914	0.005	1.292（1.081~1.544）
高危	0.527	0.134	15.467	<0.001	1.694（1.303~2.203）
PNI	-0.083	0.034	5.959	0.015	0.920（0.861~0.984）