术前预后营养指数对前列腺根治性切除术患者的生存预测价值

梁玉杰; 张永琪; 陈梦杰; 关翰; 李文永; 刘贝贝; 刘建民

doi:10.16766/j.cnki.issn.1674-4152.002318

术前预后营养指数对前列腺根治性切除术患者的生存预测价值

doi: 10.16766/j.cnki.issn.1674-4152.002318

蚌埠医学院第一附属医院泌尿外科，安徽蚌埠 233004

基金项目:

安徽省自然科学基金项目 2008085QH358

蚌埠医学院自然科学重点项目 BYKY2019035ZD

详细信息

通讯作者:
刘建民，E-mail: LIU-john-jm@sina.com

中图分类号: R737.25 R730.7
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- 文章访问数: 443
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- 被引次数: 0
出版历程
- 收稿日期: 2021-07-23
- 网络出版日期: 2022-03-04

Predictive value of the pre-operative prognostic nutrition index for the survival of patients undergoing radical prostatectomy

Department of Urology, the First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233004, China

摘要

摘要: 目的探究术前预后营养指数(prognostic nutritional index，PNI)能否有效地用于评价前列腺癌根治性切除术患者的预后。方法回顾性分析2014年1月—2015年1月在蚌埠医学院第一附属医院首诊并行前列腺癌根治性切除术的156例患者的相关资料。根据行根治手术当次入院首次采血检查结果，确定前列腺癌患者临床资料和随访资料，分别计算患者PNI、中性粒细胞与淋巴细胞计数比值(neutrophil to lymphocyte ratio，NLR)和淋巴与单核细胞计数比值(lymphocyte to monocyte ratio，LMR)。利用受试者工作特征曲线(receiver operating characteristic curve, ROC)的特点，截取曲线上的最佳Cut-off值。对患者的总体生存采用Kaplan-Meier生存曲线进行分析，根治术患者预后相关因素的关联性通过Cox比例风险模型进行分析。结果患者术前PNI为49.58±6.69，最佳截断值为50.77，低PNI组(＜50.77，81例)患者的生存风险明显高于高PNI组(≥50.77，75例)。PNI可能是前列腺癌根治术5年总体生存的独立影响因素。结论术前前列腺癌患者的PNI是根治术后生存的独立影响因素，有一定评估行根治手术的前列腺癌患者预后的临床应用价值。
- 前列腺癌 /
- 预后营养指数 /
- 炎症指数 /
- 预后
Abstract: Objective To explore whether or not the prognostic nutrition index (PNI) can be used to evaluate the prognosis of patients undergoing the radical resection of prostate cancer. Methods Retrospective analysis was performed on 156 patients who underwent radical resection of prostate cancer in the First Affiliated Hospital of Bengbu Medical College from January 2014 to January 2015. Clinical data and follow-up data of patients with prostate cancer were determined on the basis of the results of the first blood examination at the time of radical surgery. Pre-operative PNI, neutrophil-to-lymphocyte ratio and lymphatic-to-monocyte ratio were calculated. On the basis of the characteristics of receiver operating characteristic curve, the optimal cut-off value on the curve was intercepted. The overall survival (OS) of patients was analysed by Kaplan-Meier survival curve, and the association between the prognosis of patients undergoing radical surgery and pre-operative PNI was analysed by Cox proportional risk model. Results The pre-operative PNI of patients was 49.58±6.69, the best cut-off value was 50.77. The high PNI group (≥ 50.77, 75 patients) had a significantly higher 5-year OS rate than the low PNI group (< 50.77, 81 patients). PNI was an independent risk element for 5-year OS after the radical resection of prostate cancer. Conclusion Pre-operative PNI is an independent risk factor affecting the survival of patients with prostate cancer after radical surgery, and it has a certain clinical application value to evaluate the prognosis of patients with prostate cancer undergoing radical surgery.
- Prostate cancer /
- Prognostic nutritional index /
- Inflammation index /
- Prognosis

HTML全文

图 1 预后营养指数(PNI)、淋巴细胞-单核细胞比(LMR)、中性粒细胞-淋巴细胞比(NLR)的ROC曲线

下载: 全尺寸图片幻灯片

图 2 高PNI组与低PNI组前列腺癌根治术后生存的Kaplan-Meier曲线

下载: 全尺寸图片幻灯片

表 1 PNI、NLR和LMR的ROC曲线结果

项目	AUC	Cut-off	灵敏度(%)	特异度(%)	P值	95%CI
PNI	0.742	50.770	0.575	0.833	＜0.001	0.660~0.825
NLR	0.631	3.386	0.842	0.417	0.017	0.523~0.739
LMR	0.615	4.040	0.692	0.556	0.037	0.503~0.727

下载: 导出CSV

表 2 影响前列腺根治术后生存的COX单因素分析

项目	B	SE	Wald χ²	P值	HR值	95%CI
年龄	0.023	0.031	0.551	0.458	1.023	0.963~1.086
T分期	0.863	0.411	4.411	0.036	2.370	1.059~5.304
N分期	1.219	0.434	7.879	0.005	3.383	1.444~7.922
AJCC预后分期	1.106	0.562	3.881	0.049	3.023	1.006~9.089
PSA	0.008	0.007	1.474	0.225	1.008	0.995~1.021
Gleason评分	0.291	0.449	0.421	0.516	1.338	0.555~3.224
NLR	-0.244	0.090	7.378	0.007	0.784	0.657~0.934
LMR	-0.098	0.088	1.244	0.265	0.907	0.763~1.077
PNI	-0.168	0.037	20.504	＜0.001	0.845	0.786~0.909

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表 3 影响前列腺根治术后生存的COX多因素分析

项目	B	SE	Wald χ²	P值	HR值	95%CI
T分期	0.990	0.396	6.250	0.012	2.691	1.238~5.848
N分期	1.302	0.416	9.822	0.002	3.677	1.629~8.303
AJCC预后分期	1.254	0.521	5.801	0.016	3.505	1.263~9.724
NLR	-0.249	0.087	8.081	0.004	0.780	0.657~0.926
PNI	-0.197	0.035	31.930	＜0.001	0.821	0.767~0.879

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