Prognosis prediction of elderly patients with gastric cancer based on geriatric nutrition risk index before adjuvant chemotherapy
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摘要:
目的 探讨辅助化疗前老年营养风险指数（geriatric nutrition risk index，GNRI）评估老年胃癌患者的复发率和死亡率。 方法 收集2013年1月至2017年1月连云港市东方医院162例接受根治性手术并行规范化疗的老年胃癌患者的临床资料，计算术前和化疗前GNRI，绘制其预测患者预后的ROC曲线，比较两者的诊断精度，分析化疗前GNRI不同水平患者的临床病理特征和预后。 结果 化疗前GNRI的AUC值均大于术前GNRI，差异有统计学意义（均P<0.05）。根据最佳截断值将化疗前GNRI分为高GNRI组和低GNRI组。通过Kaplan-Meier分析，高GNRI组患者5年生存率和无病生存率均高于低GNRI组患者（均P<0.05）。根据pTNM分期分层分析，在pTNM Ⅱ期患者中，高GNRI组患者5年生存率高于低GNRI组患者（P<0.05）。高GNRI组和低GNRI组患者的5年无病生存率无显著性差异（P>0.05）。在pTNM Ⅲ期患者中，高GNRI组患者5年生存率和无病生存率均高于低GNRI组患者（均P<0.05）。多因素Cox回归分析，低GNRI和肿瘤中低分化是患者死亡和复发的独立危险因素。 结论 化疗前GNRI是评估老年胃癌患者预后的独立因素，低GNRI的老年胃癌患者死亡和复发风险高，预后差。 Abstract:Objective To investigate the recurrence and mortality rates of elderly patients with gastric cancer using the geriatric nutrition risk index (GNRI) before adjuvant chemotherapy. Methods Clinical data from 162 elderly patients with gastric cancer who underwent radical surgery and standardized chemotherapy at Lianyungang Oriental Hospital from January 2013 to January 2017 were collected. Preoperative and pre-chemotherapy GNRI scores were calculated, and receiver operating characteristic (ROC) curve analysis was used to predict patient prognosis and compare diagnostic accuracy between the two. Additionally, the clinicopathological characteristics and prognosis of patients with different pre-chemotherapy GNRI scores were analyzed. Results The area under the ROC curve for pre-chemotherapy GNRI was greater than for preoperative GNRI, and the difference was statistically significant (P<0.05). Pre-chemotherapy GNRI scores were divided into high and low GNRI groups according to an optimal cut-off value. Kaplan–Meier analysis revealed that the 5-year and disease-free survival (DFS) rates of patients with high GNRI were higher than those with low GNRI scores (all P<0.05). According to a hierarchical analysis of pTNM stage, among patients of pTNM Ⅱ stage, the 5-year survival rate of patients with high GNRI was higher than that in those with low GNRI scores (P<0.05). There was no significant difference in 5-year DFS rate between the high and low GNRI groups (P>0.05). Among patients with pTNM Ⅲ, the 5-year and DFS rates of patients with high GNRI were higher than those in patients with low GNRI scores (all P<0.05). Multivariate Cox regression analysis revealed that low GNRI score and low tumor differentiation were independent risk factors for patient mortality and recurrence. Conclusions Pre-chemotherapy GNRI score was an independent prognostic factor in elderly patients with gastric cancer. Elderly patients of gastric cancer with low GNRI score exhibited a higher risk for mortality and recurrence, the prognosis is poor. -
Key words:
- gastric cancer /
- chemotherapy /
- geriatric nutritional risk index (GNRI) /
- prognosis
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表 1 化疗前临床病理特征与GNRI的关系
特征 例数 GNRI（基于OS） χ2 P GNRI（基于DFS） χ2 P < 93.3 ≥ 93.3 <93.05 ≥93.05 性别 2.676 0.102 1.449 0.229 男性 127 60 67 68 59 女性 35 22 13 12 23 ASA评分 2.157 0.142 1.188 0.276 1 96 44 52 44 52 2 66 38 28 36 30 高血压 0.625 0.429 0.199 0.656 是 48 28 20 25 23 否 114 54 60 55 59 糖尿病 5.054 0.025 3.208 0.073 是 52 33 19 31 21 否 110 49 61 49 61 肿瘤位置* 1.280 0.527 1.459 0.482 上部 45 24 21 23 22 中部 39 22 17 22 17 下部 78 36 42 35 43 手术方式 0.331 0.565 0.198 0.656 全胃切除术 50 27 23 26 24 远端胃切除术 112 55 57 54 58 肿瘤分化程度 8.332 0.004 7.886 0.005 高 60 21 39 21 39 中/低 102 61 41 59 43 TMN分期（期） 67.132 0.008 7.321 0.007 Ⅱ 72 28 44 27 45 Ⅲ 90 54 36 53 37 并发症 13.660 <0.001 9.659 0.002 有 36 28 8 26 10 无 126 54 72 54 72 *：肿瘤位置根据胃大弯和小弯的三等分连线简单划分。 
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表 2 基于OS和DFS的Cox多因素回归分析
参数 OS DFS B Wald HR（95%CI） P B Wald HR（95%CI） P GNRI −0.909 18.793 0.403（0.267～0.608） 0.000 −0.942 21.884 0.390（0.263～0.579） <0.001 分化程度 −0.548 6.292 0.578（0.377～0.887） 0.012 −0.998 20.205 0.368（0.238～0.569） <0.001
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