辅助化疗前基于老年营养风险指数预测老年胃癌患者预后的研究

马亚辉 苗祥 朱洪波 刘冬良 孙刚

马亚辉, 苗祥, 朱洪波, 刘冬良, 孙刚. 辅助化疗前基于老年营养风险指数预测老年胃癌患者预后的研究[J]. 中国肿瘤临床, 2023, 50(6): 319-324. doi: 10.12354/j.issn.1000-8179.2023.20221023
引用本文: 马亚辉, 苗祥, 朱洪波, 刘冬良, 孙刚. 辅助化疗前基于老年营养风险指数预测老年胃癌患者预后的研究[J]. 中国肿瘤临床, 2023, 50(6): 319-324. doi: 10.12354/j.issn.1000-8179.2023.20221023
Yahui Ma, Xiang Miao, Hongbo Zhu, Dongliang Liu, Gang Sun. Prognosis prediction of elderly patients with gastric cancer based on geriatric nutrition risk index before adjuvant chemotherapy[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2023, 50(6): 319-324. doi: 10.12354/j.issn.1000-8179.2023.20221023
Citation: Yahui Ma, Xiang Miao, Hongbo Zhu, Dongliang Liu, Gang Sun. Prognosis prediction of elderly patients with gastric cancer based on geriatric nutrition risk index before adjuvant chemotherapy[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2023, 50(6): 319-324. doi: 10.12354/j.issn.1000-8179.2023.20221023

辅助化疗前基于老年营养风险指数预测老年胃癌患者预后的研究

doi: 10.12354/j.issn.1000-8179.2023.20221023
详细信息
    作者简介:

    马亚辉:专业方向为普通外科临床及基础研究

    通讯作者:

    孙刚 sdfgz9@163.com

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。

     

  • 图  1  术前和化疗前GNRI受试者工作特征曲线

    A:OS;B:DFS

    图  2  化疗前GNRI水平与预后的关系

    图  3  pTNM Ⅱ期患者化疗前GNRI水平与预后的关系

    图  4  pTNM Ⅲ期患者化疗前GNRI水平与预后的关系

    表  1  化疗前临床病理特征与GNRI的关系

    特征例数GNRI(基于OS)χ2PGNRI(基于DFS)χ2P
    < 93.3≥ 93.3<93.05≥93.05
    性别2.6760.1021.4490.229
     男性12760676859
     女性3522131223
    ASA评分2.1570.1421.1880.276
     19644524452
     26638283630
    高血压0.6250.4290.1990.656
     是4828202523
     否11454605559
    糖尿病5.0540.0253.2080.073
     是5233193121
     否11049614961
    肿瘤位置*1.2800.5271.4590.482
     上部4524212322
     中部3922172217
     下部7836423543
    手术方式0.3310.5650.1980.656
     全胃切除术5027232624
     远端胃切除术11255575458
    肿瘤分化程度8.3320.0047.8860.005
     高6021392139
     中/低10261415943
    TMN分期(期)67.1320.0087.3210.007
     Ⅱ7228442745
     Ⅲ9054365337
    并发症13.660<0.0019.6590.002
     有362882610
     无12654725472
    *:肿瘤位置根据胃大弯和小弯的三等分连线简单划分。
    下载: 导出CSV

    表  2  基于OS和DFS的Cox多因素回归分析

    参数OSDFS
    BWaldHR(95%CI)PBWaldHR(95%CI)P
    GNRI−0.90918.7930.403(0.267~0.608)0.000−0.94221.8840.390(0.263~0.579)<0.001
    分化程度−0.5486.2920.578(0.377~0.887)0.012−0.99820.2050.368(0.238~0.569)<0.001
    下载: 导出CSV
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出版历程
  • 收稿日期:  2022-07-08
  • 录用日期:  2022-09-07
  • 修回日期:  2022-08-21

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