老年营养风险指数对食管鳞癌患者根治性切除术后生存的影响

苗晓慧; 尚晓滨; 张洪典; 马钊; 吴贤贤; 于振涛

doi:10.3969/j.issn.1000-8179.2019.06.163

老年营养风险指数对食管鳞癌患者根治性切除术后生存的影响

doi: 10.3969/j.issn.1000-8179.2019.06.163

苗晓慧^{①, ②,},
尚晓滨^①,
张洪典^①,
马钊^①,
吴贤贤^①,
于振涛^①, ,

①.
天津医科大学肿瘤医院食管肿瘤科，国家肿瘤临床医学研究中心，天津市肿瘤防治重点实验室，天津市恶性肿瘤临床医学研究中心（天津市300060）
②.
天津市海河医院胸外科

基金项目:

国家自然科学基金项目 81772619

天津医科大学临床医学研究项目 2017kylc008

吴阶平医学基金会临床科研专项 320.6750.17519

详细信息

作者简介:
苗晓慧专业方向为胸部肿瘤和肺结核的临床诊治。E-mail：717354564@qq.com

通讯作者:
于振涛 E-mail:yuzhtao@hotmail.com

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- 被引次数: 0
出版历程
- 收稿日期: 2019-02-28
- 修回日期: 2019-04-02
- 刊出日期: 2019-03-30

Effect of the preoperative Geriatric Nutritional Risk Index on the prognosis of patients with esophageal squamous cell carcinoma after radical resection

Miao Xiaohui^{①, ②
,},
Shang Xiaobin^①,
Zhang Hongdian^①,
Ma Zhao^①,
Wu Xianxian^①,
Yu Zhentao^{①
, ,}

①.
Department of Esophageal Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy of Tianjin, Tianjin Clinical Research Center for Cancer, Tianjin 300060, China
②.
Department of Thoracic Surgery, Tianjin Haihe Hospital, Tianjin 300350, China

Funds:

the National Natural Science Foundation of China 81772619

Tianjin Medical University Clinical Medical Research Project 2017kylc008

Wu Jieping Medical Foundation 320.6750.17519

More Information

Corresponding author: Zhentao Yu; E-mail:yuzhtao@hotmail.com

摘要

摘要: 目的探讨术前老年营养风险指数（Geriatric Nutritional Risk Index，GNRI）对食管鳞癌患者根治性切除术后预后的评估价值。方法回顾性分析天津医科大学肿瘤医院2008年1月至2012年12月行根治性手术切除的315例年龄>60岁食管鳞癌患者的临床病理学及实验室资料。GNRI=1.489×血清白蛋白（g/L）+41.7×（体重/理想体重）。根据GNRI水平将患者分为GNRI正常组和GNRI异常组，χ²检验分析GNRI与患者临床病理特征之间的关系，采用Kaplan-Meier法进行生存分析，生存率比较采用Log-rank检验，Cox比例风险回归模型进行多因素生存分析。结果 GNRI正常组（GNRI>98）259例，GNRI异常组（GNRI≤98）56例。GNRI与患者年龄、肿瘤部位、肿瘤直径、血清白蛋白水平、BMI和淋巴结转移密切相关（均P < 0.05）。GNRI正常组与异常组患者的5年生存率分别为41.2%和27.0%，差异具有统计学意义（P=0.002）。单因素分析显示：年龄、肿瘤直径、血清白蛋白水平、BMI、GNRI、PLR、肿瘤浸润深度和淋巴结转移是影响食管鳞癌患者预后的危险因素（均P < 0.05）；多因素分析结果显示，术前GNRI（HR= 0.687，95%CI：0.487~0.968，P=0.032）异常是影响食管鳞癌患者预后的独立危险因素。亚组分析显示，无论有无淋巴结转移，GNRI正常组患者的生存均显著高于GNRI异常组患者（P=0.036和0.010）。结论术前GNRI与老年食管鳞癌患者恶性生物学行为相关，可作为预测患者根治术后生存的有用指标。
- 食管鳞癌 /
- 老年营养风险指数 /
- 临床病理特征 /
- 预后
Abstract: Objective To evaluate the prognostic value of the preoperative Geriatric Nutritional Risk Index (GNRI) in patients with esophageal squamous cell carcinoma after radical resection. Methods Clinicopathological and laboratory data of 315 elderly patients with esophageal squamous cell carcinoma who were older than 60 years and underwent radical resection in Tianjin Medical University Cancer Institute and Hospital from January 2008 to December 2012 were retrospectively analyzed. The GNRI formula was as follows: 1.489 × serum albumin (g/L) + 41.7 × (current body weight/ideal body weight). According to the GNRI, patients were divided into the normal and abnormal GNRI groups. The χ₂ test was used to analyze the relationship between the GNRI and the clinicopathological characteristics of patients. The Kaplan-Meier method was used to analyze the survival rate, and survival analysis was conducted using the Log-rank test. Multivariate survival analysis was conducted using the Cox proportional risk regression model. Results There were 259 patients in the normal GNRI group (GNRI>98) and 56 patients in the abnormal GNRI group (GNRI≤98). The GNRI was closely correlated with age, tumor location, tumor diameter, serum albumin level, body mass index (BMI), and lymph node metastasis (all P < 0.05). The 5- year survival rates in the normal and abnormal GNRI groups were 41.2% and 27.0%, respectively, with statistical significance (P=0.002). Univariate analysis showed that age, tumor diameter, serum albumin level, BMI, GNRI, platelet- lymphocyte ratio, tumor invasion depth, and lymph node metastasis were risk factors for the prognosis of patients with esophageal squamous cell carcinoma (all P < 0.05). Multivariate analysis showed that the preoperative GNRI (hazard ratio=0.687, 95% confidence interval: 0.487-0.968, P=0.032) was an independent factor affecting the prognosis of patients with esophageal squamous cell carcinoma. Subgroup analysis showed that the survival rates in the normal GNRI group were significantly higher than those in the abnormal GNRI group (P=0.036 and 0.010, respectively), regardless of lymph node metastasis. Conclusions The preoperative GNRI is associated with malignant biological behavior in elderly patients with esophageal squamous cell carcinoma and can be used as a useful indicator for predicting survival after radical resection.
- esophageal squamous cell carcinoma /
- Geriatric Nutritional Risk Index (GNRI) /
- clinicopathologic characteristics /
- prognosis

HTML全文

图 1 术前GNRI对食管鳞癌患者根治术后总体生存曲线的影响

例数
GNRI异常 56 31 19 12 6 3
GNRI正常248 161 126 91 45 15

下载: 全尺寸图片幻灯片

图 2 术前GNRI对无淋巴结转移食管鳞癌患者根治术后总体生存曲线的影响

例数
GNRI异常 32 24 14 9 3 3
GNRI正常138 105 87 67 32 11

下载: 全尺寸图片幻灯片

图 3 术前GNRI对有淋巴结转移食管鳞癌患者根治术后总体生存曲线的影响

例数
GNRI异常 24 10 5 3 3 0
GNRI正常110 56 39 24 13 4

下载: 全尺寸图片幻灯片

表 1 术前GNRI与食管鳞癌患者临床病理特征的相关性 n（%）

表 2 影响本组315例食管鳞癌患者预后的单因素分析结果

表 3 影响本组315例食管鳞癌患者预后的多因素分析结果

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