北京大学学报(医学版) ›› 2023, Vol. 55 ›› Issue (1): 149-155. doi: 10.19723/j.issn.1671-167X.2023.01.023
张铨,宋海峰,马冰磊,张喆楠,周朝晖,李傲林,刘军,梁磊,朱时雨,张骞*()
Quan ZHANG,Hai-feng SONG,Bing-lei MA,Zhe-nan ZHANG,Chao-hui ZHOU,Ao-lin LI,Jun LIU,Lei LIANG,Shi-yu ZHU,Qian ZHANG*()
摘要:
目的: 探讨预后营养指数(prognostic nutrition index, PNI)对非转移性肾细胞癌术后患者预后的意义,并将PNI与中性粒细胞与淋巴细胞比值(neutrophil to lymphocyte ratio, NLR)、血小板与淋巴细胞比值(platelet to lymphocyte ratio, PLR)、全身免疫炎症指数(systemic immune inflammation index, SII)等血液学指标进行比较。方法: 回顾性收集2010年1月至2012年12月于北京大学第一医院泌尿外科接受手术治疗的328例非转移性肾细胞癌患者的临床病理资料。采用受试者工作特征(receiver operating characteristic, ROC)曲线分析各个血液学指标的敏感度、特异度,根据最大约登指数(Youden index)确定其最佳截断值。采用Kaplan-Meier法绘制术后生存曲线,Cox回归模型分析PNI与总生存期(overall survival, OS)、无病生存期(disease-free survival, DFS)的相关性。结果: 根据ROC曲线最大约登指数得出PNI最佳截断值为47.3。低水平的PNI与患者高龄、低体重指数、更高的肿瘤病理T分期相关(P < 0.05)。Kaplan-Meier单因素分析显示,较低的PNI与较差的OS和DFS均显著相关(P < 0.05),此外,高龄、低体重指数、肿瘤坏死、更高的肿瘤病理T分期及Fuhrman分级均与较差的OS显著相关(P < 0.05)。Cox多因素分析结果表明,4种血液学指标中,只有PNI不论作为连续变量(HR=0.9,95%CI=0.828~0.978,P=0.013)还是分类变量(HR=2.397,95%CI=1.061~5.418,P=0.036)都是影响OS的独立因素。结论: 非转移性肾细胞癌患者术前低PNI是术后高病理T分期的重要预测指标,同时也是术后OS、DFS不佳的独立危险因素。PNI作为预测肾细胞癌患者的预后指标优于其他血清学指标。
中图分类号:
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