切换至 "中华医学电子期刊资源库"
高级检索
中华肝脏外科手术学电子杂志

中华肝脏外科手术学电子杂志 ›› 2015, Vol. 04 ›› Issue (06) : 363 -367. doi: 10.3877/cma.j.issn.2095-3232.2015.06.010

所属专题： 文献；

临床研究

术前预后营养指数在评价肝细胞癌患者术后生存预后中的价值
华赟鹏1, 吉斐2, 付顺军2, 沈顺利1, 李绍强1, 梁力建1, 彭宝岗1,†()   
  1. 1. 510080　广州，中山大学附属第一医院肝胆外科
    2. 510080　广州，中山大学附属第一医院器官移植中心
  • 收稿日期:2015-08-25 出版日期:2015-12-10
  • 通信作者: 彭宝岗
  • 基金资助:
    国家自然科学基金(81201918); 教育部留学回国人员科研启动基金(教外司留（2015）311号); 广东省科技计划项目(2012B031800099)

Value of preoperative prognostic nutritional index in postoperative survival prognosis of hepatocellular carcinoma patients

Yunpeng Hua1, Fei Ji2, Shunjun Fu2, Shunli Shen1, Shaoqiang Li1, Lijian Liang1, Baogang Peng1,†()   

  1. 1. Department of Hepatobiliary Surgery, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
    2. Organ Transplantation Center, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
  • Received:2015-08-25 Published:2015-12-10
  • Corresponding author: Baogang Peng
  • About author:
    Corresponding author: Peng Baogang, Email:
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

华赟鹏, 吉斐, 付顺军, 沈顺利, 李绍强, 梁力建, 彭宝岗. 术前预后营养指数在评价肝细胞癌患者术后生存预后中的价值[J]. 中华肝脏外科手术学电子杂志, 2015, 04(06): 363-367.

Yunpeng Hua, Fei Ji, Shunjun Fu, Shunli Shen, Shaoqiang Li, Lijian Liang, Baogang Peng. Value of preoperative prognostic nutritional index in postoperative survival prognosis of hepatocellular carcinoma patients[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2015, 04(06): 363-367.

目的

探讨术前预后营养指数（PNI）在肝细胞癌（肝癌）患者术后生存预后中的价值。

方法

回顾性分析2006年1月至2009年12月在中山大学附属第一医院行根治性切除的322例肝癌患者临床资料。其中男286例，女36例；年龄21～79岁，中位年龄51岁。所有患者均签署知情同意书，符合医学伦理学规定。根据患者术前1周检查结果计算PNI值，将患者分为高PNI组（253例）和低PNI组（69例），观察PNI与肝癌患者术后生存时间的关系，分析术前PNI在生存预后中的价值。采用Kaplan-Meier法和Log-rank检验进行生存分析。多因素分析采用Cox比例风险模型。

结果

高PNI组1、3、5年无瘤生存率分别为48.0%、34.9%、31.3%，低PNI组相应为33.3%、15.8%、11.7%，高PNI组无瘤生存明显优于低PNI组（χ2=9.990，P<0.05）。高PNI组1、3、5年总体生存率分别为72.3%、49.0% 、42.6%，低PNI组相应为65.2%、36.2%、25.9%，高PNI组总体生存明显优于低PNI组（χ2=8.172，P<0.05）。多因素分析结果显示，AFP、肿瘤数量、肿瘤直径、门静脉癌栓（PVTT）和PNI是患者无瘤生存率的独立危险因素（HR=1.355、0.783、2.295、1.920、0.710；P<0.05）；肿瘤数量、肿瘤直径、PVTT和PNI是总体生存率的独立危险因素（HR=0.780、2.340、2.013、0.653；P<0.05）。

结论

术前PNI是肝癌患者术后生存预后的独立危险因素，可作为预测肝癌患者术后生存预后的常用指标。

关键词: 肝细胞癌, 营养预后指数, 病理学，临床, 预后
Objective

To investigate the value of preoperative prognostic nutritional index (PNI) in postoperative survival prognosis of hepatocellular carcinoma (HCC) patients.

Methods

Clinical data of 322 HCC patients undergoing radical resection in the First Affiliated Hospital of Sun Yat-sen University between January 2006 and December 2009 were retrospectively studied. Among the 322 patients, 286 were males and 36 were females with the age ranging from 21 to 79 years old and the median age of 51 years old. The informed consents of all patients were obtained and the local ethical committee approval had been received. PNI value was calculated according to the examination results 1 week before surgery, then the patients were divided into the high PNI group (n=253) and low PNI group (n=69). The relationship between PNI and postoperative survival time was observed, and the value of preoperative PNI in postoperative survival prognosis was analyzed. The survival analysis was conducted using Kaplan-Meier method and Log-rank test, and the multivariate analysis was conducted using Cox proportional hazards model.

Results

The 1-, 3-, 5-year disease free survival rate was respectively 48.0%, 34.9% and 31.3% in high PNI group, and 33.3%, 15.8% and 11.7% in low PNI group. The disease free survival in high PNI group was significantly better than that in low PNI group (χ2=9.990, P<0.05). The 1-, 3-, 5-year overall survival rate was respectively 72.3%, 49.0% and 42.6% in high PNI group, and 65.2%, 36.2% and 25.9% in low PNI group. The overall survival in high PNI group was significantly better than that in low PNI group (χ2=8.172, P<0.05). The results of the multivariate analysis showed that AFP, tumor number, tumor diameter, portal vein tumor thrombus (PVTT) and PNI were the independent risk factors for disease free survival rate (HR=1.355, 0.783, 2.295, 1.920, 0.710; P<0.05), and tumor number, tumor diameter, PVTT and PNI were the independent risk factors for overall survival rate (HR=0.780, 2.340, 2.013, 0.653; P<0.05).

Conclusions

Preoperative PNI is the independent risk factor for postoperative survival prognosis of HCC patients and can be used as the common index for predicting postoperative survival of HCC patients.

Key words: Hepatocellular cancer, Prognostic nutritional index, Pathology,clinical, Prognosis
图1 预后营养指数的受试者工作特征曲线（ROC）
图2 高、低PNI组肝癌患者术后无瘤生存的Kaplan-Meier曲线
图3 高、低PNI组肝癌患者术后总体生存的Kaplan-Meier曲线
表1 影响肝癌患者无瘤生存率及总体生存率的多因素分析结果
变量 无瘤生存率 总生存率
HR P值 95%CI HR P值 95%CI
AFP≥200 μg/L 1.355 <0.05 1.041～1.765 - - -
肿瘤数量多发 0.783 <0.05 0.680～0.901 0.780 <0.05 0.672～0.906
PVTT 2.295 <0.05 1.653～3.185 2.340 <0.05 1.673～3.274
肿瘤大小≥5 cm 1.920 <0.05 1.423～2.591 2.013 <0.05 1.442～2.811
PNI≤45 0.710 <0.05 0.527～0.957 0.653 <0.05 0.477～0.895
[1]
Forner A, Llovet JM, Bruix J. Hepatocellular carcinoma[J]．Lancet, 2012, 379(9822):1245-1255.
[2]
Jemal A, Bray F, Center MM, et al．Global cancer statistics[J]. CA Cancer J Clin, 2011, 61(2):69-90.
[3]
Ng KK, Lo CM, Liu CL, et al. Survival analysis of patients with transplantable recurrent hepatocellular carcinoma: implications for salvage liver transplant[J]. Arch Surg, 2008, 143 (1): 68-74.
[4]
Kim do Y, Paik YH, Ahn SH, et al. PIVKA-II is a useful tumor marker for recurrent hepatocellular carcinoma after surgical resection[J]. Oncology, 2007, 72 Suppl 1:52-57.
[5]
Pinato DJ, North BV, Sharma R. A novel, externally validated inflammation-based prognostic algorithm in hepatocellular carcinoma: the prognostic nutritional index (PNI)[J]．Br J Cancer，2012, 106(8): 1439-1445.
[6]
Kanda M, Fujii T, Kodera Y, et a1．Nutritional predictors of postoperative outcome in pancreatic cancer[J]．Br J Surg，2011, 98(2):268-274.
[7]
Mohri Y, Inoue Y, Tanaka K, et al．Prognostic nutritional index predicts postoperative outcome in colorectal cancer[J]．World J Surg, 2013, 37(11):2688-2692.
[8]
Yang Z, Zhang B, Hou L, et al. Pre-operative prognostic nutritional index predicts the outcomes for triple-negative breast cancer[J]. Tumour Biol, 2014, 35(12): 12165-12171.
[9]
Sun P, Zhang F, Chen C, et al. Comparison of the prognostic values of various nutritional parameters in patients with esophageal squamous cell carcinoma from Southern China[J]. J Thorac Dis, 2013, 5(4):484-491.
[10]
Poziomyck AK, Weston AC, Lameu EB, et al. Preoperative nutritional assessment and prognosis in patients with foregut tumors[J]. Nutr Cancer, 2012, 64(8): 1174-1181.
[11]
Van Cutsem E, Arends J. The causes and consequences of cancer-associated malnutrition[J]. Eur J Oncol Nurs, 2005, 9 Suppl 2:S51-63.
[12]
van Bokhorst-de van der Schueren MA. Nutritional support strategies for malnourished cancer patients[J]. Eur J Oncol Nurs, 2005, 9 Suppl 2:S74-83.
[13]
Schütte K, Tippelt B, Schulz C, et al. Malnutrition is a prognostic factor in patients with hepatocellular carcinoma (HCC)[J]. Clin Nutr, 2014, DOI:10.1016/j.clnu.2014.11.007[Epub ahead of print].
[14]
Crumley AB, Stuart RC, McKernan M, et a1．Is hypoalbuminemia an independent prognostic factor in patients with gastric cancer?[J]．World J Surg, 2010, 34(10):2393-2398.
[15]
刘宁，梁寒，张汝鹏，等．术前血清白蛋白水平对胃癌根治术患者的预后评估价值[J]．中华胃肠外科杂志，2011, 14(2):100-103.
[16]
Gomes de Lima KV, Maio R. Nutritional status, systemic inflammation and prognosis of patients with gastrointestinal cancer[J]．Nutr Hosp, 2012, 27(3):707-714.
[17]
Halazun KJ, Hardy MA, Rana AA, et al. Negative impact of neutrophil-lymphocyte ratio on outcome after liver transplantation for hepatocellular carcinoma[J]. Ann Surg, 2009, 250(1):141-151.
[18]
Kanda M, Fujii T, Kodera Y, et a1．Nutritional predictors of postoperative outcome in pancreatic cancer[J]．Br J Surg, 2011, 98(2):268-274.
[1] 李淼, 朱连华, 韩鹏, 姜波, 费翔. 高帧频超声造影评价肝细胞癌血管形态与风险因素的研究[J]. 中华医学超声杂志（电子版）, 2023, 20(09): 911-915.
[2] 丁建民, 秦正义, 张翔, 周燕, 周洪雨, 王彦冬, 经翔. 超声造影与普美显磁共振成像对具有高危因素的≤3 cm肝结节进行LI-RADS分类诊断的前瞻性研究[J]. 中华医学超声杂志（电子版）, 2023, 20(09): 930-938.
[3] 衣晓丽, 胡沙沙, 张彦. HER-2低表达对乳腺癌新辅助治疗疗效及预后的影响[J]. 中华乳腺病杂志(电子版), 2023, 17(06): 340-346.
[4] 李越洲, 张孔玺, 李小红, 商中华. 基于生物信息学分析胃癌中PUM的预后意义[J]. 中华普通外科学文献(电子版), 2023, 17(06): 426-432.
[5] 董杰, 杨松, 杨浩, 陈翔, 张万里. 乙酰辅酶A羧化酶2基因高甲基化与肝细胞癌临床病理因素和生存期的关系[J]. 中华普通外科学文献(电子版), 2023, 17(06): 433-437.
[6] 张俊, 罗再, 段茗玉, 裘正军, 黄陈. 胃癌预后预测模型的研究进展[J]. 中华普通外科学文献(电子版), 2023, 17(06): 456-461.
[7] 杨倩, 李翠芳, 张婉秋. 原发性肝癌自发性破裂出血急诊TACE术后的近远期预后及影响因素分析[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 33-36.
[8] 栗艳松, 冯会敏, 刘明超, 刘泽鹏, 姜秋霞. STIP1在三阴性乳腺癌组织中的表达及临床意义研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 52-56.
[9] 马伟强, 马斌林, 吴中语, 张莹. microRNA在三阴性乳腺癌进展中发挥的作用[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 111-114.
[10] 江振剑, 蒋明, 黄大莉. TK1、Ki67蛋白在分化型甲状腺癌组织中的表达及预后价值研究[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 623-626.
[11] 晏晴艳, 雍晓梅, 罗洪, 杜敏. 成都地区老年转移性乳腺癌的预后及生存因素研究[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 636-638.
[12] 鲁鑫, 许佳怡, 刘洋, 杨琴, 鞠雯雯, 徐缨龙. 早期LC术与PTCD续贯LC术治疗急性胆囊炎对患者肝功能及预后的影响比较[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 648-650.
[13] 李永胜, 孙家和, 郭书伟, 卢义康, 刘洪洲. 高龄结直肠癌患者根治术后短期并发症及其影响因素[J]. 中华临床医师杂志(电子版), 2023, 17(9): 962-967.
[14] 王军, 刘鲲鹏, 姚兰, 张华, 魏越, 索利斌, 陈骏, 苗成利, 罗成华. 腹膜后肿瘤切除术中大量输血患者的麻醉管理特点与分析[J]. 中华临床医师杂志(电子版), 2023, 17(08): 844-849.
[15] 索利斌, 刘鲲鹏, 姚兰, 张华, 魏越, 王军, 陈骏, 苗成利, 罗成华. 原发性腹膜后副神经节瘤切除术麻醉管理的特点和分析[J]. 中华临床医师杂志(电子版), 2023, 17(07): 771-776.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号