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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 ›› 2020, Vol. 09 ›› Issue (05) : 439 -444. doi: 10.3877/cma.j.issn.2095-3232.2020.05.010

所属专题： 文献；

临床研究

预后营养指数在胰头和壶腹周围癌腹腔镜胰十二指肠切除术后患者预后中的价值
蔡健华1, 何嘉琦1, 刘猛1, 王巍1,†()   
  1. 1. 200040　上海，复旦大学附属华东医院普通外科
  • 收稿日期:2020-05-12 出版日期:2020-10-10
  • 通信作者: 王巍

Prediction value of prognostic nutritional index for prognosis of patients with pancreatic head and periampullary carcinoma after laparoscopic pancreaticoduodenectomy

Jianhua Cai1, Jiaqi He1, Meng Liu1, Wei Wang1,†()   

  1. 1. Department of General Surgery, Huadong Hospital Affiliated to Fudan University, Shanghai 200040, China
  • Received:2020-05-12 Published:2020-10-10
  • Corresponding author: Wei Wang
  • About author:
    Corresponding author: Wang Wei, Email:
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蔡健华, 何嘉琦, 刘猛, 王巍. 预后营养指数在胰头和壶腹周围癌腹腔镜胰十二指肠切除术后患者预后中的价值[J/OL]. 中华肝脏外科手术学电子杂志, 2020, 09(05): 439-444.

Jianhua Cai, Jiaqi He, Meng Liu, Wei Wang. Prediction value of prognostic nutritional index for prognosis of patients with pancreatic head and periampullary carcinoma after laparoscopic pancreaticoduodenectomy[J/OL]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2020, 09(05): 439-444.

目的

探讨预后营养指数（PNI）在行腹腔镜胰十二指肠切除术（LPD）的胰头和壶腹周围癌患者预后中的价值。

方法

回顾性分析2014年7月至2019年7月在复旦大学附属华东医院行LPD的85例胰头和壶腹周围癌患者临床资料。其中男49例，女36例；年龄27～84岁，中位年龄67岁。患者均签署知情同意书，符合医学伦理学规定。根据术前1周内化验结果计算患者PNI。采用受试者工作特征（ROC）曲线评估PNI预测总体生存时间的敏感度及特异度，确定PNI最佳界值。根据最佳界值将患者分为高PNI组和低PNI组。PNI与患者临床病理特征的关系分析采用χ2检验。采用Kaplan-Meier法绘制生存曲线，术前PNI与患者术后总体生存关系分析采用Log-rank检验。采用Cox比例风险模型分析胰头和壶腹周围癌患者术后预后的影响因素。

结果

根据ROC曲线，PNI最佳界值为48.4，敏感度为0.61，特异度为0.80。PNI与肿瘤部位、分期、淋巴结转移、脉管癌栓、CA19-9和TB有关（χ2=6.834，10.530，5.818，10.530，5.265，8.056；P<0.05）。高PNI组生存明显优于低PNI组（χ2=8.270，P<0.05）。多因素分析显示，术前TB和PNI是胰头和壶腹周围癌患者LPD术后预后的独立影响因素(OR=3.863，0.265；95%CI：1.197～12.465，0.073～0.968；P<0.05)。

结论

PNI可作为胰头和壶腹周围癌LPD术后预后判断的简便有效的临床指标。

关键词: 胰腺肿瘤, 腹腔镜, 胰十二指肠切除术, 预后营养指数, 危险因素, 预后
Objective

To evaluate the prognostic nutrition index (PNI) in the clinical prognosis of patients with pancreatic head and periampullary carcinoma after laparoscopic pancreaticoduodenectomy (LPD).

Methods

Clinical data of 85 patients with pancreatic head and periampullary carcinoma who underwent LPD in Huadong Hospital Affiliated to Fudan University from July 2014 to July 2019 were retrospectively analyzed. Among them, 49 patients were male and 36 female, aged 27-84 years with a median age of 67 years. The informed consents of all patients were obtained and the local ethical committee approval was received. The patients' PNI was calculated according to the test results within 1 week before operation. The sensitivity and specificity of PNI in predicting the overall survival were evaluated by using the receiver operating characteristic (ROC) curve, and the optimal cut-off value of PNI was determined. Patients were divided into high- and low-PNI groups according to the optimal cut-off value. The relationship between PNI and the clinicopathological characteristics of patients was analyzed by Chi-square test. The survival curve was delineated by Kaplan-Meier method, and the relationship between preoperative PNI and postoperative overall survival was analyzed by Log-rank test. The risk factors of postoperative prognosis in patients with pancreatic head and periampullary carcinoma were identified by Cox's proportional hazards model.

Results

According to the ROC curve, the optimal cut-off value of PNI was 48.4 with a sensitivity of 0.61 and a specificity of 0.80. PNI was significantly correlated with tumor location, tumor stage, lymph node metastasis, tumor thrombus, CA19-9 and TB (χ2=6.834, 10.530, 5.818, 10.530, 5.265, 8.056; P<0.05). The overall survival in high-PNI group was significantly better than that in low-PNI group (χ2=8.270, P<0.05). Multivariate analysis showed that preoperative TB and PNI were the independent prognostic factors for patients with pancreatic head and periampullary carcinoma after LPD (OR=3.863, 0.265; 95%CI: 1.197-12.465, 0.073-0.968; P<0.05).

Conclusions

PNI can be utilized as a simple, convenient and effective clinical parameter to evaluate the prognosis of patients with pancreatic head and periampullary carcinoma after LPD.

Key words: Pancreatic neoplasms, Laparoscopes, Pancreaticoduodenectomy, Prognostic nutritional index, Risk factors, Prognosis
图1 预后营养指数与胰头和壶腹周围癌患者术后生存关系的ROC曲线
表1 PNI与胰头和壶腹周围癌患者临床病理特征的关系（例）
临床病理因素 高PNI组 低PNI组 χ2值 P值
性别 ? ? 0.447 0.504
? 男 25 24 ? ?
? 女 21 15 ? ?
年龄 ? ? 2.262 0.133
? <65岁 24 14 ? ?
? ≥65岁 22 25 ? ?
肿瘤部位 ? ? 6.834 0.009
? 胰头 36 20 ? ?
? 壶腹部周围 10 19 ? ?
肿瘤分期 ? ? 10.530 0.001
? T1+T2 42 23 ? ?
? T3+T4 4 16 ? ?
淋巴结转移 ? ? 5.818 0.016
? 无 38 23 ? ?
? 有 8 16 ? ?
脉管癌栓 ? ? 10.530 0.001
? 无 42 23 ? ?
? 有 4 16 ? ?
神经侵犯 ? ? 3.721 0.054
? 无 34 21 ? ?
? 有 12 18 ? ?
远处转移 ? ? 0.036 0.514
? M0 44 36 ? ?
? M1 2 3 ? ?
CA19-9 ? ? 5.265 0.022
? ≤34 μg/L 28 14 ? ?
? >34 μg/L 18 25 ? ?
CA125 ? ? 0.095 0.757
? ≤35 μg/L 40 33 ? ?
? >35 μg/L 6 6 ? ?
CEA ? ? 0.156 0.693
? ≤5 μg/L 37 30 ? ?
? >5 μg/L 9 9 ? ?
TB ? ? 8.056 0.005
? ≤25 μmol/L 35 18 ? ?
? >25 μmol/L 11 21 ? ?
图2 高PNI组和低PNI组胰头和壶腹周围癌患者术后生存Kaplan-Meier曲线
表2 影响胰头和壶腹周围癌患者LPD术后总体生存的单因素及多因素分析
因素 单因素分析 多因素分析
OR 95%CI P值 OR 95%CI P值
淋巴结转移 3.169 1.148～8.747 0.026 2.429 0.587～10.041 0.22
? 无 ? ? ? ? ? ?
? 有 ? ? ? ? ? ?
脉管癌栓 2.931 1.062～8.088 0.038 0.442 0.095～2.065 0.299
? 无 ? ? ? ? ? ?
? 有 ? ? ? ? ? ?
神经侵犯 2.914 1.037～8.191 0.043 1.661 0.410～6.731 0.478
? 无 ? ? ? ? ? ?
? 有 ? ? ? ? ? ?
CA19-9 4.131 1.165～14.651 0.028 2.437 0.497～11.958 0.272
? ≤34 μg/L ? ? ? ? ? ?
? >34 μg/L ? ? ? ? ? ?
TB 5.257 1.672～16.534 0.005 3.863 1.197～12.465 0.024
? ≤25 μmol/L ? ? ? ? ? ?
? >25 μmol/L ? ? ? ? ? ?
PNI 0.190 0.054～0.675 0.010 0.265 0.073～0.968 0.045
? ≥48.4 ? ? ? ? ? ?
? <48.4 ? ? ? ? ? ?
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