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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 ›› 2024, Vol. 13 ›› Issue (01) : 51 -56. doi: 10.3877/cma.j.issn.2095-3232.2024.01.010

临床研究

预后营养指数对交界可切除胰腺癌患者术后预后的预测价值
黄金灿, 王迪, 崔松平, 陈晴, 吕少诚, 贺强, 郎韧†()   
  1. 100020　首都医科大学附属北京朝阳医院肝胆外科
  • 收稿日期:2023-10-31 出版日期:2024-02-10
  • 通信作者: 郎韧

Predictive value of prognostic nutritional index for postoperative prognosis in patients with borderline resectable pancreatic cancer

Jincan Huang, Di Wang, Songping Cui, Qing Chen, Shaocheng Lyu, Qiang He, Ren Lang†()   

  1. Department of Hepatobiliary Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
  • Received:2023-10-31 Published:2024-02-10
  • Corresponding author: Ren Lang
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黄金灿, 王迪, 崔松平, 陈晴, 吕少诚, 贺强, 郎韧. 预后营养指数对交界可切除胰腺癌患者术后预后的预测价值[J]. 中华肝脏外科手术学电子杂志, 2024, 13(01): 51-56.

Jincan Huang, Di Wang, Songping Cui, Qing Chen, Shaocheng Lyu, Qiang He, Ren Lang. Predictive value of prognostic nutritional index for postoperative prognosis in patients with borderline resectable pancreatic cancer[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2024, 13(01): 51-56.

目的

探讨预后营养指数（PNI）对交界可切除胰腺癌患者术后预后的预测价值。

方法

回顾性分析2013年3月至2021年12月首都医科大学附属北京朝阳医院行手术治疗的77例交界可切除胰腺癌患者临床资料。患者均签署知情同意书，符合医学伦理学规定。其中男34例，女43例；平均年龄（61±11）岁。根治性胰十二指肠切除术61例，根治性全胰十二指肠切除术16例。根据术前血清ALB和外周血淋巴细胞计数，计算术前PNI为45±5，以45为界值，将患者分为低PNI组（39例）和高PNI组（38例）。生存分析采用Kaplan-Meier法和Log-rank检验，采用Cox多因素分析筛选影响患者远期预后的危险因素。

结果

两组患者均顺利完成手术，术后并发症发生率为30%（23/77）。低PNI组和高PNI组患者中位生存时间分别为8.0、15.5个月，患者术后6个月、1年、2年总体生存率分别为76.7%、40.1%、17.2%和91.8%、65.3%、49.8%，差异有统计学意义（χ2=5.826，P<0.05）。Cox多因素分析显示，低PNI（HR=1.864，95%CI：1.089～3.190，P=0.023）、肿瘤低分化（HR=2.166，95%CI：1.225～3.828，P=0.008）是影响术后远期生存的独立危险因素。

结论

PNI可作为预测交界可切除胰腺癌患者总体生存期的有效指标，低PNI患者预后较差。

关键词: 胰腺肿瘤, 交界可切除胰腺癌, 营养评估, 预后营养指数（PNI）, 预后
Objective

To evaluate the predictive value of prognostic nutritional index (PNI) for prognosis of patients with borderline resectable pancreatic cancer.

Methods

Clinical data of 77 patients with borderline resectable pancreatic cancer who underwent surgical treatment in Beijing Chaoyang Hospital, Capital Medical University from March 2013 to December 2021 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 34 patients were male and 43 female, aged (61±11) years on average. 61 patients underwent radical pancreaticoduodenectomy and 16 cases of radical total pancreaticoduodenectomy. According to preoperative serum ALB and peripheral blood lymphocyte count, preoperative PNI was calculated as 45±5. All patients were divided into low (n=39) and high PNI groups (n=38) with PNI of 45 as the cut-off value. Survival analysis was performed by Kaplan-Meier analysis and Log-rank test. The risk factors affecting the long-term prognosis of patients were screened by multivariate Cox's model.

Results

All patients successfully completed the surgery. The incidence of postoperative complications was 30%(23/77). The median survival of patients in the low and high PNI groups was 8.0 and 15.5 months. The postoperative 6-month, 1-year and 2-year overall survival rates in two groups were 76.7%, 40.1%, 17.2% and 91.8%, 65.3%, 49.8%, and the differences were statistically significant (χ2=5.826, P<0.05). Multivariate Cox's model showed that low PNI (HR=1.864, 95%CI:1.089-3.190, P=0.023) and low degree of tumor differentiation (HR=2.166, 95%CI:1.225-3.828, P=0.008) were the independent risk factors for postoperative long-term survival.

Conclusions

PNI can be utilized as an effective index to predict the overall survival of patients with borderline resectable pancreatic cancer. Patients with low PNI obtain poor prognosis.

Key words: Pancreatic neoplasms, Borderline resectable pancreatic cancer, Nutrition evaluation, Prognostic nutritional index (PNI), Prognosis
表1 低PNI组和高PNI组交界可切除胰腺癌患者一般资料比较
组别 例数 性别（例） 年龄（岁，±s） CA19-9[kU/L，M（Q1,Q3）] PD（例） 新辅助治疗（例） 术中出血量（ml，±s） 术中输血（例） 手术时间（h，±s）
男 女
低PNI组 39 16 23 60±11 1 191（533，1 848） 34 9 774±440 22 12.9±2.8
高PNI组 38 18 20 62±10 636（226，1 047） 27 14 766±558 17 12.4±2.7
统计值   χ2=0.948 t=-0.564 Z=1.913 χ2=13.415 χ2=6.709 t=0.006 χ2=1.049 t=0.042
P值   0.581 0.455 0.171 0.085 0.193 0.940 0.306 0.839
组别 例数 肿瘤长径[cm，M（Q1,Q3）] 肿瘤分化（例） TNM分期Ⅰ期（例） R0切除（例） 淋巴结转移（例） 术后并发症（例） 术后化疗（例）
低 高
低PNI组 39 3.6（3.1，4.1） 13 26 6 37 30 11 10
高PNI组 38 3.8（3.3，4.4） 14 24 9 33 27 12 14
统计值   Z=-0.375 χ2=4.495 χ2=0.119 χ2=6.397 χ2=1.350 χ2=0.105 χ2=4.289
P值   0.542 0.272 0.864 0.229 0.563 0.746 0.295
图1 交界可切除胰腺癌患者术后Kaplan-Meier生存曲线注：PNI为预后营养指数
表2 交界可切除胰腺癌患者术后远期生存的单因素分析
因素 例数 1年生存率（%） 2年生存率（%） χ2值 P值
性别       0.855 0.355
男性 34 55.6 26.2    
女性 43 63.1 38.4    
年龄（岁）       3.120 0.077
≤60 32 68.3 49.3    
>60 45 54.1 22.1    
ALB（g/L）       1.744 0.187
≤35 20 49.1 16.4    
>35 57 63.7 39.1    
淋巴细胞总数（×109/L）       1.081 0.298
≤1 14 55.0 15.7    
>1 63 61.0 36.9    
CA19-9（kU/L）       0.168 0.682
≤37 24 64.3 21.4    
>37 53 58.0 37.3    
PNI       5.826 0.016
≤45 39 51.6 17.2    
>45 38 68.4 49.8    
手术时间（h）       0.006 0.941
≤10 18 65.2 32.6    
>10 59 58.0 32.9    
出血量（ml）       0.201 0.654
≤500 38 74.9 37.5    
>500 39 45.4 28.4    
手术方式       2.434 0.119
PD 61 62.6 37.6    
TP 16 47.2 9.4    
新辅助治疗       4.573 0.032
是 23 77.6 53.4    
否 54 52.0 23.8    
肿瘤分化程度       4.149 0.042
低 27 50.8 30.0    
中-高 50 76.6 38.3    
肿瘤直径（cm）       1.533 0.216
≤2 10 80.0 57.1    
>2 67 56.9 29.3    
切除方式       0.525 0.469
R0 70 60.6 34.4    
R1 7 51.4 17.1    
TNM分期       0.173 0.677
Ⅰ～Ⅱ级 54 59.3 36.5    
Ⅲ级 23 60.9 26.1    
淋巴结转移       2.688 0.101
是 57 56.9 26.4    
否 20 68.6 51.4    
术后化疗       1.284 0.257
是 24 72.6 36.3    
否 53 53.8 31.0    
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