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

doi:10.3877/cma.j.issn.2095-3232.2020.05.010

Abstract

Abstract:

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

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]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2020, 09(05): 439-444.

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References 25

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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	?	?

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	?	?

因素		单因素分析			多因素分析
因素		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	?	?	?	?	?	?

因素		单因素分析			多因素分析
因素		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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