预后营养指数在原发性肝癌肝切除患者预后评估中的价值

摘要

目的：评价预后营养指数（PNI）在接受根治性肝切除的原发性肝癌患者预后评估中的意义及价值。方法：回顾性分析西安交通大学第一附属医院肝胆外科2002年12月至2011年12月间接受肝切除的原发性肝癌患者病例及随访资料，根据患者术前的血清白蛋白和总的淋巴细胞计数算出 PNI 值，分析 PNI 与患者临床病理特征及预后的关系。结果：预后危险因素分析显示：PNI 是影响肝癌切除术后患者生存率的独立危险因素（P ＜0．05），高 PNI 组患者的5年累计生存率为56．20％，而低 PNI 组仅为36．10％，差异显著（P ＝0．01）。分层分析发现在早期肝癌患者中，PNI 亚组间的总体生存存在显著差异（P ＜0．05），而在晚期患者中差异不明显（P ＞0．05）。结论：PNI 是影响原发性肝癌切除术后患者生存情况的独立危险因素，但对术后肿瘤的复发作用不明显。%Objective:To investigate the impact of prognostic nutritional index (PNI)on the clinicopathological features and the long -term outcomes of hepatocellular carcinoma (HCC)after surgical resection.Methods:The clin-ical and follow -up records of 172 patients with hepatocellular carcinoma undergoing resection surgery were analyzed retrospectively.Preoperative serum albumin and lymphocyte counts were obtained.The PNI value was calculated by serum albumin concentration (g/L)+5 ×lymphocyte count (109 /L).All patients were divided into two groups based on the PNI value (PNI≥45 was defined as high -PNI.PNI <45 was defined as low -PNI).Multivariate and stratifi-cation analysis were used to assess the correlation between the PNI and the patients'prognosis.Results:Compared with the high -PNI group,patients in the low -PNI group were older (P <0.05).Besides,the patients in the low -PNI group had a higher incidence of live fibrosis than those in the high -PNI group (P <0.05).In univariate analy-sis,the result hinted that the PNI,carcinoma embolus,HBV and TNMstages might affect the overall survival of post-operative patients.Multivariate Cox analysis further indicated that PNI was an independent protective factor associated with patients'overall survival,with TNMstages and HBV being independent risk factors.Subgroup analysis was used to confirm the result.In addition,76 patients had tumor recurrence after surgical resection.Nevertheless,the result of the multivariate Cox analysis failed to find the statistics difference between the high -PNI group and the low -PNI group.Hence,PNI is not the independent protective factor of tumor recurrence.Conclusion:PNI is a convenient and useful index to predict the prognosis of the patients with HCC.