术前营养状况对非小细胞肺癌患者预后的影响

摘要

Objective:To evaluate preoperative nutritional factors in patients with non -small cell lung cancer (NSCLC)undergoing surgical resection.Methods:A retrospective analysis was used in this study.The clinical data of surgical excised NSCLC patients who were hospitalized in the department of thoracic surgery in our hospital were selected.Serum albumin,total lymphocyte count,total neutrophils count,prognostic nutritional index(PNI)and neu-trophil/lymphocyte ratio(NLR)were used to evaluate the preoperative nutritional status of the patients.The patients were divided into three groups (the normal lung group,the emphysema group and the pulmonary fibrosis group)ac-cording to the results of high resolution computed tomography.The patients were followed up for 5 years to compare the total survival (OS)and the recurrence-free survival (RFS)of the patients with different nutritional status.Cox proportional hazards regression model was used for multivariate analysis of preoperative nutritional factors affecting the prognosis of patients.Results:The OS decreased significantly in patients with low serum albumin,high total neutro-phils count and low PNI (P＜0.001,P＝0.032,P＝0.008,respectively).At the same time,the RFS of the patients with low serum albumin were significantly decreased (P＝0.004).In normal patients,the OS was significantly lower in patients with low serum albumin(P＝0.003).In the patients with pulmonary fibrosis,the RFS was significantly lower in the patients with low serum protein (P＝0.035).Multivariate analysis showed that serum albumin level was an independent risk factor affecting OS and RFS in patients with NSCLC surgery (P＝0.014 and P＝0.046 respec-tively).Conclusion:Preoperative serum albumin level is an important prognostic factor for OS and RFS in patients with NSCLC after resection.The serum albumin level has no effect on the prognosis of NSCLC patients with emphyse-ma.%目的:探讨影响行手术切除的非小细胞肺癌(NSCLC)患者预后的术前营养因素.方法:采用回顾性分析,选取在我院胸外科行手术切除的NSCLC患者的临床资料.采用血清白蛋白、总淋巴细胞计数、总中性粒细胞计数、预后营养指数(PNI)和中性粒细胞/淋巴细胞比值(NLR)评价患者术前的营养状况.根据胸部高分辨率计算机断层扫描的结果,将患者分为3组(正常肺组、肺气肿组和肺纤维化组).对患者进行5年随访,比较不同营养状况患者的总生存期(OS)和无复发生存期(RFS).应用Cox比例风险回归模型进行多变量分析影响患者预后的术前营养因素.结果:低血清白蛋白、高总中性粒细胞计数和低PNI患者的OS显著降低(分别为P＜0.001,P＝0.032,P＝0.008).同时只有低血清白蛋白患者RFS明显降低(P＝0.004).正常肺患者中,低血清白蛋白患者 OS显著降低(P＝0.003).肺纤维化患者中,低血清蛋白患者RFS显著降低(P＝0.035).多变量分析表明,血清白蛋白水平是影响NSCLC手术切除患者OS与RFS的独立危险因素(分别P＝0.014与P＝0.046).结论:术前血清白蛋白水平是影响NSCLC患者行切除术后OS和RFS的重要预后因素.血清白蛋白水平对合并肺气肿的NSCLC患者预后无影响.