老年营养风险指数对食管鳞癌患者根治性切除术后生存的影响*

摘要

Objective: To evaluate the prognostic value of the preoperative Geriatric Nutritional Risk Index (GNRI) in patients with esophageal squamous cell carcinoma after radical resection. Methods: Clinicopathological and laboratory data of 315 elderly patients with esophageal squamous cell carcinoma who were older than 60 years and underwent radical resection in Tianjin Medical University Cancer Institute and Hospital from January 2008 to December 2012 were retrospectively analyzed. The GNRI formula was as follows:1.489×serum albumin (g/L)+41.7×(current body weight/ideal body weight). According to the GNRI, patients were divided into the normal and abnormal GNRI groups. The χ2 test was used to analyze the relationship between the GNRI and the clinicopathological char-acteristics of patients. The Kaplan-Meier method was used to analyze the survival rate, and survival analysis was conducted using the Log-rank test. Multivariate survival analysis was conducted using the Cox proportional risk regression model. Results: There were 259 patients in the normal GNRI group (GNRI>98) and 56 patients in the abnormal GNRI group (GNRI≤98). The GNRI was closely correlated with age, tumor location, tumor diameter, serum albumin level, body mass index (BMI), and lymph node metastasis (all P60岁食管鳞癌患者的临床病理学及实验室资料.GNRI=1.489×血清白蛋白(g/L)+41.7×(体重/理想体重).根据GNRI水平将患者分为GNRI正常组和GNRI异常组,χ2检验分析GNRI与患者临床病理特征之间的关系,采用Kaplan-Meier法进行生存分析,生存率比较采用Log-rank检验,Cox比例风险回归模型进行多因素生存分析.结果:GNRI正常组(GNRI>98)259例,GNRI异常组(GNRI≤98)56例.GNRI与患者年龄、肿瘤部位、肿瘤直径、血清白蛋白水平、BMI和淋巴结转移密切相关(均P<0.05).GNRI正常组与异常组患者的5年生存率分别为41.2%和27.0%,差异具有统计学意义(P=0.002).单因素分析显示:年龄、肿瘤直径、血清白蛋白水平、BMI、GNRI、PLR、肿瘤浸润深度和淋巴结转移是影响食管鳞癌患者预后的危险因素(均P<0.05);多因素分析结果显示,术前GNRI(HR=0.687,95%CI:0.487～0.968,P=0.032)异常是影响食管鳞癌患者预后的独立危险因素.亚组分析显示,无论有无淋巴结转移, GNRI正常组患者的生存均显著高于GNRI异常组患者(P=0.036和0.010).结论:术前GNRI与老年食管鳞癌患者恶性生物学行为相关,可作为预测患者根治术后生存的有用指标.