预后营养指数与晚期结直肠癌患者三线治疗的生存相关性分析

doi:10.16689/j.cnki.cn11-9349/r.2020.02.014

摘要
图/表
参考文献
相关文章 (15)

全文: PDF (1025 KB) HTML (1 KB)
输出: BibTeX | EndNote (RIS)

摘要目的探讨营养预后指数与接受替吉奥联合阿帕替尼治疗的晚期三线结直肠癌患者的疗效的相关性。方法回顾性收集接受阿帕替尼联合替吉奥治疗的43例三线结直肠癌患者的临床资料，计算预后营养指数（PNI）、白蛋白/球蛋白比值（AGR）、中性粒细胞/淋巴细胞比值（NLR）、血小板/淋巴细胞比值（PLR）以及淋巴细胞/单核细胞比值（LMR）等营养免疫评估指标，采用Cox比例风险回归模型及Kaplan-Meier生存曲线评价相关免疫营养指标对于患者生存的影响。结果根据总生存时间（OS）的受试者工作特征曲线（ROC）曲线分析，PNI最佳临界值定义为47.08；单因素分析结果显示，美国东部肿瘤协作组（ECOG）评分、PNI、AGR、血红蛋白（HGB）、NLR及LMR与患者OS显著相关；多变量分析显示ECOG评分及PNI是OS的独立预后因素。低PNI患者中位生存时间（mOS）为5.70个月（95%CI=4.42~6.98），高PNI患者mOS为15.77个月（95%CI=7.43~24.1），P=0.000；低PNI的患者中位无进展生存时间（mPFS）为3.42个月（95%CI=2.31~4.53），高PNI患者mPFS为6.29个月（95%CI=4.96~7.62），P=0.003。结论 PNI在作为晚期结直肠癌接受替吉奥联合阿帕替尼三线治疗的生存预测方面具有较好临床应用价值，简单易行。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	李一鸣
	邹曼
	庄亮
	邹燕梅
	张明生
	邱红
	戴宇翃

关键词 ：结直肠癌, 预后营养指数, 预后指标

Abstract：Objective To investigate the prognostic value of prognostic nutritional index （PNI） in the advanced colorectal cancer patients of third-line therapy. Methods Clinical data of 43 advanced colorectal cancer patients were retrospectively analysed， who were treated with S-1 plus apatinib as third-line therapy. PNI（prognostic nutritional index）， AGR（albumin-to-globulin ratio）， PLR （platelet lymphocyte ratio）and LMR（lymphocyte monocyte ratio） were calculated. Cox proportional hazards regression models and Kaplan-Meier curve were used to evaluate the impact on survival. Results According to receiver operating characteristic （ROC） curves， the cutoff value for PNI was 47.08； the result of univariate analysis showed PNI， AGR， ECOG， HGB， NLR and LMR were significantly correlated with overall survival （OS）； multivariate analysis showed that ECOG and PNI were independent prognostic factor of OS. The median overall survival for PNI-low patients were 5.70months（95%CI=4.42-6.98）， while the mOS for PNI-high patients were 15.77months（95%CI=7.43-24.1），P=0.000.The mPFS for PNI-low and PNI-high patients were 3.42months（95%CI=2.31-4.53）and 6.29months（95%CI=4.96-7.62）respectively，P=0.003. Conclusion PNI could be a useful prognostic indicator for advanced colorectal cancer patients who received the combination of S1 plus apatinib as third-line treatment.

Key words： Colorectal cancer Prognostic nutritional index Prognostic factor

基金资助:国家自然科学基金面上项目（81372664）
华中科技大学双一流自主创新学科医师资助项目（3011540024， 5001540074， 5001540095）
武汉市中青年医学骨干人才培养工程（2016whzqnyxggrcl）

通讯作者: 戴宇翃，电子邮箱：eier_dai@163.com

引用本文:

李一鸣，邹曼，庄亮，邹燕梅，张明生，邱红，戴宇翃. 预后营养指数与晚期结直肠癌患者三线治疗的生存相关性分析[J]. 肿瘤代谢与营养电子杂志, 2020, 7(2): 209-213.
Li Yiming， Zou Man， Zhuang Liang， Zou Yanmei， Zhang Mingsheng， Qiu Hong， Dai Yuhong. Prognostic significance of prognostic nutritional index in advanced colorectal cancer with third-line therapy. Electron J Metab Nutr Cancer, 2020, 7(2): 209-213.

1.TAMPELLINI M， DI MAIO M， BARATELLI C， et al. Treatment of patients with metastatic colorectal cancer in a real-world scenario: probability of receiving second and further lines of therapy and description of clinical benefit［J］. Clin Colorectal Cancer， 2017， 16（4）: 372-376.
2.YOSHINO T， ARNOLD D， TANIGUCHI H， et al. Pan-Asian adapted ESMO consensus guidelines for the management of patients with metastatic colorectal cancer: a JSMO-ESMO initiative endorsed by CSCO， KACO， MOS， SSO and TOS［J］. Ann Oncol， 2018， 29（1）: 44-70.
3.VOGEL A， HOFHEINZ R D， KUBICKA S， et al. Treatment decisions in metastatic colorectal cancer-beyond first and second line combination therapies［J］. Cancer Treat Rev， 2017， 59: 54-60.
4.LI J， QIN S， XU R H， et al. Effect of fruquintinib vs placebo on overall survival in patients with previously treated metastatic colorectal cancer: the FRESCO randomized clinical trial［J］. JAMA， 2018， 319（24）: 2486-2496.
5.LI J， QIN S， XU R， et al. Regorafenib plus best supportive care versus placebo plus best supportive care in Asian patients with previously treated metastatic colorectal cancer （CONCUR）: a randomised， double-blind， placebo-controlled， phase 3 trial［J］. Lancet Oncol， 2015， 16（6）: 619-629.
6.GROTHEY A， VAN CUTSEM E， SOBRERO A， et al. Regorafenib monotherapy for previously treated metastatic colorectal cancer （CORRECT）: an international， multicentre， randomised， placebo-controlled， phase 3 trial［J］. Lancet， 2013， 381（9863）: 303-312.
7.戴宇翃，孙黎，黄婷婷，等. 替吉奥联合阿帕替尼三线治疗晚期肠癌患者的临床观察［J］. 中国肿瘤临床， 2019， 46（18）: 945-948.
8.PROCTOR M J， MCMILLAN D C， MORRISON D S， et al. A derived neutrophil to lymphocyte ratio predicts survival in patients with cancer［J］. Br J Cancer， 2012， 107（4）: 695-699.
9.刘妮，方玉，季加孚，等. 预后营养指数对胃肠肿瘤择期手术患者营养状况的预测价值探讨. 肿瘤代谢与营养电子杂志［J］， 2019， 6（1）: 94-98.
10.OKADOME K， BABA Y， YAGI T， et al. Prognostic nutritional index， tumor-infiltrating lymphocytes， and prognosis in patients with esophageal cancer［J］. Ann Surg， 2018.
11.AZAB B， SHAH N， RADBEL J， et al. Pretreatment neutrophil/lymphocyte ratio is superior to platelet/lymphocyte ratio as a predictor of long-term mortality in breast cancer patients［J］. Med Oncol， 2013， 30（1）: 432.
12.GARCEA G， LADWA N， NEAL C P，et al. Preoperative neutrophil-to-lymphocyte ratio （NLR） is associated with reduced disease-free survival following curative resection of pancreatic adenocarcinoma［J］. World J Surg， 2011， 35（4）: 868-872.
13.ONODERA T， GOSEKI N， KOSAKI G. Prognostic nutritional index in gastrointestinal surgery of malnourished cancer patients［J］. Nihon Geka Gakkai zasshi， 1984， 85（9）: 1001-1005.
14.ALMASAUDI A S， MCSORLEY S T， DOLAN R D， et al. The relation between Malnutrition Universal Screening Tool （MUST）， computed tomography-derived body composition， systemic inflammation， and clinical outcomes in patients undergoing surgery for colorectal cancer［J］. Am J Clin Nutr， 2019.
15.HU W H， EISENSTEIN S， PARRY L， et al. Preoperative malnutrition with mild hypoalbuminemia associated with postoperative mortality and morbidity of colorectal cancer: a propensity score matching study［J］. Nutr J， 2019， 18（1）: 33.
16.HUBBARD T J， LAWSON-MCLEAN A， FEARON K C. Nutritional predictors of postoperative outcome in pancreatic cancer［J］. Br J Surg， 2011， 98（7）: 1032； author reply 1032-1033.
17.FENG J F， CHEN Q X. Significance of the prognostic nutritional index in patients with esophageal squamous cell carcinoma［J］. Ther Clin Risk Manag， 2014， 10: 1-7.
18.TOKUNAGA R， SAKAMOTO Y， NAKAGAWA S， et al. Prognostic nutritional index predicts severe complications， recurrence， and poor prognosis in patients with colorectal cancer undergoing primary tumor resection［J］. Dis Colon Rectum， 2015， 58（11）: 1048-1057.
19.CEZE N， THIBAULT G， GOUJON G， et al. Pre-treatment lymphopenia as a prognostic biomarker in colorectal cancer patients receiving chemotherapy［J］. Cancer Chemother Pharmacol， 2011， 68（5）: 1305-1313.
20.ONATE-OCANA L F， AIELLO-CROCIFOGLIO V， GALLARDO-RINCON D， et al. Serum albumin as a significant prognostic factor for patients with gastric carcinoma［J］. Ann Surg Oncol， 2007， 14（2）: 381-389.
21.BAI X， FENG L. Correlation between prognostic nutritional index， glasgow prognostic score， systemic inflammatory response， and TNM staging in colorectal cancer patients［J］. Nutr Cancer， 2019， 1-8.
22.HE W， YIN C， GUO G， et al. Initial neutrophil lymphocyte ratio is superior to platelet lymphocyte ratio as an adverse prognostic and predictive factor in metastatic colorectal cancer［J］. Med Oncol， 2013， 30（1）: 439.
23.OVERMAN M J， MARU D M， CHARNSANGAVEJ C， et al. Oxaliplatin-mediated increase in spleen size as a biomarker for the development of hepatic sinusoidal injury［J］. J Clin Oncol， 2010， 28（15）: 2549-2555.