国际肿瘤学杂志

国际肿瘤学杂志 ›› 2018, Vol. 45 ›› Issue (6): 341-346.doi: 10.3760/cma.j.issn.1673-422X.2018.06.005

• 论著 • 上一篇    下一篇

预后营养指数与晚期肺腺癌脑转移患者生存期的相关性

薛瑞琪，李红卫，张霞琴，宋欣，彭华，周炜，张长城   

  1. 030001 太原，山西医科大学附属肿瘤医院放射治疗中心
  • 收稿日期:2018-01-15 出版日期:2018-06-08 发布日期:2018-07-31
  • 通讯作者: 李红卫 E-mail:3420010@163.com
  • 基金资助:

    山西省自然科学基金（201701D121169）

Association of the prognostic nutrition index with overall survival time of the patients with brain metastases of lung adenocarcinoma

Xue Ruiqi, Li Hongwei, Zhang Xiaqin, Song Xin, Peng Hua, Zhou Wei, Zhang Changcheng   

  1. Department of Radiotherapy, Affiliated Tumor Hospital of Shanxi Medical University, Taiyuan 030001, China
  • Received:2018-01-15 Online:2018-06-08 Published:2018-07-31
  • Contact: Li Hongwei E-mail:3420010@163.com
  • Supported by:

    Natural Science Foundation of Shanxi Province of China (201701D121169)

PDF

855

摘要： 目的 初步探讨预后营养指数（PNI）对晚期肺腺癌脑转移患者生存时间的影响。方法 回顾性分析我院2013年5月至2016年5月收治的肺腺癌脑转移患者274例。分析其PNI以及性别、年龄、吸烟史、表皮生长因子受体（EGFR）基因状态、脑转移时Karnofsky功能状态（KPS）评分、脑转移灶个数、脑转移治疗方式、有无脑外远处转移、原发病灶控制情况与总生存时间的关系。通过受试者工作特征（ROC）曲线确定PNI的最佳截断值，将患者分为高PNI组和低PNI组，采用Log-rank检验进行单因素分析，通过Cox比例风险模型进行多因素分析。结果 患者分为高PNI（＞50.45）组（n=72）和低PNI（≤50.45）组（n=202）。全组患者出现脑转移后的中位总生存时间（OS）为11.20个月，低PNI组与高PNI组患者的中位OS分别为10.13个月和15.17个月。单因素分析结果显示，患者性别（χ2=5.459，P=0.019）、年龄（χ2=3.986，P=0.046）、吸烟与否（χ2=6.878，P=0.009）、EGFR状态（χ2=20.484，P＜0.001）、KPS评分（χ2=126.573，P＜0.001）、有无脑外远处转移（χ2=4.403，P=0.036）、脑转移治疗方式（χ2=40.444，P＜0.001）、PNI（χ2=7.972，P=0.005）与预后相关。Cox多因素分析结果显示，患者年龄（HR=1.580，95%CI为1.104～2.295，P=0.012）、EGFR状态（HR=0.549，95%CI为0.408～0.738，P＜0.001）、KPS评分（HR=0.077，95%CI为0.045～0.134，P＜0.001）、脑转移治疗方式（HR=0.882，95%CI为0.789～0.987，P=0.029）、PNI（HR=0.614，95%CI为0.437～0.861，P=0.005）与预后相关。结论 PNI是影响肺腺癌脑转移患者OS的独立因素，高PNI值预示着更长的OS，有一定的临床实用价值。

关键词: 癌, 非小细胞肺, 肿瘤转移, 脑, 营养评价, 预后

Abstract: Objective To explore the effect of prognostic nutrition index (PNI) on the overall survival time of patients with brain metastases of lung adenocarcinoma. Methods A retrospective analysis was performed on the clinic data of 274 patients who were admitted to our hospital and confirmed with brain metastases of lung adenocarcinoma from May 2013 to May 2016. The prognosic factors for brain metastases such as PNI, gender, age, smoking history, epidermal growth factor receptor (EGFR) mutation status, Karnofsky performance status (KPS) score, the number of brain lesions, treatment of brain lesions, extracranial metastases and the status of primary disease were analyzed. The receiver operating characteristic (ROC) curve was drawn to determine the optimal cutoff value of PNI, and the patients were divided into high PNI group and low PNI group. The univariate and multivariate prognostic analyses were performed by the Logrank test and the Cox proportional hazards model. Results The patients were divided into high PNI (＞50.45) group (n=72) and low PNI (≤50.45) group (n=202). The median overall survival (OS) was 11.20 months in all patients with brain metastases, and the median OS of the low PNI group  and high PNI group  were 10.13 months and 15.17 months respectively. The univariate analysis results showed that gender (χ2=5.459, P=0.019), age (χ2=3.986, P=0.046), smoking or not (χ2=6.878, P=0.009), EGFR mutation status (χ2=20.484, P＜0.001), KPS score (χ2=126.573, P＜0.001), extracranial metastases or not (χ2=4.403, P=0.036), treatment on the brain lesions (χ2=40.444, P＜0.001) and PNI (χ2=7.972,P=0.005) were related to the prognosis. The Cox multivariate analysis results showed that age (HR=1.580, 95%CI: 1.1042.295, P=0.012), EGFR mutation status (HR=0.549, 95%CI: 0.4080.738, P＜0.001), KPS score (HR=0.077, 95%CI: 0.0450.134, P＜0.001), treatment on brain metastases (HR=0.882, 95%CI: 0.7890.987, P=0.029) and PNI (HR=0.614, 95%CI: 0.4370.861, P=0.005) were related to the prognosis. Conclusion PNI is an independent prognostic predictor of brain metastases in patients with lung adenocarcinoma, and the highPNI is correlated to the long OS of patients with brain metastases of lung adenocarcinoma, which has certain clinical practical value.

Key words: Carcinoma, non-small-cell lung, Neoplasm metastasis, brain, Nutrition assessment, Prognosis