国际肿瘤学杂志

国际肿瘤学杂志 ›› 2022, Vol. 49 ›› Issue (2): 89-94.doi: 10.3760/cma.j.cn371439-20210526-00014

• 论著 • 上一篇    下一篇

术前Naples预后评分对胸段食管鳞状细胞癌患者预后的影响

郭信伟1, 张晗2, 叶宏勋1, 刘阳晨1, 冀胜军3, 周绍兵1(), 周菊英4()   

  1. 1扬州大学附属泰兴人民医院肿瘤放疗科,泰兴 225400
    2南京师范大学泰州学院数学科学与应用学院,泰州 225300
    3南京医科大学附属苏州医院肿瘤放疗科,苏州 215002
    4苏州大学附属第一医院肿瘤放疗科,苏州 215006
  • 收稿日期:2021-05-26 修回日期:2021-12-25 出版日期:2022-02-08 发布日期:2022-03-11
  • 通讯作者: 周绍兵,周菊英 E-mail:zsb633@163.com;zhoujuyingsy@163.com
  • 基金资助:
    苏州市肿瘤临床医学中心项目(Szzx201506)

Influence of preoperative Naples prognostic score on prognosis of patients with thoracic esophageal squamous cell carcinoma

Guo Xinwei1, Zhang Han2, Ye Hongxun1, Liu Yangchen1, Ji Shengjun3, Zhou Shaobing1(), Zhou Juying4()   

  1. 1Department of Radiation Oncology, Affiliated Taixing People's Hospital of Yangzhou University, Taixing 225400, China
    2School of Mathematics, Nanjing Normal University Taizhou College, Taizhou 225300, China
    3Department of Radiation Oncology, Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou 215002, China
    4Department of Radiation Oncology, First Affiliated Hospital of Soochow University, Suzhou 215006, China
  • Received:2021-05-26 Revised:2021-12-25 Online:2022-02-08 Published:2022-03-11
  • Contact: Zhou Shaobing,Zhou Juying E-mail:zsb633@163.com;zhoujuyingsy@163.com
  • Supported by:
    Project of Suzhou Cancer Clinical Medical Center(Szzx201506)

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摘要：

目的 探索术前Naples预后评分(NPS)对胸段食管鳞状细胞癌(ESCC)患者生存预后的影响。方法 回顾性分析2014年12月至2020年12月在扬州大学附属泰兴人民医院胸外科接受食管癌根治术的134例患者,根据术前血清白蛋白、总胆固醇、中性粒细胞计数与淋巴细胞计数的比值(NLR)以及淋巴细胞计数与单核细胞计数的比值(LMR)的中位值计算NPS,并将患者分为NPS 0分组(20例)、NPS 1或2分组(62例)和NPS 3或4分组(52例),采用Kaplan-Meier法计算生存率并行log-rank检验,应用Cox模型单因素及多因素分析NPS与患者预后的关系。结果 NPS 0分组患者的1、3和5年无进展生存率分别为95.0%、70.0%和60.0%,NPS 1或2分组患者的1、3和5年无进展生存率分别为66.1%、24.2%和24.2%,NPS 3或4分组患者的1、3和5年无进展生存率分别为48.1%、3.8%和1.9%,差异有统计学意义(χ2=31.27,P<0.001);NPS 0分组患者的1、3、5年总生存率分别为100.0%、80.0%和70.0%,NPS 1或2分组患者的1、3、5年总生存率分别为96.8%、36.7%和32.3%,NPS 3或4分组患者的1、3、5年总生存率分别为90.4%、32.7%和5.8%,差异有统计学意义(χ2=29.70,P<0.001)。单因素分析显示,性别、T分期、N分期、TNM分期和NPS均与胸段ESCC患者的无进展生存期和总生存期密切相关(均P<0.05)。Cox多因素分析结果显示,T分期(HR=1.46,95%CI为1.07~2.00,P=0.019)、N分期(HR=1.34,95%CI为1.02~1.76,P=0.037)和NPS(将NPS 0分组设为哑变量,NPS 1或2分组:HR=3.35,95%CI为1.58~7.11,P=0.002;NPS 3或4分组:HR=6.15,95%CI为2.89~13.11,P=0.001)是影响无进展生存期的独立因素。另外,T分期(HR=1.67,95%CI为1.01~2.77,P=0.046),N分期(HR=1.44,95%CI为1.00~2.20,P=0.048)和NPS(将NPS 0分组设为哑变量,NPS 1或2分组:HR=3.10,95%CI为1.31~7.32,P=0.010;NPS 3或4分组:HR=5.09,95%CI为2.14~12.11,P=0.001)也是影响总生存期的独立因素。结论 术前NPS在预测胸段ESCC患者生存预后方面具有重要价值。

关键词: 食管肿瘤, Naples预后评分, 预后

Abstract:

Objective To explore the impact of preoperative Naples prognostic score (NPS) on the survival prognosis of patients with thoracic esophageal squamous cell carcinoma (ESCC). Methods From December 2014 to December 2020, a total of 134 patients who underwent radical esophagectomy in Department of Thoracic Surgery, Affiliated Taixing People's Hospital of Yangzhou University were retrospectively analyzed. The NPS was calculated by the median values of preoperative serum albumin, total cholesterol, neutrophil to lymphocyte ratio (NLR) and lymphocyte to monocyte ratio (LMR), and then the enrolled patients were divided into NPS 0 group (20 cases), NPS 1 or 2 group (62 cases) and NPS 3 or 4 group (52 cases). Kaplan-Meier method was used to calculate survival rate and survival comparison was performed by log-rank test. The univa-riate and multivariate Cox models were used to analyze the relationship between NPS and survival prognosis. Results The 1-, 3- and 5-year progression free survival (PFS) rates were 95.0%, 70.0% and 60.0% in the NPS 0 group, 66.1%, 24.2% and 24.2% in the NPS 1 or 2 group, and 48.1%, 3.8% and 1.9% in the NPS 3 or 4 group respectively, with a statistically significant difference (χ2=31.27, P<0.001). In the NPS 0 group, the 1-, 3- and 5-year overall survival (OS) rates were 100.0%, 80.0% and 70.0% respectively. In the NPS 1 or 2 group, the 1-, 3- and 5-year OS rates were 96.8%, 36.7% and 32.3% respectively, while in the NPS 3 or 4 group, the 1-, 3- and 5-year OS rates were 90.4%, 32.7% and 5.8% respectively, and there was a statistically significant difference (χ 2=29.70, P<0.001). Univariate analysis found that sex, T stage, N stage, TNM stage and NPS were closely related to PFS and OS of patients with thoracic ESCC (all P<0.05). Furthermore, multivariate Cox regression analysis showed that T stage (HR=1.46, 95%CI: 1.07-2.00, P=0.019), N stage (HR=1.34, 95%CI: 1.02-1.76, P=0.037) and NPS (set NPS 0 group as the subvariable, NPS 1 or 2 group: HR=3.35, 95%CI: 1.58-7.11, P=0.002; NPS 3 or 4 group: HR=6.15, 95%CI: 2.89-13.11, P=0.001) were independent prognostic factors for PFS. Additionally, T stage (HR=1.67, 95%CI: 1.01-2.77, P=0.046), N stage (HR=1.44, 95%CI: 1.00-2.20, P=0.048) and NPS (set NPS 0 group as the subvariable, NPS 1 or 2 group: HR=3.10, 95%CI: 1.31-7.32, P=0.010; NPS 3 or 4 group: HR=5.09, 95%CI: 2.14-12.11, P=0.001) were independent prognostic factors for OS. Conclusion Preoperative NPS plays an important role in predicting the survival prognosis of patients with thoracic ESCC.

Key words: Esophageal neoplasms, Naples prognostic score, Prognosis