摘要
目的 分析胆固醇校正的预后营养指数(cPNI)对交界可切除胰腺癌患者术后远期预后的影响.方法 回顾分析首都医科大学附属北京朝阳医院肝胆胰脾外科2011年1月至2023年9月收治的行手术治疗的交界可切除胰腺癌患者资料.共入组173例患者,其中男性90例,女性83例,年龄(61.7±9.8)岁.绘制术前cPNI预测患者术后1年生存的受试者工作特征曲线,以最佳界值 77.36 分为低 cPNI 组(n=83,cPNI≤77.36)和高 cPNI 组(n=90,cPNI＞77.36).Kaplan-Meier法分析生存情况,log-rank检验比较生存率进行单因素分析,Cox比例风险模型进行多因素分析,分析cPNI对交界可切除胰腺癌术后远期生存的影响.结果 低cPNI组术后1、2、3年累积生存率分别为70.6％、40.3％、21.8％,优于高 cPNI 组的 48.3％、21.5％、9.5％,差异有统计学意义(x2=8.49,P=0.004).单因素分析,术前cPNI、门静脉侵犯长度、肿瘤分化程度、肿瘤TNM分期、肿瘤长径、淋巴结转移、术后化疗与交界可切除胰腺癌患者术后远期生存相关(均P＜0.05).Cox比例风险模型进行多因素分析,结果显示,术前cPNI＞77.36(HR=1.452,95％CI:1.026～2.053,P=0.035)的交界可切除胰腺癌患者术后死亡风险增加.同时,门静脉侵犯长度＞3.0 cm、肿瘤低分化、淋巴结转移和无术后化疗的患者术后死亡风险增加.结论 术前cPNI＞77.36是交界可切除胰腺癌患者术后远期生存的危险因素.
Abstract
Objective To investigate the effect of cholesterol-modified prognostic nutritional index(cPNI)on postoperative long-term prognosis of the borderline resectable pancreatic cancer(BRPC).Methods Clinical data of 173 patients with BRPC admitted to the Department of Hepatobiliary and Pancre-aticosplenic Surgery,Beijing Chaoyang Hospital,Capital Medical University from January 2011 to September 2023 were retrospectively analyzed,including 90 males and 83 females,aged(61.7±9.8)years.The re-ceiver operating curve(ROC)of preoperative cPNI predicting 1-year postoperative survival was drawn and the optimal cut-off value in predicting 1-year survival was 77.36.Patients were divided into low cPNI(n=83,cPNI ≤77.36)and high cPNI group(n=90,cPNI＞77.36).Kaplan-Meier method was used for sur-vival analysis,log-rank test was used for univariate analysis,and Cox proportion hazard model was used for multivariate analysis to reveal the effect of cPNI on postoperative long-term survival in patients with BRPC.Results The cumulative survival rates at 1,2 and 3 years after surgery in low cPNI group and high cPNI group were 70.6％,40.3％,21.8％,and 48.3％,21.5％,9.5％,respectively(x2=8.49,P=0.004).Univariate analysis showed that preoperative cPNI,length of portal vein invasion,tumor differentia-tion degree,tumor TNM stage,tumor diameter,lymph node metastasis,and postoperative chemotherapy were correlated with long-term survival of BRPC patients(all P＜0.05).Multivariate analysis showed that BRPC patients with preoperative cPNI＞77.36(HR=1.452,95％CI:1.026-2.053,P=0.035)had a increased risk of postoperative death,while patients with length of portal venous invasion＞3.0 cm,poorer tumor differentiation,lymph node metastasis and no postoperative chemotherapy had an increased risk of postoperative death.Conclusion Preoperative cPNI＞77.36 is a risk factor for long-term survival in BRPC patients.
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