术前预后营养指数对肺鳞状细胞癌患者术后复发及死亡的预测价值分析

摘要 目的：探讨术前预后营养指数（PNI）与肺鳞状细胞癌患者预后的关系及对术后复发、死亡的预测效能。方法：纳入2017年1月-2019年1月在我院接受治疗的78例肺鳞状细胞癌患者，所有患者均具有完整的临床资料及病理信息，对其进行门诊复查随访3年，除去失访病例共纳入76例患者资料，期间共有43例患者复发、37例患者死亡；按照复发及死亡情况将该76例患者分别分为复发组（n=43）及未复发组（n=33），死亡组（n=37）及存活组（n=39），分别使用单因素和多因素Logistic回归分析影响肺鳞状细胞癌患者复发及死亡的独立危险因素；采用受试者工作特征（ROC）曲线分别分析PNI在肺鳞状细胞癌患者术后复发及死亡的预测效能及最佳截断值。结果：单因素分析显示，TNM分期、吸烟年限、糖尿病、家族史、PNI是影响肺鳞状细胞癌患者术后复发的相关因素（P＜0.05）；性别、年龄、TNM分期、BMI、吸烟史、吸烟年限及PNI是影响肺鳞状细胞癌患者术后死亡的相关因素（P＜0.05）。多因素Logistic回归模型分析显示，TNM分期为Ⅲ期、吸烟年限较长、家族史是引发肺鳞状细胞癌患者术后复发的独立危险因素，PNI为保护因素（P＜0.05）；另外男性、年龄较大、TNM分期为Ⅲ期、吸烟年限较长是引发肺鳞状细胞癌患者术后死亡的独立危险因素，PNI为保护因素（P＜0.05）；ROC分析显示PNI在预测肺鳞状细胞癌患者术后复发的曲线下面积为0.726，敏感度为0.814，特异度为0.667，最佳截断值为48；PNI在预测肺鳞状细胞癌患者术后存活的曲线下面积为0.787，敏感度为0.838，特异度为0.718，最佳截断值为50。结论：PNI对肺鳞状细胞癌患者术后复发及生存均具有较高的预测效能，提高PNI水平对改善肺鳞状细胞癌患者的预后具有积极作用。

Predictive Value Analysis of Preoperative Prognostic Nutrition Index for Postoperative Recurrence and Death of Patients with Lung Squamous Cell Carcinoma

ABSTRACT Objective: To investigate the relationship between preoperative prognostic nutrition index (PNI) and prognosis of patients with lung squamous cell carcinoma and its predictive effect on postoperative recurrence and death. Methods: A total of 78 patients with lung squamous cell carcinoma who received treatment in our hospital from January 2017 to January 2019 were included. All patients had complete clinical data and pathological information, and they were reviewed and followed up in the outpatient department for 3 years. In addition to the lost cases, 76 patients were included, during the period, 43 patients recurred and 37 patients died. The 76 patients were divided into recurrence group (n=43) and non-recurrence group (n=33), death group (n=37) and survival group (n=39) according to the recurrence and death conditions. The independent risk factors affecting the recurrence and death of patients with lung squamous cell carcinoma were analyzed by univariate and multivariate Logistic regression. The receiver operating characteristic (ROC) curve was used to analyze the predictive efficacy and optimal cutoff value of PNI in the postoperative recurrence and death of patients with lung squamous cell carcinoma. Results: Univariate analysis showed that TNM stage, smoking years, diabetes, family history, PNI were the related factors affecting the postoperative recurrence of patients with lung squamous cell carcinoma (P<0.05). Gender, age, TNM stage, BMI, smoking history, smoking years and PNI were the related factors affecting the postoperative death of patients with lung squamous cell carcinoma (P<0.05). Multivariate Logistic regression model analysis showed that TNM stage III, long smoking years and family history were independent risk factors for postoperative recurrence of patients with lung squamous cell carcinoma, and PNI was protective factor (P<0.05). In addition, male, older age, TNM stage III, and longer smoking years were independent risk factors for postoperative death of patients with lung squamous cell carcinoma, and PNI was the protective factor (P<0.05). ROC results showed that the area under curve of PNI in predicting postoperative recurrence of patients with lung squamous cell carcinoma was 0.746 the sensitivity was 83.72%, the specificity was 63.64%, and the best cutoff value was less than or equal to 49.90. The area under curve of PNI in predicting postoperative survival of patients with lung squamous cell carcinoma was 0.761, the sensitivity was 86.49%, the specificity was 66.67%, and the best cutoff value was less than or equal to 50.41. Conclusion: PNI has high predictive efficacy for postoperative recurrence and survival of patients with lung squamous cell carcinoma, increasing PNI level has a positive effect on improving the prognosis of patients with lung squamous cell carcinoma.