术前预后营养指数、全身免疫炎症指数联合血清TFF3对宫颈癌术后复发转移的预测价值

摘要 目的：探讨术前预后营养指数（PNI）、全身免疫炎症指数（SII）联合血清三叶因子3（TFF3）对宫颈癌术后复发转移的预测价值。方法：选取2018年1月～2020年1月在江苏省人民医院行手术治疗的宫颈癌患者176例，随访3年根据是否出现复发转移将宫颈癌患者分为复发转移组（38例）和无复发转移组（138例）。计算术前PNI、SII和检测术前血清TFF3水平。宫颈癌术后复发转移的影响因素采用多因素Logistic回归模型分析，绘制受试者工作特征（ROC）曲线分析PNI、SII、TFF3单独及PNI、SII联合血清TFF3预测宫颈癌术后复发转移的价值。结果：随访3年，176例宫颈癌患者复发转移率为21.59%（38/176）。与无复发转移组比较，复发转移组PNI降低，SII和血清TFF3水平升高（P＜0.05）。多因素Logistic回归分析显示，低分化、国际妇产科联盟（FIGO）分期Ⅱ期、盆腔淋巴结转移、切缘阳性、鳞状细胞癌抗原升高、SII升高、TFF3升高为影响宫颈癌术后复发转移的独立危险因素，PNI升高为独立保护因素（P＜0.05）。ROC曲线分析显示，PNI、SII联合血清TFF3预测宫颈癌术后复发转移的曲线下面积为0.906，大于PNI、SII、TFF3、PNI+SII、PNI+TFF3、SII+TFF3预测的0.795、0.785、0.772、0.860、0.874、0.860。结论：术前PNI降低和SII、血清TFF3水平降低与宫颈癌术后复发转移密切相关，术前PNI、SII联合血清TFF3对宫颈癌术后复发转移的预测价值较高。

Predictive Value of Preoperative Prognostic Nutritional Index, Systemic Immune Inflammatory Index Combined with Serum TFF3 for Postoperative Recurrence and Metastasis of Cervical Cancer

ABSTRACT Objective: To investigate the predictive value of preoperative prognostic nutritional index (PNI), systemic immune inflammatory index (SII) combined with serum trefoil factor 3 (TFF3) for postoperative recurrence and metastasis of cervical cancer. Methods: 176 cervical cancer patients who underwent surgical treatment of Jiangsu Province Hospital from January 2018 to January 2020 were selected, cervical cancer patients were divided into recurrence and metastasis group (38 cases) and non-recurrence and metastasis group (138 cases) according to whether there was recurrence and metastasis after 3 years of follow-up. Preoperative PNI, SII and preoperative serum TFF3 levels were calculated. Factors affecting postoperative recurrence and metastasis of cervical cancer were analyzed by multivariate Logistic regression model, the value of PNI, SII, TFF3 alone and PNI, SII combined with serum TFF3 in predicting postoperative recurrence and metastasis of cervical cancer were analyzed by drawn receiver operating characteristic (ROC) curve. Results: After 3 years of follow-up, the recurrence and metastasis rate of 176 cervical cancer patients was 21.59% (38/176). Compared with non-recurrence and metastasis group, the PNI was decreased, and the levels of SII and serum TFF3 were increased in recurrence and metastasis group(P<0.05). Multivariate Logistic regression analysis showed that, poor differentiation, International Federation of Gynecology and Obstetrics(FIGO) stage II, pelvic lymph node metastasis, positive margin, elevated squamous cell carcinoma antigen, elevated SII and elevated TFF3 were independent risk factors for postoperative recurrence and metastasis of cervical cancer, and elevated PNI was an independent protective factor (P<0.05). ROC curve analysis showed that, the area under the curve of PNI, SII combined with serum TFF3 in predicting postoperative recurrence and metastasis of cervical cancer was 0.906, which was greater than 0.795, 0.785, 0.772, 0.860, 0.874 and 0.860 predicted by PNI, SII, TFF3, PNI+SII, PNI+TFF3 and SII+TFF3. Conclusion: The decrease of preoperative PNI and the decrease of SII and serum TFF3 levels are closely relate to postoperative recurrence and metastasis of cervical cancer, preoperative PNI, SII combine with serum TFF3 has a high predictive value for postoperative recurrence and metastasis of cervical cancer.