BACKGROUND Patients with end-stage liver disease usually have varying degrees of malnutrition,and severe malnutrition may affect the prognosis of patients after liver transplantation(LT).However,there is no recommende...BACKGROUND Patients with end-stage liver disease usually have varying degrees of malnutrition,and severe malnutrition may affect the prognosis of patients after liver transplantation(LT).However,there is no recommended standard for the nutrition assessment of patients waiting for LT,and it is unknown whether malnutrition has an impact on the occurrence of postoperative complications.AIM The study aim was to investigate the value of the controlling nutritional status(CONUT)score and psoas muscle thickness per height(PMTH)in predicting prognosis in LT.METHODS We retrospectively analyzed the clinical data of 313 patients who underwent classic orthotopic LT from January 2016 to December 2018 in Tianjin First Central Hospital affiliated with Tianjin Medical University.The CONUT score is derived from the preoperative serum albumin and total cholesterol levels,and total lymphocyte count.Patients were divided into low(≤4),medium(5–8),and high(9–12)CONUT score groups perioperative characteristics,Clavien-Dindo grade III/IV/V postoperative complications,graft loss and infection,and cumulative postoperative survival in the three groups were compared 3 mo after LT.PMTH was calculated as the ratio of the transverse thickness of the psoas muscle in the umbilical plane to the height of the patient.The cutoff values of receiver operating characteristic curves were determined separately for men and women.The values were 14.1 cm/m2 for women and 17.9 cm/m2 for men.The patients were then divided into low and high PMTH groups by the cutoff values.The comparison of data between the two groups was the same as above.RESULTS Patients with medium and high CONUT scores had lower preoperative serum hemoglobin,more intraoperative red blood cell(RBC)transfusions,longer postoperative intensive care unit stay and hospital stays,higher 7 and 14 preoperative-day serum bilirubin levels,and a higher incidence of postoperative grade III/IV complications and infections than patients with low CONUT scores.Differences in the 3-mo cumulative survival among the three groups were not significant.Patients with a low PMTH had higher preoperative serum urea nitrogen,more intraoperative packed RBC and frozen plasma transfusions,longer times to postoperative ventilator extubation,higher incidence of total postoperative complications,and a lower 3-mo cumulative survival than those with a high PMTH.CONCLUSION A CONUT score≥5 and a low PMTH were both associated with poor prognosis in LT.The CONUT score had no predictive value for short-term patient survival after LT,but the PMTH was predictive of short-term patient survival after LT.展开更多
BACKGROUND The controlling nutritional status(CONUT)score effectively reflects a patient’s nutritional status,which is closely related to cancer prognosis.This study invest-igated the relationship between the CONUT s...BACKGROUND The controlling nutritional status(CONUT)score effectively reflects a patient’s nutritional status,which is closely related to cancer prognosis.This study invest-igated the relationship between the CONUT score and prognosis after radical surgery for colorectal cancer,and compared the predictive ability of the CONUT score with other indexes.AIM To analyze the predictive performance of the CONUT score for the survival rate of colorectal cancer patients who underwent potentially curative resection.METHODS This retrospective analysis included 217 patients with newly diagnosed colorectal.The CONUT score was calculated based on the serum albumin level,total lymphocyte count,and total cholesterol level.The cutoff value of the CONUT score for predicting prognosis was 4 according to the Youden Index by the receiver operating characteristic curve.The associations between the CONUT score and the prognosis were performed using Kaplan-Meier curves and Cox regression analysis.RESULTS Using the cutoff value of the CONUT score,patients were stratified into CONUT low(n=189)and CONUT high groups(n=28).The CONUT high group had worse overall survival(OS)(P=0.013)and relapse-free survival(RFS)(P=0.015).The predictive performance of CONUT was superior to the modified Glasgow prognostic score,the prognostic nutritional index,and the neutrophil-to-lymphocyte ratio.Meanwhile,the predictive performances of CONUT+tumor node metastasis(TNM)stage for 3-year OS[area under the receiver operating characteristics curve(AUC)=0.803]and 3-year RFS(AUC=0.752)were no less than skeletal muscle mass index(SMI)+TNM stage.The CONUT score was negatively correlated with SMI(P<0.01).CONCLUSION As a nutritional indicator,the CONUT score could predict long-term outcomes after radical surgery for colorectal cancer,and its predictive ability was superior to other indexes.The correlation between the CONUT score and skeletal muscle may be one of the factors that play a predictive role.展开更多
Objective:Several studies have reported that the controlling nutritional status(CONUT)score is a prognostic predictor for survival among patients with different types of cancer.We assessed the prognostic value of chan...Objective:Several studies have reported that the controlling nutritional status(CONUT)score is a prognostic predictor for survival among patients with different types of cancer.We assessed the prognostic value of changes in the CONUT score during treatment and theΔCONUT-EBV DNA score in patients with advanced nasopharyngeal carcinoma(NPC).Methods:We retrospectively analyzed 433 patients with advanced NPC having no evidence of metastasis from January 2007 to June 2011;the patients underwent radical concurrent chemoradiotherapy(CCRT)at Sun Yat-sen University Cancer Center and were grouped based on theirΔCONUT andΔCONUT-EBV DNA scores.Kaplan-Meier curves were used to compare the patient outcomes according to the cut-offΔCONUT score and theΔCONUT-EBV DNA scoring system.Results:Among all patients,overall survival(OS)was independently predicted by a highΔCONUT score(P=0.031)and high EBV DNA(P<0.001).TheΔCONUT-EBV DNA score[OS area under the curve(AUC)=0.621;progression free survival(PFS)-AUC=0.612;distant metastasis-free survival(DMFS)-AUC=0.622]was more predictive of OS,PFS,and DMFS in patients with advanced NPC than theΔCONUT score(OS-AUC=0.547;PFS-AUC=0.533;DMFS-AUC=0.522)and pretreatment plasma EBV DNA levels alone(OS-AUC=0.600;PFS-AUC=0.591,DMFS-AUC=0.610).TheΔCONUT-EBV DNA score was significantly correlated with OS,PFS,and DMFS in patients with advanced NPC treated with CCRT.Conclusions:TheΔCONUT-EBV DNA score may be useful in clinical practice as a convenient biomarker for predicting the outcomes in patients with advanced NPC treated with CCRT.展开更多
Objective To investigate the prognostic value of serum carcinoembryonic antigen(CEA)and controlling nutritional status(CONUT)score in patients with colorectal cancer.Methods We retrospectively studied 261 patients wit...Objective To investigate the prognostic value of serum carcinoembryonic antigen(CEA)and controlling nutritional status(CONUT)score in patients with colorectal cancer.Methods We retrospectively studied 261 patients with colorectal cancer in our hospital.The patients were divided into two groups by CONUT=3 and CEA=5 ng/mL,and the effects of CONUT score and CEA level on the prognosis and clinicopathological parameters were statistically analyzed.Results(1)Different CONUT scores were significantly correlated with age,tumor diameter,differentiation type,and T stage(P<0.05).The older the patient was,the larger the tumor diameter,undifferentiated tumor,and T stage were,the higher the CONUT score was.(2)Seventy-five patients died during the follow-up period,and 45 patients died of progression or recurrence of colorectal cancer.The 5-year overall survival(OS)rate of the low CONUT score group was significantly higher than that of the high CONUT score group,and the 5-year OS rate of the low CEA group was significantly higher than that of the high CEA group;the difference was statistically significant(P<0.01).(3)According to the serum CEA level and CONUT score,the 5-year survival rates of CEAlow/CONUTlow,CEAlow/CONUThigh,CEAhigh/CONUTlow,and CEAhigh/CONUThigh were 84.7%,69%,55.3%,and 36.1%respectively,with statistical significance(P<0.01).(4)The Cox multivariate analysis showed that age,CONUT score,CEA combined with CONUT score,lymph node metastasis,and distant metastasis were independent risk factors for the prognosis of colorectal cancer patients.Conclusion:The combination of CEA detection and CONUT score can more accurately judge the prognosis of colorectal cancer patients.展开更多
BACKGROUND Remnant gastric cancer(GC)is defined as GC that occurs five years or more after gastrectomy.Systematically evaluating the preoperative immune and nutritional status of patients and analyzing its prognostic ...BACKGROUND Remnant gastric cancer(GC)is defined as GC that occurs five years or more after gastrectomy.Systematically evaluating the preoperative immune and nutritional status of patients and analyzing its prognostic impact on postoperative remnant gastric cancer(RGC)patients are crucial.A simple scoring system that combines multiple immune or nutritional indicators to identify nutritional or immune status before surgery is necessary.AIM To evaluate the value of preoperative immune-nutritional scoring systems in predicting the prognosis of patients with RGC.METHODS The clinical data of 54 patients with RGC were collected and analyzed retrospectively.Prognostic nutritional index(PNI),controlled nutritional status(CONUT),and Naples prognostic score(NPS)were calculated by preoperative blood indicators,including absolute lymphocyte count,lymphocyte to monocyte ratio,neutrophil to lymphocyte ratio,serum albumin,and serum total cholesterol.Patients with RGC were divided into groups according to the immune-nutritional risk.The relationship between the three preoperative immune-nutritional scores and clinical characteristics was analyzed.Cox regression and Kaplan–Meier analysis was performed to analyze the difference in overall survival(OS)rate between various immune-nutritional score groups.RESULTS The median age of this cohort was 70.5 years(ranging from 39 to 87 years).No significant correlation was found between most pathological features and immune-nutritional status(P>0.05).Patients with a PNI score<45,CONUT score or NPS score≥3 were considered to be at high immune-nutritional risk.The areas under the receiver operating characteristic curves of PNI,CONUT,and NPS systems for predicting postoperative survival were 0.611[95%confidence interval(CI):0.460–0.763;P=0.161],0.635(95%CI:0.485–0.784;P=0.090),and 0.707(95%CI:0.566–0.848;P=0.009),respectively.Cox regression analysis showed that the three immunenutritional scoring systems were significantly correlated with OS(PNI:P=0.002;CONUT:P=0.039;NPS:P<0.001).Survival analysis revealed a significant difference in OS between different immune-nutritional groups(PNI:75 mo vs 42 mo,P=0.001;CONUT:69 mo vs 48 mo,P=0.033;NPS:77 mo vs 40 mo,P<0.001).CONCLUSION These preoperative immune-nutritional scores are reliable multidimensional prognostic scoring systems for predicting the prognosis of patients with RGC,in which the NPS system has relatively effective predictive performance.展开更多
目的:探讨营养状态指标包括控制营养状态(controlling nutritional status,CONUT)评分和预后营养指数(prognostic nutritional index,PNI)在预测弥漫大B细胞淋巴瘤(diffuse large B cell lymphoma,DLBCL)预后中的作用。方法:回顾性收集...目的:探讨营养状态指标包括控制营养状态(controlling nutritional status,CONUT)评分和预后营养指数(prognostic nutritional index,PNI)在预测弥漫大B细胞淋巴瘤(diffuse large B cell lymphoma,DLBCL)预后中的作用。方法:回顾性收集105例在南京医科大学附属淮安第一医院血液科就诊的DLBCL患者的临床资料,计算出每个患者的CONUT评分和PNI,并通过ROC曲线确定截断值。CONUT评分和PNI分别以6.5和47.28作为截断值,将患者根据截断值进行分组。依次进行Kaplan-Meier生存分析、单因素和多因素COX回归分析以及Spearman相关分析。结果:生存曲线显示CONUT评分和PNI对患者的总生存期(overall survival,OS)具有预测作用(P<0.05)。单因素分析显示CONUT评分、PNI、国际预后指数(international prognostic index,IPI)危险度分型、白蛋白、胆固醇均是患者OS的预后因素。多因素分析结果表明CONUT评分对DLBCL患者的OS具有独立预测作用(HR=2.742,95%CI:1.030~7.300,P<0.05),PNI不是患者OS的独立预测因素(HR=0.526,95%CI:0.135~2.047,P=0.35)。相关性分析结果显示两种营养状态指标呈高度负相关(r=-0.79,P<0.01)。结论:CONUT评分是DLBCL患者预后的独立预测因素,患者CONUT评分越高,预后越差。展开更多
目的:探讨第三腰椎骨骼肌质量指数(L3-skeletal muscle mass index,L3-SMI)和控制营养状况(controlling nutritional status,CONUT)评分对胃癌患者术后预后的预测价值。方法:收集2017年01月至2020年12月于我院行胃癌手术的528例患者的...目的:探讨第三腰椎骨骼肌质量指数(L3-skeletal muscle mass index,L3-SMI)和控制营养状况(controlling nutritional status,CONUT)评分对胃癌患者术后预后的预测价值。方法:收集2017年01月至2020年12月于我院行胃癌手术的528例患者的临床及生存资料,采用受试者工作特征(receiver operating characteristic,ROC)曲线确定不同性别患者术前L3-SMI的最佳截断值,比较不同L3-SMI、CONUT评分水平患者的临床病理特征。使用Kaplan-Meier法进行生存分析,采用Cox比例风险模型进行单因素和多因素回归分析胃癌患者术后预后的影响因素。应用R软件构建胃癌患者术后总生存时间(overall survival,OS)列线图预测模型,计算C指数评估模型的准确性,绘制校准图评价模型的预测效能。结果:术前L3-SMI预测胃癌患者预后的最佳截断值:男性为43.95 cm^(2)/m^(2)、女性为37.6 cm^(2)/m^(2),曲线下面积(area under the curve,AUC)值分别为0.729(95%CI为0.672~0.785)和0.680(95%CI为0.607~0.753)。术前低L3-SMI水平胃癌患者1、3、5年累积总生存率分别为97.1%、69.4%、33.6%,高L3-SMI水平患者1、3、5年累积总生存率分别为98.4%、78.4%、52.3%,差异有统计学意义(χ^(2)=31.718,P<0.001)。术前低CONUT评分水平胃癌患者1、3、5年累积总生存率分别为98.8%、80.2%、56.4%,高CONUT评分水平患者1、3、5年累积总生存率分别为96.7%、67.6%、29.0%,差异有统计学意义(χ^(2)=48.240,P<0.001)。单因素及多因素Cox回归分析结果显示:L3-SMI水平(高:HR=0.581,95%CI为0.459~0.735)及CONUT评分水平(高:HR=1.999,95%CI为1.574~2.539)是胃癌患者术后OS的独立影响因素(P<0.001)。根据多因素Cox回归分析构建胃癌患者术后OS的列线图预测模型,其C指数为0.671(95%CI为0.639~0.703),校准曲线显示预测曲线和真实曲线拟合度较好。结论:术前L3-SMI、CONUT评分是胃癌患者术后预后的独立影响因素,早期检测L3-SMI、CONUT评分有助于预测胃癌患者术后预后情况,为临床决策提供参考和帮助。展开更多
基金Nation Natural Science Foundation of China(General Program),No.81870444Natural Science Foundation of Tianjin,No.17JCQNJC12800.
文摘BACKGROUND Patients with end-stage liver disease usually have varying degrees of malnutrition,and severe malnutrition may affect the prognosis of patients after liver transplantation(LT).However,there is no recommended standard for the nutrition assessment of patients waiting for LT,and it is unknown whether malnutrition has an impact on the occurrence of postoperative complications.AIM The study aim was to investigate the value of the controlling nutritional status(CONUT)score and psoas muscle thickness per height(PMTH)in predicting prognosis in LT.METHODS We retrospectively analyzed the clinical data of 313 patients who underwent classic orthotopic LT from January 2016 to December 2018 in Tianjin First Central Hospital affiliated with Tianjin Medical University.The CONUT score is derived from the preoperative serum albumin and total cholesterol levels,and total lymphocyte count.Patients were divided into low(≤4),medium(5–8),and high(9–12)CONUT score groups perioperative characteristics,Clavien-Dindo grade III/IV/V postoperative complications,graft loss and infection,and cumulative postoperative survival in the three groups were compared 3 mo after LT.PMTH was calculated as the ratio of the transverse thickness of the psoas muscle in the umbilical plane to the height of the patient.The cutoff values of receiver operating characteristic curves were determined separately for men and women.The values were 14.1 cm/m2 for women and 17.9 cm/m2 for men.The patients were then divided into low and high PMTH groups by the cutoff values.The comparison of data between the two groups was the same as above.RESULTS Patients with medium and high CONUT scores had lower preoperative serum hemoglobin,more intraoperative red blood cell(RBC)transfusions,longer postoperative intensive care unit stay and hospital stays,higher 7 and 14 preoperative-day serum bilirubin levels,and a higher incidence of postoperative grade III/IV complications and infections than patients with low CONUT scores.Differences in the 3-mo cumulative survival among the three groups were not significant.Patients with a low PMTH had higher preoperative serum urea nitrogen,more intraoperative packed RBC and frozen plasma transfusions,longer times to postoperative ventilator extubation,higher incidence of total postoperative complications,and a lower 3-mo cumulative survival than those with a high PMTH.CONCLUSION A CONUT score≥5 and a low PMTH were both associated with poor prognosis in LT.The CONUT score had no predictive value for short-term patient survival after LT,but the PMTH was predictive of short-term patient survival after LT.
基金Clinical Trials from the Affiliated Drum Tower Hospital,Medical School of Nanjing University,2022-LCYJ-PY-17CIMF-CSPEN Project,Z-2017-24-2211Project of Chinese Hospital Reform and Development Institute,Nanjing University and Aid project of Nanjing Drum Tower Hospital Health,Education&Research Foundation,NDYG2022090。
文摘BACKGROUND The controlling nutritional status(CONUT)score effectively reflects a patient’s nutritional status,which is closely related to cancer prognosis.This study invest-igated the relationship between the CONUT score and prognosis after radical surgery for colorectal cancer,and compared the predictive ability of the CONUT score with other indexes.AIM To analyze the predictive performance of the CONUT score for the survival rate of colorectal cancer patients who underwent potentially curative resection.METHODS This retrospective analysis included 217 patients with newly diagnosed colorectal.The CONUT score was calculated based on the serum albumin level,total lymphocyte count,and total cholesterol level.The cutoff value of the CONUT score for predicting prognosis was 4 according to the Youden Index by the receiver operating characteristic curve.The associations between the CONUT score and the prognosis were performed using Kaplan-Meier curves and Cox regression analysis.RESULTS Using the cutoff value of the CONUT score,patients were stratified into CONUT low(n=189)and CONUT high groups(n=28).The CONUT high group had worse overall survival(OS)(P=0.013)and relapse-free survival(RFS)(P=0.015).The predictive performance of CONUT was superior to the modified Glasgow prognostic score,the prognostic nutritional index,and the neutrophil-to-lymphocyte ratio.Meanwhile,the predictive performances of CONUT+tumor node metastasis(TNM)stage for 3-year OS[area under the receiver operating characteristics curve(AUC)=0.803]and 3-year RFS(AUC=0.752)were no less than skeletal muscle mass index(SMI)+TNM stage.The CONUT score was negatively correlated with SMI(P<0.01).CONCLUSION As a nutritional indicator,the CONUT score could predict long-term outcomes after radical surgery for colorectal cancer,and its predictive ability was superior to other indexes.The correlation between the CONUT score and skeletal muscle may be one of the factors that play a predictive role.
基金This work was supported by grants from the National Key R&D Program of China(Grant Nos.2017YFC1309003 and 2017YFC0908500)the National Natural Science Foundation of China(Grant Nos.81425018,81672868,and 81802775)+10 种基金the Sci-Tech Project Foundation of Guangzhou City(Grant No.201707020039)the Sun Yat-sen University Clinical Research 5010 Program,the Special Support Plan of Guangdong Province(Grant No.2014TX01R145)the Natural Science Foundation of Guangdong Province(Grant Nos.2017A030312003 and 2018A0303131004)the Natural Science Foundation of Guangdong Province for Distinguished Young Scholar(Grant No.2018B030306001)the Sci-Tech Project Foundation of Guangdong Province(Grant No.2014A020212103)the Health&Medical Collaborative Innovation Project of Guangzhou City(Grant Nos.201400000001 and 201803040003)the Pearl River S&T Nova Program of Guangzhou(Grant No.201806010135)the Planned Science and Technology Project of Guangdong Province(Grant No.2019B020230002)the National Science&Technology Pillar Program during the Twelfth Five-year Plan Period(Grant No.2014BAI09B10)the Natural Science Foundation of Guangdong Province(Grant No.2017A030312003Fundamental Research Funds for the Central Universities。
文摘Objective:Several studies have reported that the controlling nutritional status(CONUT)score is a prognostic predictor for survival among patients with different types of cancer.We assessed the prognostic value of changes in the CONUT score during treatment and theΔCONUT-EBV DNA score in patients with advanced nasopharyngeal carcinoma(NPC).Methods:We retrospectively analyzed 433 patients with advanced NPC having no evidence of metastasis from January 2007 to June 2011;the patients underwent radical concurrent chemoradiotherapy(CCRT)at Sun Yat-sen University Cancer Center and were grouped based on theirΔCONUT andΔCONUT-EBV DNA scores.Kaplan-Meier curves were used to compare the patient outcomes according to the cut-offΔCONUT score and theΔCONUT-EBV DNA scoring system.Results:Among all patients,overall survival(OS)was independently predicted by a highΔCONUT score(P=0.031)and high EBV DNA(P<0.001).TheΔCONUT-EBV DNA score[OS area under the curve(AUC)=0.621;progression free survival(PFS)-AUC=0.612;distant metastasis-free survival(DMFS)-AUC=0.622]was more predictive of OS,PFS,and DMFS in patients with advanced NPC than theΔCONUT score(OS-AUC=0.547;PFS-AUC=0.533;DMFS-AUC=0.522)and pretreatment plasma EBV DNA levels alone(OS-AUC=0.600;PFS-AUC=0.591,DMFS-AUC=0.610).TheΔCONUT-EBV DNA score was significantly correlated with OS,PFS,and DMFS in patients with advanced NPC treated with CCRT.Conclusions:TheΔCONUT-EBV DNA score may be useful in clinical practice as a convenient biomarker for predicting the outcomes in patients with advanced NPC treated with CCRT.
基金Supported by a grant from the Support Program of Sichuan Science and Technology Department(No.2018sz2311).
文摘Objective To investigate the prognostic value of serum carcinoembryonic antigen(CEA)and controlling nutritional status(CONUT)score in patients with colorectal cancer.Methods We retrospectively studied 261 patients with colorectal cancer in our hospital.The patients were divided into two groups by CONUT=3 and CEA=5 ng/mL,and the effects of CONUT score and CEA level on the prognosis and clinicopathological parameters were statistically analyzed.Results(1)Different CONUT scores were significantly correlated with age,tumor diameter,differentiation type,and T stage(P<0.05).The older the patient was,the larger the tumor diameter,undifferentiated tumor,and T stage were,the higher the CONUT score was.(2)Seventy-five patients died during the follow-up period,and 45 patients died of progression or recurrence of colorectal cancer.The 5-year overall survival(OS)rate of the low CONUT score group was significantly higher than that of the high CONUT score group,and the 5-year OS rate of the low CEA group was significantly higher than that of the high CEA group;the difference was statistically significant(P<0.01).(3)According to the serum CEA level and CONUT score,the 5-year survival rates of CEAlow/CONUTlow,CEAlow/CONUThigh,CEAhigh/CONUTlow,and CEAhigh/CONUThigh were 84.7%,69%,55.3%,and 36.1%respectively,with statistical significance(P<0.01).(4)The Cox multivariate analysis showed that age,CONUT score,CEA combined with CONUT score,lymph node metastasis,and distant metastasis were independent risk factors for the prognosis of colorectal cancer patients.Conclusion:The combination of CEA detection and CONUT score can more accurately judge the prognosis of colorectal cancer patients.
基金Supported by National Natural Science Foundation of China,No.81871946 and No.82072708Suzhou Medical Key Discipline,No.SZXK202109+1 种基金Suzhou Clinical Key Diseases Project,No.LCZX202111Project of Gusu School of Nanjing Medical University,No.GSKY20210233.
文摘BACKGROUND Remnant gastric cancer(GC)is defined as GC that occurs five years or more after gastrectomy.Systematically evaluating the preoperative immune and nutritional status of patients and analyzing its prognostic impact on postoperative remnant gastric cancer(RGC)patients are crucial.A simple scoring system that combines multiple immune or nutritional indicators to identify nutritional or immune status before surgery is necessary.AIM To evaluate the value of preoperative immune-nutritional scoring systems in predicting the prognosis of patients with RGC.METHODS The clinical data of 54 patients with RGC were collected and analyzed retrospectively.Prognostic nutritional index(PNI),controlled nutritional status(CONUT),and Naples prognostic score(NPS)were calculated by preoperative blood indicators,including absolute lymphocyte count,lymphocyte to monocyte ratio,neutrophil to lymphocyte ratio,serum albumin,and serum total cholesterol.Patients with RGC were divided into groups according to the immune-nutritional risk.The relationship between the three preoperative immune-nutritional scores and clinical characteristics was analyzed.Cox regression and Kaplan–Meier analysis was performed to analyze the difference in overall survival(OS)rate between various immune-nutritional score groups.RESULTS The median age of this cohort was 70.5 years(ranging from 39 to 87 years).No significant correlation was found between most pathological features and immune-nutritional status(P>0.05).Patients with a PNI score<45,CONUT score or NPS score≥3 were considered to be at high immune-nutritional risk.The areas under the receiver operating characteristic curves of PNI,CONUT,and NPS systems for predicting postoperative survival were 0.611[95%confidence interval(CI):0.460–0.763;P=0.161],0.635(95%CI:0.485–0.784;P=0.090),and 0.707(95%CI:0.566–0.848;P=0.009),respectively.Cox regression analysis showed that the three immunenutritional scoring systems were significantly correlated with OS(PNI:P=0.002;CONUT:P=0.039;NPS:P<0.001).Survival analysis revealed a significant difference in OS between different immune-nutritional groups(PNI:75 mo vs 42 mo,P=0.001;CONUT:69 mo vs 48 mo,P=0.033;NPS:77 mo vs 40 mo,P<0.001).CONCLUSION These preoperative immune-nutritional scores are reliable multidimensional prognostic scoring systems for predicting the prognosis of patients with RGC,in which the NPS system has relatively effective predictive performance.
文摘目的:探讨第三腰椎骨骼肌质量指数(L3-skeletal muscle mass index,L3-SMI)和控制营养状况(controlling nutritional status,CONUT)评分对胃癌患者术后预后的预测价值。方法:收集2017年01月至2020年12月于我院行胃癌手术的528例患者的临床及生存资料,采用受试者工作特征(receiver operating characteristic,ROC)曲线确定不同性别患者术前L3-SMI的最佳截断值,比较不同L3-SMI、CONUT评分水平患者的临床病理特征。使用Kaplan-Meier法进行生存分析,采用Cox比例风险模型进行单因素和多因素回归分析胃癌患者术后预后的影响因素。应用R软件构建胃癌患者术后总生存时间(overall survival,OS)列线图预测模型,计算C指数评估模型的准确性,绘制校准图评价模型的预测效能。结果:术前L3-SMI预测胃癌患者预后的最佳截断值:男性为43.95 cm^(2)/m^(2)、女性为37.6 cm^(2)/m^(2),曲线下面积(area under the curve,AUC)值分别为0.729(95%CI为0.672~0.785)和0.680(95%CI为0.607~0.753)。术前低L3-SMI水平胃癌患者1、3、5年累积总生存率分别为97.1%、69.4%、33.6%,高L3-SMI水平患者1、3、5年累积总生存率分别为98.4%、78.4%、52.3%,差异有统计学意义(χ^(2)=31.718,P<0.001)。术前低CONUT评分水平胃癌患者1、3、5年累积总生存率分别为98.8%、80.2%、56.4%,高CONUT评分水平患者1、3、5年累积总生存率分别为96.7%、67.6%、29.0%,差异有统计学意义(χ^(2)=48.240,P<0.001)。单因素及多因素Cox回归分析结果显示:L3-SMI水平(高:HR=0.581,95%CI为0.459~0.735)及CONUT评分水平(高:HR=1.999,95%CI为1.574~2.539)是胃癌患者术后OS的独立影响因素(P<0.001)。根据多因素Cox回归分析构建胃癌患者术后OS的列线图预测模型,其C指数为0.671(95%CI为0.639~0.703),校准曲线显示预测曲线和真实曲线拟合度较好。结论:术前L3-SMI、CONUT评分是胃癌患者术后预后的独立影响因素,早期检测L3-SMI、CONUT评分有助于预测胃癌患者术后预后情况,为临床决策提供参考和帮助。
