Predictive value of inflammatory and nutritional indices for postoperative survival of elderly patients with esophageal squamous carcinoma
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摘要:目的
探讨炎症及营养指标对老年食管鳞癌患者术后生存的预测价值。
方法采用回顾性队列研究方法。收集2019年1月至2020年4月四川省肿瘤医院收治的130例老年食管鳞癌患者的临床病理资料；男102例,女28例；年龄为（70±4）岁。正态分布的计量资料以x±s表示。偏态分布的计量资料以M（Q1,Q3）或M（范围）表示。计数资料以绝对数表示,组间比较采用χ²检验。绘制受试者工作特征曲线（ROC）并计算曲线下面积（AUC）和最佳截断值,采用Kaplan⁃Meier法绘制生存曲线。Log‑rank检验进行生存分析。采用COX比例风险回归模型进行单因素和多因素分析。
结果（1）炎症及营养指标预测老年食管鳞癌患者术后生存情况。ROC分析结果显示：术前全身免疫炎症指数（SII）、系统炎症反应指数（SIRI）、中性粒细胞和淋巴细胞比值（NLR）、血小板和淋巴细胞比值（PLR）、预后营养指数（PNI）预测老年食管鳞癌患者术后生存情况的最佳截断值分别为470.71×109/L、1.11、2.07、136.24、46.28。（2）影响老年食管鳞癌患者术后生存情况的危险因素分析。多因素分析结果显示：术前SII≥470.71×109/L、术前SIRI≥1.11、术前PNI<46.28、术前患者主观整体营养评估量表（PG‑SGA）评分≥4分、术后病理学分期为Ⅳ期和术后有并发症是影响老年食管鳞癌患者术后总生存时间的独立危险因素（风险比=3.30、2.50、0.36、4.86、1.57、1.97,95%可信区间为1.10~9.88、1.07~5.88、0.16~0.81、1.13~20.87、1.20~2.06、1.02~3.82,P<0.05）。（3）随访情况。130例患者均获得随访,随访时间为39（1~60）个月。130例患者中,81例生存,49例死亡,中位总生存时间未达到。130例患者1、3年生存率分别为83.85%、54.62%。①术前SII≥470.71×109/L和<470.71×109/L患者的中位总生存时间分别为25（0,43）个月和未达到,两者比较,差异有统计学意义（χ2=60.59,P<0.05）。②术前SIRI≥1.11和<1.11患者的中位总生存时间分别为26（0,44）个月和未达到,两者比较,差异有统计学意义（χ²=45.57,P<0.05）。③术前PNI≥46.28和<46.28患者的中位总生存时间分别为未达到和38（0,47）个月,两者比较,差异有统计学意义（χ²=12.53,P<0.05）。④术前PG⁃SGA评分<4分和≥4分患者的中位总生存时间均为未达到,两者比较,差异有统计学意义（χ²=14.41,P<0.05）。⑤术后病理学分期为Ⅲ期患者的中位总生存时间为25（1,47）个月,Ⅳ期患者的中位总生存时间为12（1,32）个月,0期、Ⅰ期、Ⅱ期患者的中位总生存时间均为未达到,5者比较,差异有统计学意义（χ²=58.75,P<0.05）。⑥术后有并发症和无并发症患者的中位总生存时间分别为33（1,47）个月和未达到,两者比较,差异有统计学意义（χ²=14.27,P<0.05）。
结论术前SII、SIRI和PNI对老年食管鳞癌患者术后生存情况具有良好预测价值；术前SII≥470.71×109/L、SIRI≥1.11、PNI<46.28、PG‑SGA评分≥4分,术后病理学分期为Ⅳ期、术后有并发症是影响老年食管鳞癌患者术后总生存时间的独立危险因素。术前SII<470.71×109/L、SIRI<1.11、PNI≥46.28、PG‑SGA评分<4分,术后病理学分期为0期、Ⅰ期、Ⅱ期,术后无并发症患者的生存情况更好。
Abstract:ObjectiveTo investigate the predictive value of inflammatory and nutritional indices for postoperative survival of elderly patients with esophageal squamous carcinoma.
MethodsThe retrospective cohort study was conducted. The clinicopathological data of 130 elderly patients with esophageal squamous carcinoma who were admitted to Sichuan Cancer Hospital from January 2019 to April 2020 were collected. There were 102 males and 28 females, aged (70±4)years. Mea-surement data with normal distribution were represented as Mean±SD. Measurement data with skewed distribution were represented as M(Q1,Q3) or M(range). Count data were expressed as absolute numbers, and comparison between groups was conducted using the chi‑square test. Receiver opera-ting characteristic (ROC) curves were plotted. The area under the curve (AUC) and optimal cut-off values were calculated. The Kaplan‑Meier method was used to plot survival curves, and the Log-rank test was used for survival analysis. The COX proportional hazard regression model was used for univariate and multivariate analyses.
Results(1) Postoperative survival of elderly patients with esophageal squamous carcinoma predicted by inflammatory and multitional indices. Results of ROC curves analysis showed that the best cut‑off values of preoperative systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and prognostic nutrition index (PNI) for predicting postoperative survival of elderly patients with esophageal squamous carcinoma were 470.71×109/L, 1.11, 2.07, 136.24, and 46.28, respectively. (2) Risk factors analysis of postoperative survival of elderly patients with esophageal squamous carcinoma. Results of multivariate analysis showed that preoperative SII ≥470.71×109/L, preoperative SIRI ≥1.11, preoperative PNI<46.28, score of preoperative patient-generated subjective global assessment (PG‑SGA) ≥4, postoperative pathological stage Ⅳ and post-operative complications were independent risk factors for the overall survival time of elderly patients with esophageal squamous carcinoma (hazard ratio=3.30, 2.50, 0.36, 4.86, 1.57, 1.97, 95% confidence interval as 1.10‒9.88, 1.07‒5.88, 0.16‒0.81, 1.13‒20.87, 1.20‒2.06, 1.02‒3.82, P<0.05). (3) Follow-up. All the 130 patients were followed up for 39(range, 1‒60)months. Of the 130 patients, 81 cases survived, 49 cases died, and the median overall survival time was not reached. The 1‑ and 3‑year survival rates of the 130 patients were 83.85% and 54.62%, respectively. ① The median overall survival time was 25(0,43)months for patients with SII ≥470.71×109/L, and unreached for patients with SII <470.71×109/L, showing a significant difference between them (χ²=60.59, P<0.05). ② The median overall survival time was 26(0,44)months for patients with SIRI ≥1.11, and unreached for patients with SIRI <1.11, showing a significant difference between them (χ²=45.57, P<0.05). ③ The median overall survival time was unreached for patients with PNI ≥46.28, and 38(0,47)months for patients with PNI <46.28, showing a significant difference between them (χ²=12.53, P<0.05). ④ The median overall survival time was unreached for patients with PG-SGA <4 and ≥4, showing a signifi-cant difference between them (χ²=14.41, P<0.05). ⑤ The median overall survival time was 25(1,47)months for patients in pathological stage Ⅲ, 12(1,32)months for patients in stage Ⅳ, and unreached for patients in stage 0, Ⅰ, Ⅱ, respectively, showing a significant difference among them (χ²=58.75, P<0.05). ⑥ The median overall survival time was 33(1,47)months for patients with postoperative complication, and unreached for patients without postoperative complication, showing a significant difference between them (χ²=14.27, P<0.05).
ConclusionsPreoperative SII, SIRI and PNI have good predictive value for postoperative survival in elderly patients with esophageal squamous carcinoma. Preoperative SII ≥470.71×109/L, preoperative SIRI ≥1.11, preoperative PNI <46.28, score of preoperative PG‑SGA ≥4, postoperative pathological stage Ⅳ, and postoperative complications are independent risk factors for the overall survival time of elderly patients with esophageal squamous carcinoma. Patients with preoperative SII <470.71×109/L, preoperative SIRI <1.11, preoperative PNI >46.28, score of preoperative PG-SGA <4, postoperative pathological stage 0, Ⅰ, Ⅱ, and non post-operative complications have better survival.
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张玉霞、谢钦：收集数据,数据整理和论文撰写；张玉霞、魏思瑞、姜龙琳、缪艳：数据分析及论文修改；谢丽：统计学方法指导及审核；韩泳涛、缪艳：研究指导,经费支持所有作者均声明不存在利益冲突张玉霞, 谢钦, 魏思瑞, 等. 炎症及营养指标对老年食管鳞癌患者术后生存的预测价值[J]. 中华消化外科杂志, 2024, 23(9): 1200-1208. DOI: 10.3760/cma.j.cn115610-20240711-00332.
http://journal.yiigle.com/LinkIn.do?linkin_type=cma&DOI=10.3760/cma.j.cn115610-20240711-24332
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图 1 术前SII、SIRI、NLR、PLR预测130例老年食管鳞癌患者术后生存情况的受试者工作特征曲线
注：SII为全身免疫炎症指数；SIRI为系统炎症反应指数；NLR为中性粒细胞和淋巴细胞比值；PLR为血小板和淋巴细胞比值
Figure 1. Receiver operating characteristic curves of preoperative systemic immune inflammation index, systemic inflammation response index, neutrophil⁃to⁃lymphocyte ratio and platelet⁃to⁃lymphocyte ratio for predicting postoperative survival in 130 elderly patients with esophageal squamous carcinoma
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图 2 术前预后营养指数预测130例老年食管鳞癌患者术后生存情况的受试者工作特征曲线
Figure 2. Receiver operating characteristic curve of pre⁃operative prognostic nutritional index for predic⁃ting postoperative survival in 130 elderly patients with esophageal squamous cell carcinoma
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图 3 130例老年食管鳞癌患者术后的总生存曲线
Figure 3. Postoperative overall survival curve of 130 elderly patients with esophageal squamous carcinoma
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图 4 术前SII<470.71×109/L和≥470.71×109/L的老年食管鳞癌患者术后的总生存曲线
注：SII为全身免疫炎症指数
Figure 4. Postoperative overall survival curves of elderly esophageal squamous carcinoma patients with pre⁃operative systemic immuno inflammation index <470.71×109/L and ≥470.71×109/L
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图 5 术前SIRI<1.11和≥1.11的老年食管鳞癌患者术后的总生存曲线
注：SIRI为系统炎症反应指数
Figure 5. Postoperative overall survival curves of elderly esophageal squamous carcinoma patients with pre⁃operative systemic inflammation response index <1.11 and ≥1.11
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图 6 术前PNI<46.28和≥46.28的老年食管鳞癌患者术后的总生存曲线
注：PNI为预后营养指数
Figure 6. Postoperative overall survival curves of elderly eso⁃phageal squamous carcinoma patients with preoperative nutritional index < 46.28 and ≥46.28
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图 7 术前PG‑SGA<4和≥4的老年食管鳞癌患者术后的总生存曲线
注：PG‑SGA为主观整体营养评估法评分
Figure 7. Postoperative overall survival curves of elderly esophageal squamous carcinoma patients with pre⁃operative patient⁃generated subjective global asse⁃ssment scores < 4 and ≥4
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图 8 术后病理学分期为0期、Ⅰ期、Ⅱ期、Ⅲ期和Ⅳ期的老年食管鳞癌患者术后的总生存曲线
Figure 8. Postoperative overall survival curves of elderly eso⁃phageal squamous carcinoma patients in postopera⁃tive pathological stage 0, stage Ⅰ, stage Ⅱ, stage Ⅲ and stage Ⅳ
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图 9 术后无并发症和有并发症的老年食管鳞癌患者术后的总生存曲线
Figure 9. Postoperative overall survival curves of elderly eso⁃phageal squamous carcinoma patients without and with postoperative complications
表 1 影响130例老年食管鳞癌患者术后总生存时间的单因素分析
Table 1 Univariate analysis of postoperative overall survival time in 130 elderly patients with esophageal squamous carcinoma
临床病理因素 b值 标准误 Wald值 风险比（95%可信区间） P值 术前SII（≥470.71×109/L比<470.71×109/L） 2.30 0.36 40.71 9.98（4.92~20.24） <0.001 术前SIRI（≥1.11比<1.11） 1.96 0.34 33.86 7.13（3.68~13.82） <0.001 术前NLR（≥2.07比<2.07） 1.39 0.29 22.51 4.03（2.27~7.17） <0.001 术前PLR（≥136.24比<136.24） 1.25 0.31 16.68 3.49（1.92~6.37） <0.001 术前PNI（≥46.28比<46.28） -1.14 0.34 11.12 0.32（0.16~0.62） 0.001 术前PG‑SGA评分（≥4分比<4分） 2.23 0.72 9.56 9.33（2.26~38.44） 0.002 居住地（城市比农村） 0.72 0.30 5.80 2.06（1.14~3.71） 0.016 术后病理学分期（0期、Ⅰ期、Ⅱ期、Ⅲ期、Ⅳ期） 0.71 0.14 26.26 2.04（1.55~2.68） <0.001 术后并发症（无比有） 1.08 0.30 12.83 2.94（1.63~5.30） <0.001 文化程度（小学及以下、初中、高中、大专、本科及以上） -0.01 0.17 0.01 0.99（0.71~1.38） 0.944 婚姻状况（在婚、离异、其他） 0.07 0.23 0.10 1.08（0.69~1.69） 0.757 家庭人均月收入（<4 000元、4 000~7 999元、≥8 000元） -0.03 0.12 0.07 0.97（0.76~1.23） 0.789 医疗付费方式（自费、市职工医保、市城乡医保、省医保、省异地医保、其他） -0.15 0.09 2.53 0.86（0.72~1.04） 0.112 基础疾病（无比有） 0.10 0.32 0.10 1.11（0.59~2.08） 0.758 注： SII为全身免疫炎症指数；SIRI为系统炎症反应指数；NLR为中性粒细胞和淋巴细胞比值；PLR为血小板和淋巴细胞比值；PNI为预后营养指数；PG‑SGA为患者主观整体营养评估量表
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表 2 影响130例老年食管鳞癌患者术后总生存时间的多因素分析
Table 2 Multivariate analysis of postoperative overall survival time in 130 elderly patients with esophageal squamous carcinoma
临床病理因素 b值 标准误 Wald 值 风险比（95%可信区间） P值 术前SII（≥470.71×109/L比<470.71×109/L） 1.19 0.56 4.56 3.30（1.10~9.88） 0.033 术前SIRI（≥1.11比<1.11） 0.92 0.44 4.42 2.50（1.07~5.88） 0.035 术前PNI（≥46.28比<46.28） -1.03 0.42 6.12 0.36（0.16~0.81） 0.013 术前PG‑SGA评分（≥4分比<4分） 1.58 0.74 4.53 4.86（1.13~20.87） 0.033 术后病理学分期（0期、Ⅰ期、Ⅱ期、Ⅲ期、Ⅳ期） 0.45 0.14 10.91 1.57（1.20~2.06） 0.001 术后并发症（无比有） 0.68 0.34 4.06 1.97（1.02~3.82） 0.044 注： SII为全身免疫炎症指数；SIRI为系统炎症反应指数；PNI为预后营养指数；PG‑SGA为患者主观整体营养评估量表
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