预后免疫营养指数与腹腔镜结肠癌患者预后的相关性分析

Analysis on Correlation between Prognostic Immunenutritional Index with Prognosis of Patients with Colon Cancer after Laparoscopic Surgery

摘要: 目的：探究预后免疫营养指数(PINI)与腹腔镜下结肠癌切除患者临床病理特征的关系，及其对结肠癌患者预后的影响。方法：回顾性分析接受腹腔镜根治性切除术的210例结肠癌患者资料，采用Clavien-Dindo评分对术后并发症分级。计算患者术前PINI值，将患者分为低PINI组与高PINI组，采用χ2检验或Fisher确切概率法分析PINI与临床病理特征的关系；采用Kaplan-Meier曲线进行生存分析；应用单因素及多因素分析PINI对患者术后并发症(CD评分 ≥ 2级)及远期死亡率的影响。结果：两组患者在年龄、体重指数、CEA、T分期、淋巴结转移、肿瘤大小、住院时间、术后并发症(CD评分 ≥ 2级)均有显著差异(P < 0.05)，logistic多因素回归分析得出，低PINI值(OR = 2.926, 95%CI: 1.919~3.521, P < 0.01)是影响患者术后并发症的独立危险因素；低PINI患者的5年总生存率明显低于高PNI患者(71.9% vs 84.3%, P < 0.05)；采用Cox多因素生存分析提示，低PINI值(RR = 2.093, 95%CI: 2.560~8.171, P < 0.05)、T ≥ 3期(RR = 2.491, 95%CI: 1.181~5.255, P < 0.05)是患者5年生存率的独立预测因子。结论：对于腹腔镜根治性切除术的结肠癌患者，术前低PINI提示患者预后不良，PINI是影响患者预后的重要独立危险因素，有助于个性化治疗决策制定。

Abstract: Objective: To investigate the correlation between prognostic immunenutritional index and postop-erative outcomes in patients with colon cancer treated with laparoscopic surgery, and to evaluate its predictive value. Methods: The clinical data of 210 patients with colon cancer who underwent curative laparoscopic colectomy were analyzed retrospectively. Clavien-Dindo grading standard was used to evaluate postoperative complications. The patients were classifified into Low-PINI group and High-PINI group. The relationship between PINI and clinicopathological features was analyzed by χ2 test or Fisher’s exacttest; survival analysis was described by Kaplan-Meier curve; univariate and multivariate analysis were used to analyze the factors that might affect the complications (CD grade ≥ 2) and overall survival. Results: There were significant differences between the two groups in terms of age, body mass index, CEA, Clinical T status, lymph node metastasis, tumor size, hospital stay, postoperative complications (CD grade ≥ 2) (P < 0.05). The logistic regression analysis showed that Low-PINI value (OR = 2.926, 95%CI: 1.919~3.521, P < 0.01) was independent risk factors for postoperative complications. The 5-year overall survival rate of Low-PINI patients was significantly lower than those of High-PINI patients (71.9% vs 84.3%, P < 0.05). The Cox regression analysis showed that low PINI (RR = 2.093, 95%CI: 2.560~8.171, P < 0.05) and Clinical T status (T ≥ 3) (RR = 2.491, 95%CI: 1.181~5.255, P < 0.05) were independent risk factors for overall survival rate. Con-clusion: For patients with colon cancer treated with laparoscopic surgery, preoperative low PINI in-dicates poor prognosis, and PINI is an important independent risk factor affecting patient prognosis, which helps to make personalized treatment decisions.