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    NAR联合SII对晚期胰腺癌患者的预后价值评估

    Prognostic value of NAR combined with SII in advanced pancreatic cancer patients

    • 摘要: 目的 探讨中性粒细胞与白蛋白比值(NAR)联合全身免疫炎症指数(SII)对晚期胰腺癌患者的预后预测价值。方法 分析2011年10月—2023年6月盐城市第一人民医院收治的194例晚期胰腺癌患者的临床资料。运用X-Tile软件确定癌胚抗原(CEA)、糖类抗原19-9(CA19-9)、中性粒细胞与淋巴细胞比值(NLR)、血小板与淋巴细胞比值(PLR)、血小板与白蛋白比值(PAR)、NAR、SII的最佳截断值,并通过R软件绘制上述指标的时间依赖性受试者工作特征(ROC)曲线下面积(t-AUC)。采用Kaplan-Meier法绘制生存曲线,以log-rank检验比较生存率。通过多因素Cox分析确定独立预后因素,构建列线图模型,并利用ROC曲线和校准曲线进行评估。结果 本研究的中位随访时间为22.6个月,中位总生存期为5.7个月。t-AUC显示,NAR和SII在预测晚期胰腺癌预后方面性能更优,据此构建N-SII评分。多因素Cox分析显示,原发肿瘤最大径>4 cm (HR=1.398,95% CI:1.001~1.951)、转移器官个数≥2(HR=1.897,95% CI:1.030~3.493)、未接受化疗(HR=2.353,95% CI:1.711~3.235)、CEA>8.59 U/mL (HR=1.410,95% CI:1.008~1.972)及高N-SII评分(HR=1.501,95% CI:1.011~2.231;HR=2.951,95% CI:1.938~4.494)是晚期胰腺癌患者预后的独立危险因素。基于N-SII评分等预后因素构建的列线图模型3、6、12个月的AUC值分别为0.775、0.796和0.825;校准曲线显示,该模型具有较好的准确性。结论 N-SII评分是晚期胰腺癌患者生存的独立预后因素,基于此构建的列线图可准确预测患者预后。

       

      Abstract: Objective To explore the prognostic value of the neutrophil-to-albumin ratio (NAR) combined with the systemic immune-inflammation index (SII) in advanced pancreatic cancer patients.Methods A total of 194 advanced pancreatic cancer patients who were admitted to Yancheng First People's Hospital from October 2011 to June 2023 were selected ant their clinical data were analyzed. The optimal cutoff values for carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), platelet-to-albumin ratio (PAR), NAR, and SII were determined using X-Tile software. The time-dependent area under the receiver operating characteristic (t-AUC) curves for these indices were plotted using R software. Kaplan-Meier survival curves were drawn, and log-rank tests were used to compare survival rates. Multivariate Cox regression analysis was conducted to identify independent prognostic factors, and a nomogram model was constructed. The discriminative ability and accuracy of the model were evaluated using receiver operating characteristic (ROC) curves and calibration curves.Results The median follow-up time was 22.6 months, and the median survival time was 5.7 months. t-AUC analysis showed that NAR and SII performed better in predicting prognosis for advanced pancreatic cancer, leading to the development of the N-SII score. Multivariate Cox regression analysis identified the following as independent risk factors for advanced pancreatic cancer: primary tumor diamete >4 cm (HR=1.398, 95%CI:1.001-1.951), number of metastatic organs ≥2 (HR=1.897, 95%CI:1.030-3.493), no chemotherapy (HR=2.353, 95%CI: 1.711-3.235), CEA >8.59 U/mL (HR=1.410, 95%CI:1.008-1.972), and high N-SII score (HR=1.501, 95%CI:1.011-2.231; HR=2.951,95%CI:1.938-4.494). The nomogram model constructed based on the N-SII score and other prognostic factors showed AUC values of 0.775, 0.796, and 0.825 at 3, 6, and 12 months, respectively. The calibration curve demonstrated good accuracy of the model.Conclusions The N-SII score is an independent prognostic factor for survival in advanced pancreatic cancer patients, and the nomogram model based on it can accurately predict patient prognosis.

       

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