术前营养炎症指标对胃癌根治术联合腹腔热灌注化疗患者的预后价值评估

刘宇杰; 詹森; 张易

doi:10.12467/j.issn.2096-3882.20250151

术前营养炎症指标对胃癌根治术联合腹腔热灌注化疗患者的预后价值评估

Prognostic value of preoperative nutritional and inflammatory indexes in assessing patients undergoing radical gastric cancer surgery combined with hyperthermic intraperitoneal chemotherapy

摘要

摘要: 目的探讨术前营养炎症指标预后营养指数(PNI)、系统免疫炎症指数(SII)、血小板与淋巴细胞比值(PLR)、中性粒细胞与淋巴细胞比值(NLR)对胃癌根治术联合腹腔热灌注化疗患者预后的预测价值。方法选取2020年1月—2021年12月于徐州医科大学附属医院接受胃癌根治术联合腹腔热灌注化疗的102例患者,收集临床资料进行分析。绘制受试者工作特征(ROC)曲线,计算术前PNI、SII、PLR、NLR的最佳截断值,并根据这些截断值对患者进行分组。采用Kaplan-Meier生存曲线分析不同分组的总生存率,使用Cox回归分析影响胃癌患者预后的因素。结果本研究共纳入102例患者,年龄33~81岁,其中男70例,女32例。ROC曲线分析确定各指标的最佳截断值:PNI=45.05、SII=574.5、PLR=160.7、NLR=2.501。根据最佳截断值,将患者分为2组:低风险组(满足0~2项高风险指标,59例)和高风险组(满足3~4项高风险指标,43例)。低风险组和高风险组的3年总生存率分别为76.2%和25.6%(P<0.000 1)。多因素Cox回归分析显示,淋巴受累,PNI、SII、PLR和NLR联合评估高风险是胃癌根治术联合腹腔热灌注化疗患者3年总生存率的独立影响因素。结论联合使用PNI、SII、PLR和NLR四项指标对胃癌根治术联合腹腔热灌注化疗患者的预后具有较高的预测效能,可为相关治疗和患者预后改善提供参考。

Abstract: Objective To explore the role of preoperative nutritional and inflammatory indicators, including prognostic nutritional index (PNI), systemic immune-inflammation index (SII), platelet to lymphocyte ratio (PLR), and neutrophil to lymphocyte ratio (NLR) in predicting the prognosis of patients undergoing gastric cancer radical surgery combined with hyperthermic intraperitoneal chemotherapy (HIPEC).Methods A total of 102 patients who underwent gastric cancer radical surgery combined with HIPEC at the Affiliated Hospital of Xuzhou Medical University from January 2020 to December 2021 were selected, and their clinical data were collected for retrospective analysis. Receiver operating characteristic (ROC) curves were plotted to determine the optimal cutoff values for PNI, SII, PLR, and NLR. The patients were divided into groups based on these cutoff values. Kaplan-Meier survival analysis was performed to analyze the overall survival of different groups, and Cox regression analysis was conducted to identify factors influencing the prognosis of gastric cancer patients.Results A total of 102 patients were included in this study, aged between 33 and 81 years, with 70 males and 32 females. ROC curve analysis determined the optimal cutoff values for each indicator: PNI=45.05, SII=574.5, PLR=160.7, and NLR=2.501. Based on these cutoff values, the patients were divided into two groups: a low-risk group (with 0-2 high-risk indicators, n=59) and a high-risk group (with 3-4 high-risk indicators, n=43). The 3-year overall survival rates for the low-risk and high-risk groups were 76.2% and 25.6%, respectively (P<0.000 1). Multivariate Cox regression analysis showed that lymph node metastasis, and high risk in PNI, SII, PLR, and NLR combined assessment were independent prognostic factors for gastric cancer patients undergoing radical surgery combined with HIPEC.Conclusions The combined use of PNI, SII, PLR, and NLR in assessing the prognosis of gastric cancer patients undergoing radical surgery combined with HIPEC provides a higher predictive efficacy. This combined scoring system can provide valuable reference for clinical decision-making regarding individualized treatment and postoperative follow-up strategies for gastric cancer patients.

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