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    基于炎症营养相关指标建立Ⅰ—Ⅱ期子宫内膜癌患者术后的列线图预测模型及验证

    Development and validation of a nomogram based on multiple preoperative immunoinflammatory indexes for survival prediction in patients with stage Ⅰ—Ⅱ endometrial cancer

    • 摘要: 目的 探讨术前血小板与淋巴细胞比值(PLR)、中性粒细胞与淋巴细胞比值(NLR)、晚期肺癌炎症指数(ALI)、预后营养指数(PNI)和全身免疫炎症指数(SII)在Ⅰ—Ⅱ期子宫内膜癌患者预后判断中的价值。方法 回顾性分析2013年1月—2017年1月在徐州医科大学附属医院首次术后确诊的Ⅰ—Ⅱ期子宫内膜癌患者的临床和随访资料。通过受试者工作特征(ROC)曲线确定PLR、NLR、ALI、PNI和SII的最佳截断值。通过Kaplan-Meier法和Cox回归模型对Ⅰ—Ⅱ期子宫内膜癌患者预后影响因素进行单因素和多因素分析,建立基于术前PLR、NLR、ALI、PNI和SII以及其他临床病理因素的列线图模型。结果 通过ROC曲线确定术前PLR、NLR、ALI、PNI和SII预测生存的最佳截断值分别为131.8、3.23、38.46、51.55和763.1。Cox多因素分析显示淋巴结转移、子宫肌层浸润深度、Ki-67表达水平、PNI和ALI是Ⅰ—Ⅱ期子宫内膜癌患者术后总生存期的独立危险因素(P<0.05)。列线图预测Ⅰ—Ⅱ期子宫内膜癌患者预后的C指数为0.846。结论 低水平的ALI和PNI是Ⅰ—Ⅱ期子宫内膜癌患者术后预后不良的独立危险因素,基于ALI和PNI建立的列线图可有效预测Ⅰ—Ⅱ期子宫内膜癌患者预后。

       

      Abstract: Objective To evaluate the value of preoperative platelet to lymphocyte ratio (PLR), neutrophil to lymphocyte ratio (NLR), advanced lung cancer inflammation index (ALI), prognostic nutritional index (PNI) and systemic immune-inflammation index (SII) in predicting the prognosis of patients with endometrial cancer (EC). Methods We retrospectively analyzed the clinical and follow-up data of stage Ⅰ—Ⅱ EC patients who underwent radical surgical resection and diagnosed in the Affiliated Hospital of Xuzhou Medical University from January 2013 to January 2017. A receiver operating characteristic (ROC) curve was plotted to determine the optimal cut-off values for PLR, NLR, ALI, PNI and SII. Univariate and multivariate analyses was performed by Kaplan-Meier method and Cox regression model to analyze the prognostic factors of EC. Then, a nomogram prediction model was established. Results According to the ROC curve, the optimal cut-off value of PLR, NLR, ALI, PNI and SII for predicting survival was 131.8, 3.23, 38.46, 51.55 and 763.1, respectively. Cox regression multivariate analysis suggested that lymph node infiltration, the depth of myometrial infiltration, high Ki-67 expression, low PNI and low ALI were the independent risk factors for overall survival (OS). The C-index of the nomogram model for predicting the prognosis of patients with stage Ⅰ—Ⅱ endometrial cancer was 0.846. Conclusions Low ALI and PNI expression is the independent factor for the OS of EC patients. The nomogram model based on ALI and PNI may effectively predict the prognosis of EC patients with stage Ⅰ—Ⅱ.

       

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