目的 探讨预后营养指数(PNI)预测非小细胞肺癌(NSCLC)预后的临床应用价值。 方法 回顾性收集 2017 年 1 月 至 2019 年 1 月南通大学附属海安医院行手术治疗的 150 例 NSCLC 患者的临床资料与生存数据,计算每例患者的 PNI 值(外 周血淋巴细胞计数×5+血清白蛋白值)。 通过受试者操作特征曲线(ROC 曲线)确定 PNI 的最佳截止点,采用 Kaplan-Meier 曲 线及多因素 Cox 回归分析评估 PNI 在 NSCLC 患者中的预后意义。 结果 ROC 曲线展示术前 PNI 预测 NSCLC 患者总生存 (OS)期的最佳截止点为 42. 6,曲线下面积(AUC)值为 0. 766(95%CI = 0. 605 ~ 0. 928),敏感度为 73. 3%,特异度为 77. 8%。 基于此截止点将所有患者分为高 PNI 组(≥42. 6,n = 108)与低 PNI 组(PNI<42. 6,n = 42)。 比较两组患者的一般资料及临床 病理特征后,发现低 PNI( < 42. 6) 与高龄(P = 0. 011)、美国东部肿瘤协作组(ECOG) 评分(P = 0. 041) 及肿瘤 T 分期 (P< 0. 001)显著相关。 Kaplan-Meier 曲线表明 PNI<42. 6 与 PNI≥42. 6 组患者的 3 年 OS 率分别为 65. 5%与 96. 3%,差异有统计 学意义 (χ 2 = 21. 922,P<0. 001),术前低 PNI 提示 NSCLC 患者预后不佳。 多因素 Cox 回归分析进一步证实 ECOG 评分(HR = 4. 192,95%CI = 1. 136~ 15. 465,P= 0. 031)、T 分期(HR = 6. 832,95%CI = 2. 014 ~ 23. 178,P = 0. 002)、淋巴结转移(HR = 2. 836, 95%CI = 1. 001~ 8. 038,P= 0. 048)与术前低 PNI(HR= 5. 069,95%CI = 1. 330 ~ 19. 317,P = 0. 017)是影响 NSCLC 患者预后的独 立风险因素。 结论 术前 PNI 或许可以作为一项评估 NSCLC 患者预后的可靠指标,具有一定的临床应用价值。

Objective To investigate the clinical value of prognostic nutritional index PNI for predicting the survival outcome of non-small cell lung cancer NSCLC patients. Method The clinicopathological information and survival data of 150 NSCLC patients who underwent surgical resection in Haian Hospital from January 2017 to January 2019 were retrospectively collected and the PNI value calculated as peripheral blood lymphocyte count× 5+ serum albumin level. Receiver operator characteristic ROC curve was used to determine the optimal cut-off value of PNI. Kaplan-Meier curves were plotted and multivariate Cox regression analysis were conducted to determine the prognostic significance of PNI for NSCLC patients. Result ROC curve showed that the optimal cut-off value of preoperative PNI for predicting overall survival OS of NSCLC patients was 42. 6 and the area under curve AUC value sensitivity and specificity was 0. 766 95%CI = 0. 605-0. 928 73. 3% and 77. 8% respectively. Based on the threshold of preoperative PNI all patients were divided into high PNI ≥42. 6 n = 108 and low PNI group PNI<42. 6 n = 42 . By comparing the general information and clinicopathological features between the two groups we found that preoperative low PNI <42. 6 was significantly correlated with advanced age P= 0. 011 ECOG performance status P= 0. 041 and T stage P<0. 001 . Kaplan-Meier curves indicated that the 3-year overall survival OS of patients with PNI< 42. 6 and PNI≥42. 6 were 65. 5% and 96. 3% respectively χ 2 = 21. 922 P< 0. 001 . The preoperative low PNI was a predictor of poor OS in NSCLC patients. Furthermore the results of the multivariate Cox regression analysis demonstrated that ECOG performance status HR = 4. 192 95% CI = 1. 136- 15. 465 P = 0. 031 T stage HR = 6. 832 95%CI = 2. 014-23. 178 P= 0. 002 lymph node metastasis HR= 2. 836 95%CI = 1. 001-8. 038 P= 0. 048 and preoperative PNI HR= 5. 069 95%CI = 1. 330-19. 317 P = 0. 017 were independent prognostic factors for NSCLC patients. Conclusion Preoperative PNI might be used as a reliable predictor of OS in NSCLC patients with a significant clinical value.