目的 探讨控制营养状态(CONUT)在宫颈癌患者预后评估中的临床应用价值。 方法 将 2016 年 1 月至 2018 年 12 月于泰州市人民医院接受手术治疗的 122 例国际妇产科协会(FIGO)分期ⅠB~ ⅡA 期宫颈癌患者纳入本研究中。 以 3 分为 CONUT 评分临界值,将所有患者分为 CONUT<3 分组与 CONUT≥3 分组。 采用 χ 2 检验或 Fisher 确切概率法比较两组患者基 线特征的分布情况;绘制 Kaplan-Meier 曲线并计算两组患者的 5 年总生存(OS)率。 通过单、多变量 Cox 回归分析认定影响宫 颈癌患者预后的独立预测因素。 结果 CONUT≥3 分组患者盆腔淋巴结转移率(42. 9%比 23. 7%, χ 2 = 4. 758, P = 0. 029)与 FIGO 分期ⅡA 期比例(64. 3% 比 42. 5%, χ 2 = 5. 229, P=0. 022)较 CONUT<3 分组明显更高。 Kaplan-Meier 曲线展示 CONUT≥ 3 分与 CONUT<3 分组患者的 5 年 OS 率分别为 63. 4%和 86. 6%,差异具有统计学意义(χ 2 = 11. 409, P= 0. 001)。 亚组分析进 一步证实 CONUT 评分可独立于 FIGO 分期预测宫颈癌患者预后,术前 CONUT≥3 分提示患者预后不佳(FIGO 分期ⅠB 期: 65. 8% 比 95. 5%, χ 2 = 7. 902, P= 0. 005; FIGO 分期ⅡA 期: 62. 7% 比 76. 1%, χ 2 = 4. 206, P= 0. 043)。 单、多因素 Cox 回归 分析表明,术前 CONUT 评分(HR= 3. 542, 95%CI = 1. 529 ~ 8. 207,P = 0. 008)、肿瘤大小(HR = 2. 668, 95%CI = 1. 158 ~ 6. 149, P= 0. 021)和盆腔淋巴结转移(HR= 3. 542, 95%CI = 1. 529~ 8. 207,P = 0. 003)是 FIGO 分期ⅠB~ ⅡA 期宫颈癌患者的独立预 后因子。 结论 CONUT 评分是一项评估 FIGO 分期ⅠB~ⅡA 期宫颈癌患者预后的有效工具,具有一定的临床应用价值。

Objective To explore the clinical value of controlling nutritional status CONUT in the prognostic evaluation of cervical cancer patients. Method A total of 122 FIGO ⅠB~ⅡA stage patients who received surgical resection for cervical cancer in Taizhou People's Hospital from January 2016 to December 2018 were included in this study. All patients were divided into CONUT <3 points and CONUT ≥3 according to the CONUT score. The distributions of baseline characteristics between the two groups were compared by χ 2 test or Fisher's exact test. The survival curves were plotted and the 5-year overall survival OS rates of patients in CONUT <3 points and CONUT ≥3 points group were calculated using Kaplan-Meier curve. Univariate and multivariate Cox regression analysis was conducted to identify the independent prognostic factors for cervical cancer patients. Result The frequency of pelvic lymph node metastasis 42. 9% vs 23. 7% χ 2 = 4. 758 P= 0. 029 and the proportion of FIGO ⅡA stage 64. 3% vs 42. 5% χ 2 = 5. 229 P= 0. 022 were significantly higher in the CONUT≥3 points group than in the CONUT <3 points group. Kaplan-Meier curve showed that the 5- year OS rates of patients in the CONUT≥3 points and CONUT <3 points group were 63. 4% and 86. 6% respectively χ 2 = 11. 409 P= 0. 001 . Subgroup analysis further confirmed that CONUT≥3 points was a significant predictor of poor OS for cervical cancer patients irrespective of FIGO stage FIGO ⅠB stage 65. 8% vs 95. 5% χ 2 = 7. 902 P= 0. 005 FIGO ⅡA stage 62. 7% vs 76. 1% χ2 = 4. 206 P= 0. 043 . In addition the univariate and multivariate Cox analysis revealed that preoperative CONUT HR = 3. 542 95%CI = 1. 529 - 8. 207 P = 0. 008 tumor size HR = 2. 668 95% CI = 1. 158 - 6. 149 P = 0. 021 and pelvic lymph node metastasis HR= 3. 542 95%CI = 1. 529-8. 207 P = 0. 003 were independent prognostic factors for cervical cancer patients. Conclusion CONUT was an effective tool of prognostic evaluation and it might have an important clinical value for cervical cancer patients with FIGO ⅠB~ⅡA stage.