目的 探讨放疗前预后营养指数(PNI)、体质指数(BMI)及 N 分期在鼻咽癌放化疗患者临床结局预测中的价值。 方 法 选取 2010 年 1 月至 2015 年 12 月于成都医学院第二附属医院·核工业四一六医院行放化疗的鼻咽癌患者 128 例,回顾性 分析其一般信息、治疗方案、实验室检查、病理及影像学资料,随访临床结局至 2021 年 12 月 20 日,分析鼻咽癌患者预后的影 响因素。 结果 中位数为 69. 5 个月的随访期内患者死亡率为 21. 88%,128 例患者 3 年和 5 年生存率分别为 94. 53% 和 80. 47%。 受试者操作特征(ROC)曲线发现:白蛋白(ALB)、淋巴细胞计数(LYM)、PNI、白细胞计数(WBC)和 BMI 等 5 个指标 对预测患者生存率有统计学意义(P<0. 05),其截止点分别为 37. 5 g / L、1. 75×10 9 / L、45. 0、4. 55×10 9 / L 和 21. 85 kg / m 2 。 单因 素分析发现 PNI、 ALB、 LYM、 WBC 均是患者预后的危险因素,肿瘤分期、T 分期、N 分期和 BMI 均是患者预后的保护因素,多 因素 Cox 回归发现:PNI≥45. 0 和 BMI≥21. 85 kg / m 2 是患者预后的保护因素,而 N 分期 2~ 3 期则是患者预后的危险因素,其 HR(95%CI)分别为 0. 784(0. 725-0. 847)、0. 824(0. 700-0. 970)和 4. 289(1. 737-10. 589) (P<0. 05)。 结论 鼻咽癌患者放化 疗前营养状况与临床预后有关,PNI、BMI 和 N 分期可以作为患者预后的独立预测因素。

Objective To discuss the application value of prognostic nutritional index PNI body mass index and N stage before radiotherapy in predicting the clinical outcome of nasopharyngeal carcinoma NPC patients undergoing radiochemotherapy. Method From January 2010 to December 2015 128 NPC patients undergoing radiochemotherapy in No. 416 Hospital of the nuclear industry were selected and retrospectively analyzed their general information treatment plan laboratory examination pathology and imaging data. The clinical outcomes were followed up until December 20 2021. Kaplan-Meier method was used to draw the survival curve. Log rank χ2 Test and Cox regression analysis was used to explore the prognositic factors of nasopharyngeal carcinoma patients. Result The mortality was 21. 88% during the median at 69. 5 months follow- up. The 3 - year and 5 - year survival rates of 128 patients were 94. 53% and 80. 47% respectively. Receiver operating characteristic ROC curve showed that albumin ALB lymphocyte LYM PNI white blood cell WBC and body mass index BMI were statistically significant in predicting the survival rate of patients P< 0. 05 with cut-off values at 37. 5 g / L 1. 75 × 10 9 / L 45. 0 4. 55 × 10 9 / L and 21. 85 kg / m 2 respectively. Univariate analysis showed that PNI ALB LYM and WBC were all risk factors for prognosis while tumor stage T stage N stage and BMI were all protective factors for prognosis. Multivariate Cox regression showed that PNI ≥ 45. 0 and BMI ≥ 21. 85 kg / m 2 were protective factors while N stage 2 to 3 was a risk factor for the prognosis of nasopharyngeal carcinoma patients with HR 95%CI 0. 784 0. 725-0. 847 、 0. 824 0. 700-0. 970 and 4. 289 1. 737 - 10. 589 respectively P < 0. 05 . Conclusion The nutritional status of nasopharyngeal carcinoma patients before radiochemotherapy is related to the clinical prognosis. PNI BMI and N stage can be used as independent prognostic factors of nasopharyngeal carcinoma patients.