目的 探讨营养状态评估在胃癌全胃切除术后患者化疗耐受性中的应用研究。 方法 纳入于 2018 年 3 月至 2022 年 2 月至首都医科大学附属北京潞河医院接受根治性全胃切除术和术后化疗的 154 例胃癌患者作为研究对象,根据患者术后 6 个月内是否停止化疗分为耐受组(n = 122)和不耐受组(n = 32),采用 Kaplan-Meier 曲线分析化疗持续时间分层与全胃切除术 后患者生存率的关系,对比两组患者术前及术后化疗前基础资料,单因素 Logistic 回归分析全胃切除术后患者化疗耐受性的 影响因子,绘制 ROC 曲线分析相关因素的预测价值。 结果 Kaplan-Meier 曲线分析显示:全胃切除术后患者化疗耐受性与总 生存率相关[Log Rank (Mantel-Cox)= 11. 017,P= 0. 001]。 两组患者年龄、基础疾病、营养风险筛查 2002(NRS 2002)、预后营 养指数(PNI)、癌胚抗原(CEA)、白蛋白(ALB)及血红蛋白(Hb)水平对比,差异有统计学意义(P<0. 05)。 将单因素分析中 P< 0. 05 的变量纳入多因素 Logistic 回归模型,结果显示:年龄(OR = 6. 150)、PNI(OR = 3. 263)、Hb(OR = 1. 090) 和 ALB(OR = 1. 342)是全胃切除术后患者化疗耐受性的独立危险因素(P<0. 05)。 绘制 ROC 曲线结果显示:年龄的曲线下面积(AUC)为 0. 694(95%CI = 0. 615 ~ 0. 766), PNI 的 AUC 为 0. 774 ( 95% CI = 0. 700 ~ 0. 838), Hb 的 AUC 为 0. 893 ( 95% CI = 0. 833 ~ 0. 937),ALB 的 AUC 为 0. 814(95%CI = 0. 743~ 0. 872)。 结论 年龄较大、PNI 低和血红蛋白及白蛋白水平偏低是胃癌全胃切 除术后患者化疗耐受性的危险因素,其中血红蛋白及白蛋白水平对全胃切除术后患者化疗耐受性具有显著预测效能,有待作 为胃癌患者术后患者化疗耐受性的预测指标。

Objective To explore the application of nutritional status assessment in chemotherapy tolerance of patients after total gastrectomy. Method 154 gastric cancer patients who received radical total Gastrectomy and postoperative chemotherapy from March 2018 to February 2022 in Beijing Luhe Hospital Capital Medical University were included as the study subjects. According to whether the patients stopped chemotherapy within 6 months after surgery they were divided into tolerance group n = 122 and intolerance group n = 32 . Kaplan Meier curve was used to analyze the relationship between the stratification of chemotherapy duration and the survival rate of patients after total gastrectomy Single factor logistic regression was used to analyze the influencing factors of chemotherapy tolerance in patients after total gastrectomy and Receiver operating characteristic was drawn to analyze the predictive value of related factors. Result Kaplan Meier survival curve analysis showed that chemotherapy tolerance of patients after total gastrectomy was related to overall survival rate Log Rank Mantel Cox = 11. 017 P = 0. 001 . Age basic diseases nutritional risk screening 2002 NRS 2002 prognostic nutritional index PNI carcinoembryonic antigen CEA albumin ALB and hemoglobin Hb of the patients in the two groups. The variables in univariate analysis P<0. 05 were included in multivariate Logistic regression model and the results showed that age OR= 6. 150 PNI OR = 3. 263 Hb OR = 1. 090 and ALB OR = 1. 342 were the independent risk factors of chemotherapy tolerance of patients after total gastrectomy P<0. 05 . The ROC curve shows that the area under the curve AUC of age is 0. 694 95%CI = 0. 615-0. 766 that of PNI is 0. 774 95%CI = 0. 700-0. 838 that of Hb is 0. 893 95%CI = 0. 833-0. 937 and that of ALB is 0. 814 95% CI = 0. 743 - 0. 872 . Conclusion Older age low prognostic nutritional index and low levels of hemoglobin and albumin are risk factors for chemotherapy tolerance in patients after total gastrectomy among which hemoglobin and albumin levels have significant predictive efficacy on chemotherapy tolerance of patients after total gastrectomy and need to be used as predictive indicators for postoperative chemotherapy tolerance of patients with gastric cancer.