目的 探讨术前预后营养指数(PNI)及骨骼肌面积( SMA)与胃癌胃全切除术患者预后的相关性。 方法 选取 2019 年 3 月至 2020 年 12 月于江汉大学附属医院/ 武汉市第六医院接受胃癌胃全切除术治疗且随访至 2023 年 12 月的胃癌患者 109 例作为研究对象,设立为胃癌组,另选取 54 例健康体检者设立为健康对照组,比较两组 PNI、SMA 变化,并观察 PNI、SMA 在胃癌患者不同病理特征中的表达;采用 Spearman 法分析 PNI、SMA 与胃癌患者临床特征的相关性;采用 Cox 比例风险模型 分析 PNI、SMA 对胃癌患者 3 年随访期中无进展生存及总生存的影响;绘制受试者操作特征(ROC)曲线分析 SMA 预测胃癌患 者预后的曲线下面积(AUC)、敏感度及特异度。 结果 胃癌组的 PNI、SMA 均低于健康对照组(P<0. 05)。 临床分期为Ⅲ期、低 分化、T3 ~ T4 浸润、存在淋巴结转移和脉管浸润的胃癌患者 PNI、SMA 低于临床分期Ⅰ~Ⅱ期、中-高分化、T1 ~ T2 浸润、无淋巴 结转移和脉管浸润的胃癌患者(P<0. 05)。 相关性分析显示,PNI、SMA 与临床分期、分化程度、浸润深度、淋巴结转移、脉管浸 润呈负相关(P<0. 05)。 Cox 比例风险模型分析显示,SMA 下降为胃癌胃全切除术患者 3 年无进展生存的独立影响因素(P< 0. 05)。 ROC 曲线分析显示,SMA 预测胃癌胃全切除术患者 3 年无进展生存的 AUC、敏感度、特异度分别为 0. 797、69. 90%、 83. 30%。 结论 PNI、SMA 在胃癌患者中呈明显下降趋势,其水平会随患者病情程度而发生改变,并影响预后,动态监测其变化 有利于为临床治疗和预后评估提供指导。 SMA 下降为胃癌胃全切除术患者无进展生存的独立影响因素。

Objective To investigate the correlation between preoperative prognostic nutritional index PNI and skeletal muscle area SMA and prognosis of patients with gastric cancer after total gastrectomy. Method A total of 109 patients with gastric cancer who received total gastectomy in the Affiliated Hospital of Jianghan University / Wuhan Sixth Hospital from March 2019 to December 2020 and were followed up to December 2023 were selected as the study subjects and set as the gastric cancer group and 54 healthy subjects were selected as the healthy control group. The changes of PNI and SMA between the two groups were compared. The expressions of PNI and SMA in different pathological features of gastric cancer patients were observed. Spearman method was used to analyze the correlation between PNI SMA and clinical features of gastric cancer patients. Cox proportional risk model was used to analyze the effects of PNI and SMA on 3 - year progression - free survival and overall survival of gastric cancer patients. Receiver operating characteristic ROC curve were drawn to analyze the area under the curve AUC sensitivity and specificity of SMA in predicting the prognosis of patients with gastric cancer. Result PNI and SMA in gastric cancer group were lower than those in healthy control group P<0. 05 . The PNI and SMA of gastric cancer patients with stage Ⅲ low differentiation T3-T4 infiltration lymph node metastasis and vascular invasion were lower than those with stage Ⅰ to Ⅱ medium to high differentiation T1-T2 infiltration and no lymph node metastasis and vascular invasion P < 0. 05 . Correlation analysis showed that PNI and SMA were negatively correlated with clinical stage differentiation degree depth of invasion lymph node metastasis and vascular invasion P<0. 05 . Cox proportional risk model multivariate analysis showed that the decrease of SMA was an independent factor for 3-year progression-free survival in patients with total gastrectomy for gastric cancer P< 0. 05 . ROC curve analysis showed that the AUC sensitivity and specificity of SMA in predicting 3 -year progression -free survival of patients with total gastrectomy for gastric cancer were 0. 797 69. 90% and 83. 30% respectively. Conclusion PNI and SMA showed a significant downward trend in gastric cancer patients and their levels changed with the severity of the patient 's disease and affected the prognosis. Dynamic detection of their changes was conducive to providing guidance for clinical treatment and prognosis assessment. Decreased SMA was an independent factor for 3-year progression-free survival in patients with total gastrectomy for gastric cancer