目的 探索营养预后标志物和身体成分对胃癌晚期患者的预后价值。方法 本研究分析的76例患者来自GAPSO 研究,记录治疗前的淋巴细胞计数和血清白蛋白水平。使用计算机断层扫描测量了两个化疗周期前后第三腰椎水平的骨骼肌质量。结果 使用X-tile计算预后营养指数(PNI)的截断点为49.45,将患者分为高PNI组和低PNI组。与低PNI组相比,高PNI组的一线化疗患者的无进展生存期(12.4个月比5.3个月, P<0.001)和总生存期(27.6个月比11.7个月, P=0.008)均显著延长。在男性和女性患者中,分别采用40.8 cm2/m2和34.9 cm2/m2的骨骼肌指数(SMI)作为截断点,分为高SMI组和低SMI组,两组间无进展生存期和总生存期差异无统计学意义。接受两个周期化疗后SMI下降超过3.56%的患者往往生存期较短。与低PNI患者相比,高PNI患者化疗不良反应有下降趋势,血小板减少的发生率表现出具有统计学意义的下降。多因素Cox比例风险回归模型分析显示,美国东部肿瘤协作组体力状况评分和PNI是总生存的独立预后因素。结论 高PNI是晚期胃癌患者长期生存的积极预后因素,并且与较低的化疗不良反应发生率相关。化疗后出现骨骼肌流失的患者显示出预后不良趋势。
Abstract
Object Based on post-hoc analysis of a prospective study, we analyzed the prognostic significance of inflammatory and nutritional markers in patients with advanced gastric cancer. Methods 76 patients with advanced gastric cancer were enrolled in the GAPSO study. Pretreatment lymphocyte count and serum albumin level were also recorded. Skeletal muscle mass at the third lumbar vertebral level was measured using computed tomography before and after two cycles of chemotherapy. Results X-tile was used to calculate the cut-off value of prognostic nutritional index (PNI) as 49.45, and the patients were divided into PNI-high and PNI-low groups. Compared with the PNI-low group, the progression-free survival (PFS, 12.4 vs 5.3 months, P<0.001) and overall survival (OS, 27.6 vs 11.7 months, P=0.008) of first-line chemotherapy in the PNI-high group were significantly longer. The skeletal muscle index (SMIs) values of males and females were 40.8 cm2/m2 and 34.9 cm2/m2, respectively, and the patients were divided into SMI-high and SMI-low groups, and there were no significant differences in PFS and OS between groups. Patients with a 3.56% decrease in SMI after two cycles of chemotherapy tended to have a shorter OS. Compared with PNI-low patients, PNI-high patients tended to have fewer adverse chemotherapy reactions and a significantly lower incidence of thrombocytopenia. Multivariate analysis showed that ECOG performance status and PNI were independent prognostic factors for OS. Conclusion PNI-high is a positive prognostic factor for long-term survival in patients with advanced gastric cancer and is associated with a lower incidence of adverse chemotherapy reactions. Patients with skeletal muscle loss after chemotherapy exhibited a trend toward worse outcomes.
关键词
胃癌 /
化疗 /
预后营养指数 /
骨骼肌指数 /
不良反应 /
身体成分 /
无进展生存 /
总生存
Key words
Gastric cancer /
Chemotherapy /
Prognostic nutritional index /
Skeletal muscle index /
Adverse reactions /
body composition /
Progression-free survival /
Overall survival
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