目的 探讨预后营养指数(PNI)、体质指数(BMI)对晚期胰腺癌同步放化疗患者预后的预测价值。方法 收集 2020年1月1日至2025年1月1日在武汉大学中南医院接受同步放化疗的晚期胰腺癌患者的临床资料进行回顾性研究。所有患者临床信息及基线数据均于开始放疗前1周内检测并记录,中位随访时间12个月并记录患者的生存情况。营养学指标主要包括PNI及BMI。使用Kaplan-Meier法绘制胰腺癌患者经同步放化疗治疗后的生存曲线,分析基线各指标与总生存(OS)的关系。通过单变量及多变量Cox比例风险回归模型筛选出独立预后因素。结果 本研究共纳入92例患者。通过受试者操作特征曲线(ROC 曲线)判断PNI、BMI和PNI-BMI联合指标的最佳截断点为42.175、20.497、0.332,曲线下面积分别为0.741、0.642、0.749。单变量Cox比例风险回归分析显示,经历过多线治疗、PNI≥42.175、BMI≥20.497 kg/m2与较长的OS期相关;PNI-BMI≥0.332与较短的OS期相关。多变量Cox比例风险回归分析显示。未经历多线治疗是OS的独立预后因素,其与较短的OS期相关。生存分析结果显示,高PNI组中位OS期显著优于低PNI组(中位OS期未达到比11个月,1年生存率为85.2%比39.2%,P<0.001);高BMI组中位OS期显著优于低BMI组(中位OS期43个月比12个月,1年生存率为82.5%比47.2%,P=0.002);低PNI-BMI组中位OS期显著优于高PNI-BMI组(中位OS期未达到比12个月,1年生存率为84.5% 比47.6%,P<0.001)。结论 营养相关指标PNI、BMI及其联合指标PNI-BMI对接受同步放化疗的晚期胰腺癌患者预后有一定预测价值,PNI-BM作为复合指标,较单一指标能更全面地反映患者的综合营养储备功能。
Abstract
Objective To investigate the predictive value of prognostic nutritional index (PNI) and body mass index (BMI) for prognosis in patients with advanced pancreatic cancer undergoing concurrent chemoradiotherapy. Method We conducted a retrospective study on clinical data from patients with advanced pancreatic cancer who underwent concurrent chemoradiotherapy at Zhongnan Hospital of Wuhan University between January 1, 2020, and January 1, 2025. All clinical information and baseline data were collected and recorded within one week prior to the initiation of radiotherapy. The median follow-up period was 12 months, during which patient survival status was documented. Nutritional indicators primarily included PNI and BMI. The Kaplan-Meier method was used to plot survival curves for pancreatic cancer patients after concurrent chemoradiotherapy, analyzing the relationship between baseline indicators and overall survival (OS). Independent prognostic factors were identified using univariate and multivariate Cox regression models. Statistical analysis was performed using SPSS version 30.0. Result A total of 92 patients were included in this study. ROC curve analysis showed optimal cutoff values for PNI, BMI, and the combined PNI-BMI index as 42.175, 20.497, and 0.332, respectively, with corresponding areas under the curve (AUC) of 0.741, 0.642, and 0.749. Univariate Cox regression analysis revealed that receipt of multiple lines of therapy, PNI ≥ 42.175, and BMI ≥ 20.497 kg/m2 were associated with better OS, while PNI-BMI ≥ 0.332 was associated with poorer OS. Multivariate Cox regression analysis identified not having received multiple lines of therapy as an independent prognostic factor for OS, correlating with poorer survival outcomes. Kaplan-Meier survival analysis demonstrated a significantly superior median OS in the high PNI group compared to the low PNI group (median OS not reached vs. 11 months, the 1-year survival rate was 82.2% vs. 39.2%, P <0 .001). Similarly, the high BMI group had a significantly better median OS than the low BMI group (43 months vs. 12 months, the 1-year survival rate was 82.5% vs. 47.2%, P = 0.002). Conversely, the low PNI-BMI group exhibited a significantly longer median OS than the high PNI-BMI group (median OS not reached vs. 12 months, the 1-year survival rate was 84.5% vs. 47.6%, P < 0.001). Conclusion Nutritional indicators, including the Prognostic Nutritional Index (PNI), Body Mass Index (BMI), and their composite index (PNI-BMI), demonstrate prognostic value in patients with locally advanced pancreatic cancer undergoing concurrent chemoradiotherapy. As a composite indicator, PNI-BMI provides a more comprehensive assessment of patients' overall nutritional reserve than any single parameter alone.
关键词
预后营养指数 /
总生存时间 /
预测 /
晚期胰腺癌 /
同步放化疗 /
体质指数 /
胰腺癌 /
预后
Key words
Prognostic nutritional index /
Overall survival time /
prediction /
Advanced pancreatic cancer /
Concurrent chemoradiotherapy /
Body mass index /
Pancreatic cancer /
Prognosis
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