目的 探讨治疗前C反应蛋白-白蛋白-淋巴细胞(CALLY)指数对喉鳞状细胞癌(简称喉癌)术后放射治疗(简称放疗)患者发生吞咽困难相关营养不良及生存预后的预测价值。方法 回顾性收集荆门市人民医院2019年1月至2021年12月收治的102例接受术后放疗的喉癌患者。收集治疗前实验室指标计算CALLY指数,通过受试者操作特征(ROC)曲线确定预测营养不良的最佳截断点,据此分为低CALLY组(n=52)与高CALLY组(n=50)。比较两组基线特征,采用Logistic回归分析营养不良的影响因素。中位随访时间33.05(9.65, 60.01)个月,低CALLY组共有36例死亡,32例复发;高CALLY组共有28例死亡,22例复发。采用Kaplan-Meier法和Cox比例风险回归模型分析CALLY指数与总生存期(OS)、无进展生存期(PFS)的关系。结果 CALLY指数预测营养不良的ROC曲线的曲线下面积(AUC)为0.942,最佳截断点为1.382。低CALLY组营养不良发生率显著高于高CALLY组(64.5% 比 26.0%,P<0.001)。多因素Logistic回归分析显示,在校正年龄、体质指数(BMI)、美国东部肿瘤协作组体力状态评分(ECOG-PS)、吸烟史、饮酒史及切缘状态等因素后,CALLY指数是营养不良的独立影响因素(OR=0.507,95%CI=0.295~0.870,P=0.014)。生存分析显示,低CALLY组OS和PFS均显著缩短(P<0.0 01)。多因素Cox比例风险回归模型分析证实,在校正年龄、肿瘤分化程度、切缘状态、TNM分期及吸烟史等因素后,CALLY指数降低是OS(HR=0.644, 95%CI=0.509~0.816,P<0.001)和PFS(HR=0.669,95%CI=0.508~0.880, P=0.004)的保护因素。结论 CALLY指数与喉癌术后放疗患者吞咽困难相关营养不良及不良生存预后密切相关,可作为早期识别营养不良及预后风险的潜在生物标志物,为临床风险分层和个体化管理提供参考。
Abstract
Objective To investigate the predictive value of the pretreatment C reactive protein-albumin-lymphocyte (CALLY) index for malnutrition due to dysphagia and survival prognosis in patients with laryngeal carcinoma undergoing postoperative radiotherapy. Method Retrospective collection of 102 laryngeal cancer patients who received postoperative radiotherapy at Jingmen People's Hospital from January 2019 to December 2021. The CALLY index was calculated from pretreatment laboratory parameters. The optimal cut-off value for predicting malnutrition was determined by receiver operating characteristic (ROC) curve analysis, and patients were accordingly stratified into low-CALLY group (n=52) and high-CALLY group (n=50). Baseline characteristics were compared. Logistic regression was used to analyze factors associated with malnutrition. The median follow-up time was 33.05 (9.65,60.01) months. In the low CALLY group, there were 36 deaths and 32 relapses; in the high CALLY group, there were 28 deaths and 22 relapses. The Kaplan-Meier method and Cox proportional hazards models were employed to assess the correlation between the CALLY index and overall survival (OS) as well as progression-free survival (PFS). Result The area under the ROC curve (AUC) of the CALLY index for predicting malnutrition was 0.942, with an optimal cut-off value of 1.382. The incidence of malnutrition was significantly higher in the low-CALLY group (64.5% vs 26.0%, P<0.001). Multivariate logistic regression identified that after adjusting for factors such as age, body mass index, ECOG-PS score, smoking history, alcohol consumption history, and resection margin status, a low CALLY index was an influencing factor for malnutrition (OR=0.507, 95%CI=0.295-0.870, P=0.014). Survival analysis revealed that the low-CALLY group had significantly shorter OS and PFS (P<0.001). Multivariate Cox analysis confirmed that after adjusting for factors such as age, tumor differentiation degree, margin status, TNM stage, and smoking history, a low CALLY index was an independent protective factor for both OS (HR=0.644,95%CI=0.509-0.816, P<0.001) and PFS (HR=0.669,95%CI=0.508-0.880, P=0.004). Conclusion The CALLY index may serve as a potential biomarker for identifying dysphagia-related malnutrition and unfavorable survival outcomes in patients with laryngeal carcinoma undergoing postoperative radiotherapy, and may provide a reference for clinical risk stratification and individualized management.
关键词
C反应蛋白-白蛋白-淋巴细胞指数 /
喉癌 /
术后放疗 /
吞咽困难 /
营养不良 /
预后 /
总生存期 /
无进展生存期
Key words
C reactive protein-albumin-lymphocyte index /
Laryngeal neoplasms /
Postoperative radiotherapy /
Dysphagia /
Malnutrition /
Prognosis /
Overall survival /
Progression-free survival
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基金
2024年荆门市引导性科研计划项目(2024YDKY034)
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