PNI对颈胸上段食管鳞癌患者预后及放射性食管炎预测价值

doi:10.3760/cma.j.cn113030-20221212-00420

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摘要目的探讨治疗前小野寺预后营养指数（PNI）对接受根治性放化疗颈胸上段食管鳞癌（CUTESCC）患者预后的影响和对≥2级放射性食管炎发生的预测价值。方法回顾性分析河北医科大学第四医院2012年1月至2017年12月符合入组条件的163例CUTESCC患者的资料。应用受试者操作特征（ROC）曲线计算PNI预测患者预后的最佳截止值,对患者的预后进行单因素和Cox多因素分析。logistic二元回归模型用于单因素和多因素分析≥2级放射性食管炎（RE）的危险因素,将logistic多因素分析中具有统计学意义的因素用来构建预测≥2级RE的列线图。结果 PNI的最佳截止值为48.57[曲线下面积（AUC）=0.653,P<0.001]。全组患者中位总生存（OS）和无进展生存（PFS）期分别为26.1、19.4个月。PNI≥48.57组（47例）患者的OS（χ²=6.900,P=0.009）和PFS（χ²=9.902,P=0.003）均显著优于PNI<48.57组（116例）。Cox多因素分析显示,患者cTNM分期和PNI为影响患者OS（HR=1.513,95%CI为1.193~1.920,P=0.001;HR=1.807,95%CI为1.164~2.807,P=0.008）和PFS（HR=1.595,95%CI为1.247~2.039,P<0.001;HR=2.260,95%CI为1.439~3.550,P<0.001）的独立性预测指标,近期疗效为影响患者PFS的另一独立性指标（HR=2.072,95%CI为1.072~4.003,P=0.030）。logistic多因素分析显示,病变最大横径（OR=3.026,95%CI为1.266~7.229,P=0.013）、大体肿瘤体积（GTV）（OR=3.456,95%CI为1.373~8.699,P=0.008）、处方剂量（OR=3.124,95%CI为1.346~7.246,P=0.009）和PNI（OR=2.072,95%CI为1.072~4.003,P=0.030）是影响患者出现≥2级RE的独立性因素。将这4项指标纳入列线图模型：ROC曲线分析显示,该模型可以较好地预测患者≥2级RE的发生（AUC=0.686,95%CI为0.585~0.787）;校正曲线显示,实际观测值与预测RE之间具有良好的一致性;决策曲线分析显示,在大多数阈值概率中列线图正净收益令人满意。结论治疗前小野寺PNI为接受根治性放化疗颈胸上段食管鳞癌患者的独立性预后影响因素;病变最大横径、GTV、处方剂量和PNI这4项指标为本组患者出现≥2级放射性食管炎的危险因素,建立包含这些因素的预测模型,预测价值更大。

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	李曙光
	陈俊强
	李幼梅
	郭雪涵
	邓文钊
	王晓斌
	祝淑钗
	沈文斌

关键词 ：食管肿瘤, 鳞状细胞, 放射性食管炎, 根治性放化疗, 列线图, 预后营养指数

Abstract：Objective To investigate the prognostic value of Onodera's prognostic nutrition index (PNI) before treatment in patients with cervical and upper thoracic esophageal squamous cell carcinoma (CUTESCC) undergoing definitive chemoradiotherapy (dCRT) and its predictive value in the occurrence of ≥ grade 2 radiation esophagitis (RE). Methods The data of 163 CUTESCC patients eligible for inclusion criteria admitted to the Fourth Hospital of Hebei Medical University from January 2012 to December 2017 were retrospectively analyzed. The receiver operating characteristic (ROC) curve was used to calculate the best cut-off value of PNI for predicting the prognosis of patients. The prognosis of patients was analyzed by univariate and Cox multivariate analyses. Logistics binary regression model was adopted to analyze the risk factors of ≥ grade 2 RE in univariate and multivariate analyses. The significant factors in logistic multivariate analysis were used to construct nomogram for predicting ≥ grade 2 RE. Results The optimal cut-off value of PNI was 48.57 [area under the curve (AUC): 0.653, P<0.001]. The median overall survival (OS) and progression-free survival (PFS) were 26.1 and 19.4 months, respectively. The OS (χ²=6.900, P=0.009) and PFS (χ²=9.902, P=0.003) of patients in the PNI ≥ 48.57 group (n=47) were significantly better than those in the PNI < 48.57 group (n=116). Cox multivariate analysis showed that cTNM stage and PNI were the independent predictors of OS (HR=1.513, 95%CI: 1.193-1.920, P=0.001; HR=1.807, 95%CI: 1.164-2.807, P=0.008) and PFS (HR=1.595, 95%CI: 1.247-2.039, P<0.001; HR=2.260, 95%CI: 1.439-3.550, P<0.001). Short-term efficacy was another independent index affecting PFS (HR=2.072, 95%CI: 1.072-4.003, P=0.030). Logistic multivariate analysis showed that the maximum transverse diameter of the lesion (OR=3.026, 95%CI: 1.266-7.229, P=0.013), gross tumor volume (GTV) (OR=3.456, 95%CI: 1.373-8.699, P=0.008), prescription dose (OR=3.124, 95%CI: 1.346-7.246, P=0.009) and PNI (OR=2.072, 95%CI: 1.072-4.003, P=0.030) were the independent factors affecting the occurrence of ≥ grade 2 RE. These four indicators were included in the nomogram model, and ROC curve analysis showed that the model could properly predict the occurrence of ≥ grade 2 RE (AUC=0.686, 95%CI: 0.585-0.787). The calibration curve indicated that the actually observed values were in good agreement with the predicted RE. Decision curve analysis (DCA) demonstrated satisfactory nomogram positive net returns in most threshold probabilities. Conclusions PNI before treatment is an independent prognostic factor for patients with CUTESCC who received definitive chemoradiotherapy. The maximum transverse diameter of the lesion, GTV, prescription dose and PNI are the risk factors for ≥ grade 2 RE in this cohort. Establishing a prediction model including these factors has greater predictive value.

Key words： Esophageal neoplasms squamous cell Radiation esophagitis Definitive chemoradiotherapy Nomogram Prognostic nutrition index

收稿日期: 2022-12-12

通讯作者: 沈文斌,Email：wbshen1979@sina.com

引用本文:

李曙光,陈俊强,李幼梅等. PNI对颈胸上段食管鳞癌患者预后及放射性食管炎预测价值[J]. 中华放射肿瘤学杂志, 2023, 32(8): 689-696.

Li Shuguang,Chen Junqiang,Li Youmei et al. Prognostic value of pre-treatment prognostic nutrition index in patients with cervical and thoracic upper esophageal squamous cell carcinoma and radiation induced esophagitis[J]. Chinese Journal of Radiation Oncology, 2023, 32(8): 689-696.

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