营养状态对非小细胞肺癌患者手术后病情进展的预测价值
Predictive value of nutritional status in postoperative progression of patients with non-small cell lung cancer

张文珺.营养状态对非小细胞肺癌患者手术后病情进展的预测价值[J].内科急危重症杂志,2021,27(2):125-128

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DOI：10.11768/nkjwzzzz20210209

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基金项目:江苏省六大人才高峰第十二批自助项目(No:2015-WSW-089)

作者	单位	E-mail
张文珺	泰州市人民医院	297445606@qq.com

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中文摘要:

目的:探讨手术治疗前及化疗1个月后营养状态对非小细胞肺癌（NSCLC）重症患者预后的预测价值。方法:选取诊断NSCLC并手术治疗的重症患者122例，随访1年，根据随访期间病情是否发生进展将患者分为进展组及病情稳定的对照组，比较2组患者一般资料及治疗前、后营养风险指数（NRI）、肿瘤标记物（CEA、CYFR21-1）水平，应用Logistic回归分析影响NSCLC复发的独立危险因素；应用ROC曲线评估不同指标对复发的预测效能。结果：本研究失访4例，发生复发（进展组）57例（48.31%），对照组61例。手术治疗前进展组体重指数显著低于对照组（24.16±3.87 vs. 28.97±5.01, P ＜0.05），治疗后进展组应用靶向治疗率显著低于对照组（5.26% vs. 19.67%， P ＜0.05），血清白蛋白水平显著低于对照组（32.18±4.97 vs. 35.18±6.12，P ＜0.01）。手术治疗前及化疗后进展组NRI显著低于对照组，血清CEA及CYFRA 21-1水平显著高于对照组（ P ＜0.05或 P ＜0.01），多因素logistic回归结果显示术后靶向治疗及治疗后高水平的NRI是病情进展的独立保护因素（ OR=0.690，0.892；P =0.008，0.037），治疗后高水平的血清CYFRA 21-1是病情进展的独立危险因素（ OR=13.284；P =0.036），术后靶向治疗、治疗后NRI、血清CYFRA 21-1预测NSCLC治疗后病情进展的曲线下面积（AUC）分别为0.727、0.627、0.673，各指标间差异无统计学意义（均 P >0.05）。结论：手术前、后营养状态对判断NSCLC患者的预后有一定价值。

英文摘要:

Objective: To explore the prognostic value of nutritional status before surgery and one month after chemotherapy in non-small cell lung cancer (NSCLC) patients. Methods: 122 cases of NSCLC diagnosed and treated in our hospital were selected for 1-year follow-up, and patients were divided into a progressive group and control group according to whether progress occurred during the follow-up period. The levels of nutritional risk index (NRI), tumor markers (CEA, CYFR21-1) before and after surgery were compared between the two groups. Logistic regression was used to analyze the independent risk factors of NSCLC recurrence. The ROC curve was used to evaluate the predictive efficacy of different indicators for recurrence. Results: In this study, there were 4 cases of lost follow-up, 57 cases of recurrence and 61 cases of control group. BMI in the progressive group was significantly lower than that in the control group (24.16±3.87 vs. 28.97±5.01, P <0.05). Postoperative targeted therapy rate (5.26% vs . 19.67%, P <0.05), levels of postoperative ALB (32.18± 4.97 vs . 35.18±6.12, P <0.01) in the progressive group was significantly lower than those in the control group. NRI in the progressive group was significantly lower than that in the control group, CEA and serum CYFRA 21-1 levels in the progressive group were significantly higher than those in the control group before and after surgery ( P<0.05 or P <0.01). Multivariate logistic regression showed that postoperative targeted therapy and high postoperative NRI were independent protective factors for progression ( OR=0.690, 0.892; P =0.008, 0.037), and high postoperative serum CYFRA 21-1 level was an independent risk factor for progression ( OR=13.284, P = 0.036). The AUC of postoperative targeted therapy, postoperative NRI, and CYFRA 21-1 in predicting postoperative progress of NSCLC was 0.727, 0.627 and 0.673 respectively without significant difference among the indicators ( P> 0.05). Conclusions: The nutritional status before and after surgery has certain value for the prognosis of NSCLC patients.