Predictive value of the Naples prognostic score on postoperative outcomes in patients with rectal cancer
Predictive value of the Naples prognostic score on postoperative outcomes in patients with rectal cancer
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DOI：
10.1007/s00423-023-02851-2
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发表时间：
2023-03-01
影响因子：
2.3
通讯作者：
Maeda，Kiyoshi
中科院分区：
文献类型：
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作者：
Sugimoto，Atsushi;Fukuoka，Tatsunari;Maeda，Kiyoshi
目的那不勒斯预后评分(NPS)是一种基于营养和炎症状态的预后指标。然而，它在预测直肠癌术后并发症(POCs)中的作用尚未被检验。方法对235例手术治疗的复发性复发性鼻咽癌患者进行回顾性分析。根据血清白蛋白、血清总胆固醇、中性粒细胞/淋巴细胞比率(NLR)和淋巴细胞/单核细胞比率(LMR)计算NPS。重度POC定义为Clavien-Dindo分级 ≥ Ⅲ级。通过受试者操作特征(ROC)曲线分析确定最佳截断值。以NPS、NLR、LMR、血小板/淋巴细胞比(PLR)、C反应蛋白/白蛋白比(CAR)、格拉斯哥预后评分(GPS)、Onodera预后营养指数(PNI)和控制营养状态评分(CONUT)作为炎症和/或营养状态评分。采用Logistic回归模型对重度POCS的预测因素进行分析。结果患者出现严重POCS者占27.2%。男性、手术时间(>； 257min)、出血量(≥ 30min)、白蛋白(<； 4.0g/dL)、C反应蛋白(≥ 1.0 mg/dL)、总胆固醇(≤ 180g/dL)、神经营养不良(≥ 2)、低密度脂蛋白(≥ 3.48)、PLR(≥ 103.6)、CAR(>； 0.025)、≥ ( 1)、PNI(<；≥ 48.1)和Conut(≤ 2)与重度POCS显著相关。多因素分析显示，男性、手术时间(>； 257min)和高NPS值(≥ -2)是严重POCS的独立预测因素。ROC曲线分析显示，在炎症和/或营养指标中，NPS具有最高的预测价值。结论NPS是预测RC严重POCS的有价值的指标。
PurposeThe Naples prognostic score (NPS) is a prognostic index based on the nutritional and inflammatory status. However, its utility in predicting postoperative complications (POCs) has not been examined in rectal cancer (RC). We evaluated the predictive value of the preoperative NPS for POCs in RC.MethodsWe retrospectively analyzed 235 patients who underwent surgery for RC. The NPS was calculated based on serum albumin, serum total cholesterol, the neutrophil-to-lymphocyte ratio (NLR) and the lymphocyte-to-monocyte ratio (LMR). Severe POCs were defined as Clavien-Dindo classification grade ≥ III. The optimal cut-off value of the NPS was determined by a receiver operator characteristic (ROC) curve analysis. The NPS, NLR, LMR, platelet-to-lymphocyte ratio (PLR), C-reactive protein (CRP)-to-albumin ratio (CAR), Glasgow prognostic score (GPS), Onodera prognostic nutritional index (PNI) and controlling nutritional status score (CONUT) were investigated as inflammation-based and/or nutritional markers. Predictors of severe POCs were analyzed by logistic regression modeling.ResultsSevere POCs were observed in 64 patients (27.2%). Male sex, operation time (> 257 min), blood loss (≥ 30 mL), albumin (< 4.0 g/dL), CRP (≥ 1.0 mg/dL), total cholesterol (≤ 180 mg/dL), NPS (≥ 2), LMR (≥ 3.48), PLR (≥ 103.6), CAR (> 0.025), GPS (≥ 1), PNI (< 48.1) and CONUT (≥ 2) were significantly associated with severe POCs. The multivariate analysis revealed that male sex, operation time (> 257 min), and a high NPS (≥ 2) were independent predictors of severe POCs. The ROC curve analysis revealed that the NPS had the greatest predictive value among the inflammation-based and/or nutritional markers.ConclusionThe NPS is a valuable predictor of severe POCs in RC.