Prediction Efficacy for Clinical Outcome of Prognostic Nutritional Index in Patients with Resectable Biliary Tract Cancer Depends on Sex and Obstructive Jaundice Status
Prediction Efficacy for Clinical Outcome of Prognostic Nutritional Index in Patients with Resectable Biliary Tract Cancer Depends on Sex and Obstructive Jaundice Status
复制标题
可切除胆道癌患者预后营养指数临床结果的预测效果取决于性别和梗阻性黄疸状况
DOI：
10.1245/s10434-020-08728-8
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发表时间：
2020-06-16
影响因子：
3.7
通讯作者：
Wang, Yueqi
中科院分区：
文献类型：
--
作者：
Wang, Jie;Bo, Xiaobo;Wang, Yueqi
背景预后营养指数 (PNI) 是营养状况和全身炎症的标志物，是某些癌症中经过验证的预后生物标志物。 PNI 对胆道癌 (BTC) 的预测价值尚未确定。目的本研究的目的是确定 PNI 与可切除 BTC 结局之间的关系。方法总共 430 例 I-III 期可切除 BTC 患者[胆囊癌 (GBC)，n= 212；纳入复旦大学附属中山医院就诊的胆管癌（CHO），n= 218]。在整个队列和选定的亚组中评估 PNI 与临床结果之间的关系。结果符合条件的患者被分为 PNI 低组 (PNI < 45) 和 PNI 高组 (PNI ≥ 45)。 PNI 低组在整个队列 (p= 0.002) 和 GBC 亚组 (p= 0.001) 中的总生存期 (OS) 均显着较差，但在 CHO 亚组中与 PNI 高组的 OS 相似 (p= 0.328)。多变量分析显示，低 PNI 是 GBC 生存较差的独立危险因素（风险比 1.623，95% 置信区间 1.063–2.480，p= 0.026）。研究发现，PNI 可预测 GBC 女性 (p< 0.001) 和无梗阻性黄疸 (p= 0.017) 患者的临床结果，但不是任何 CHO 亚组的预后因素。对于 GBC 女性，当 TNM 分期与 PNI 结合时，时间依赖性受试者工作特征曲线下的估计面积显着更大。 结论 PNI 是 GBC 中 OS 的独立预测因子，但在 CHO 中则不然。它对于患有 GBC 的男性或患有阻塞性黄疸的患者没有预后价值。
BackgroundThe Prognostic Nutritional Index (PNI), a marker of nutritional status and systemic inflammation, is a proven prognostic biomarker in some cancers. The predictive value of PNI in biliary tract cancer (BTC) has not been established.ObjectiveThe aim of this study was to determine the relationship between the PNI and outcomes of resectable BTC.MethodsIn total, 430 patients with stage I–III resectable BTC [gallbladder cancer (GBC),n= 212; cholangiocarcinoma (CHO),n= 218] who had attended Fudan University Zhongshan Hospital were enrolled. The relationship between the PNI and clinical outcomes was evaluated both in the whole cohort and in selected subgroups.ResultsEligible patients were classified into PNI-low (PNI < 45) and PNI-high (PNI ≥ 45) groups. The PNI-low group had significantly worse overall survival (OS) in both the whole cohort (p= 0.002) and in the GBC subgroup (p= 0.001), but had similar OS as the PNI-high group in the CHO subgroup (p= 0.328). Multivariate analysis revealed that low PNI is an independent risk factor for worse survival in GBC (hazard ratio 1.623, 95% confidence interval 1.063–2.480,p= 0.026). PNI was found to predict clinical outcome in women (p< 0.001) and patients without obstructive jaundice (p= 0.017) with GBC, but was not a prognostic factor in any subgroup with CHO. The estimated area under the time-dependent receiver operating characteristic curve was significantly greater when TNM stage was combined with PNI in women with GBC.ConclusionsPNI is an independent predictor of OS in GBC, but not in CHO. It has no prognostic value in men with GBC or patients with obstructive jaundice.