老年营养风险指数联合血浆纤维蛋白原与白蛋白比值对放化疗老年直肠癌患者的预后价值

Predictive value of the Geriatric Nutrition Risk Index combined with plasma fibrinogen to albumin ratio in the prognosis of elderly rectal cancer patients undergoing radiotherapy and chemotherapy

摘要:

目的 探讨老年营养风险指数（GNRI）联合血浆纤维蛋白原与白蛋白比值（F/A）对放化疗老年直肠癌患者的预后价值。方法 选取2015年1月—2017年1月新疆医科大学第一附属医院收治的150例行放化疗的老年直肠癌患者。放化疗前根据GNRI和F/A中位数分为高GNRI组（≥ 96.38）、低GNRI组（< 96.38）和高F/A组（≥ 0.12）和低F/A组（< 0.12），分别有75例、75例和86例、64例。采用Kaplan-Meier法绘制不同GNRI和血浆F/A的直肠癌患者生存曲线。随访5年根据患者存活状况分为死亡组和存活组，分别有56例94例。采用单因素和多因素Cox回归分析放化疗老年直肠癌患者预后的影响因素。绘制受试者工作特征（ROC）曲线，分析GNRI和血浆F/A单独及联合对放化疗老年直肠癌患者预后不良的诊断效能。结果 Kaplan-Meier生存曲线显示，高GNRI组5年总生存率高于低GNRI组（P <0.05），高F/A组5年总生存率低于低GNRI组（P <0.05）。死亡组BMI、Alb和GNRI ≥ 96.38比例低于存活组，糖尿病史、低位直肠癌、TNM分期Ⅲ～Ⅳ期、有淋巴结转移、Fib、F/A ≥ 0.12高于存活组（P <0.05）。两组患者性别、年龄比较，差异无统计学意义（P >0.05）。多因素Cox一般回归模型结果显示：TNM分期Ⅲ～Ⅳ期［H^R=1.909（95% CI：1.085，3.358）］、淋巴结转移［H^R=2.535（95% CI：1.218，5.278）］、F/A ≥ 0.12 ［H^R=1.484（95% CI：1.021，2.156）］是放化疗老年直肠癌患者预后危险因素（P <0.05），GNRI ≥ 96.38 ［H^R=0.918（95% CI：0.857，0.983）］是放化疗老年直肠癌患者预后保护因素（P <0.05）。ROC曲线分析结果显示，GNRI预测放化疗老年直肠癌患者预后不良的截断值为95.41，敏感性为67.86%（95% CI：0.583，0.746），特异性为72.34%（95% CI：0.659，0.857）；F/A最佳临界值为0.12，敏感性为78.57%（95% CI：0.688，0.872），特异性为78.72%（95% CI：0.664，0.895）；两者联合预测的敏感性为87.50%（95% CI：0.766，0.924），特异性为75.53%（95% CI：0.623，0.851）。结论 GNRI降低和血浆F/A升高与老年直肠癌患者预后不良有关，GNRI联合血浆F/A预测放化疗老年直肠癌患者疗效更佳。

Abstract:

Objective To investigate the predictive value of the Geriatric Nutrition Risk Index (GNRI) combined with plasma fibrinogen to albumin ratio (F/A) on the prognosis of elderly rectal cancer patients treated with radiotherapy and chemotherapy.Methods A total of 150 elderly patients with rectal cancer who received radiotherapy and chemotherapy in The First Affiliated Hospital of Xinjiang Medical University from January 2015 to January 2017 were selected. According to the GNRI and F/A before radiotherapy, patients were divided into high (≥ 96.38, 75 cases) and low (< 96.38, 75 cases) GNRI group as well as high (≥ 0.12, 86 cases) and low (< 0.12, 64 cases) F/A group. Kaplan Meier method was applied to work out the survival curves of rectal cancer patients with different GNRI and plasma F/A. Followed up for 5 years, the patients were divided into death group (56 cases) and survival group (94 cases) according to their survival status. The prognostic factors of elderly rectal cancer patients treated with radiotherapy and chemotherapy were analyzed by univariate and multivariate Cox regression models. The ROC curves were plotted to analyze the values of GNRI and plasma F/A alone and jointly in predicting the poor prognosis of elderly rectal cancer patients treated with radiotherapy and chemotherapy.Results Kaplan Meier survival curves showed that the 5-year overall survival rate of the high GNRI group was higher than that of the low GNRI group, and the 5-year overall survival rate of the high F/A group was lower than that of the low GNRI group (P < 0.05). Compared with the survival group, BMI, Alb and the proportion of patients with GNRI ≥ 96.38 were lower, and the proportions of patients with a history of diabetes mellitus, low rectal cancer, TNM stage Ⅲ to Ⅳ tumors, lymph node metastasis, and F/A ≥ 0.12 as well as Fib were higher in the death group (P < 0.05). There was no difference in the sex composition and age between the two groups (P > 0.05). Multivariate Cox regression analysis revealed that TNM stage Ⅲ to Ⅳ tumors [H^R = 1.909 (95% CI: 1.085, 3.358) ], lymph node metastasis [H^R = 2.535 (95% CI: 1.218, 5.278) ] and F/A ≥ 0.12 [H^R = 1.484 (95% CI: 1.021, 2.156) were risk factors for the prognosis of elderly rectal cancer patients treated with radiotherapy and chemotherapy (P < 0.05), while GNRI ≥ 96.38 [H^R = 0.918 (95% CI: 0.857, 0.983) ] was a protective factor (P < 0.05). ROC curve analysis showed that the optical cut-off value of GNRI for predicting poor prognosis of elderly rectal cancer patients treated with radiotherapy and chemotherapy was 95.41, with the sensitivity being 67.86% (95% CI: 0.583, 0.746) and the specificity being 72.34% (95% CI: 0.659, 0.857). The optimal cut-off value of F/A was 0.12, with the sensitivity being 78.57% (95% CI: 0.688, 0.872) and the specificity being 78.72% (95% CI: 0.664, 0.895). In addition, the sensitivity of the combined GNRI and F/A for prediction was 87.50% (95% CI: 0.766, 0.924), with the specificity being 75.53% (95% CI: 0.623, 0.851).Conclusions The decrease of GNRI and the increase of plasma F/A are related to the poor prognosis of elderly rectal cancer patients. GNRI combined with plasma F/A is of great predictive value on the prognosis of elderly rectal cancer patients treated with radiotherapy and chemotherapy.