The predictive effect of geriatric nutritional risk index combined with D-dimer on the prognosis of esophageal cancer patients with radiotherapy and chemotherapy
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摘要: 目的 探讨老年营养风险指数(GNRI)联合D-二聚体(D-D)在放化疗食管癌患者预后中的预测价值。方法 回顾性分析2016年1月—2019年12月接受根治性放化疗的278例食管癌患者的临床资料，记录患者放化疗前临床资料，并进行随访。采用多因素Cox回归分析食管癌患者死亡的危险因素，并绘制生存曲线图。结果 中位随访时间37个月，278例患者中存活73例(26.26%)，死亡205例(73.74%)。受试者工作特征曲线分析显示，GNRI、D-D分别以85、2.35 mg/L预测食管癌死亡的曲线下面积为0.781(95%CI0.714~0.819，P< 0.001)、0.704(95%CI0.625~0.782，P< 0.001)，联合预测的曲线下面积为0.851(95%CI0.800~0.819，P=0.901)，高于二者单独预测(Z=5.562，P< 0.001;Z=3.816，P< 0.001)，且灵敏度和特异度分别为81.95%、78.08%。单因素分析显示，死亡组TNM分期Ⅲ期、低分化、D-D>2.35 mg/L、中性粒细胞/淋巴细胞比值>2.95、GNRI≤85的比例明显高于存活组(P< 0.05)。Kaplan-Meier曲线显示，高GNRI(>85)组生存率(40.00%，36/90)明显高于低GNRI(≤85)组(19.68%，37/188)，高D-D(>2.35 mg/L)组生存率(21.88%，42/192)明显低于低D-D(≤2.35 mg/L)组(36.05%，31/86)(P< 0.05)。多因素Cox回归分析结果显示，低分化(HR=1.707，95%CI1.134~2.956，P=0.023)、D-D>2.35 mg/L(HR=1.378，95%CI1.064~2.013，P=0.045)是食管癌患者死亡的独立危险因素，GNRI>85(HR=0.456，95%CI0.137~0.727，P=0.010)为其保护因素。结论 GNRI升高是根治性食管癌患者预后的保护因素，D-D是其危险因素，二者联合检测可精准预测食管癌患者的死亡风险。Abstract: Objective To investigate the predictive value of geriatric nutritional risk index(GNRI) combined with D-dimer(D-D) in the prognosis of patients with esophageal cancer during chemotherapy and radiotherapy.Methods The clinical data of 278 patients with esophageal cancer who received radical radiotherapy and chemotherapy in our hospital from January 2016 to December 2019 were retrospectively analyzed. The clinical data of patients before radiotherapy and chemotherapy were recorded and followed up. Multivariate Cox regression was used to analyze the risk factors of death in patients with esophageal cancer, and the survival curve was drawn.Results The median follow-up time was 37 months. Of the 278 patients, 73 cases(26.26%) survived, and 205 cases(73.74%) died. ROC curve analysis showed that the area under the curve of GNRI and D-D at 85 and 2.35 mg/L to predict esophageal cancer death was 0.781(95%CI0.714-0.819,P< 0.001) and 0.704(95%CI0.625-0.782,P< 0.001), the area under the curve of the combined prediction was 0.851(95%CI0.800-0.819,P=0.901), which was higher than the two independent predictions(Z=5.562,P< 0.001;Z=3.816,P< 0.001), and the sensitivity and the specificity was 81.95% and 78.08% respectively. Univariate analysis showed that the proportions of TNM stage Ⅲ, poorly differentiated, D-D>2.35 mg/L, neutrophil/lymphocyte ratio>2.95, GNRI≤85 in the death group were significantly higher than those in the survival group(P< 0.05). Kaplan-Meier curve showed that the survival rate in the high GNRI(>85) group(40.00%, 36/90) was significantly higher than that in the low GNRI(≤85) group(19.68%, 37/188), and the survival rate in the high D-D(>2.35 mg/L) group(21.88%, 42/192) was lower than that in the low D-D(≤2.35 mg/L) group(36.05%, 31/86)(P< 0.05). The results of multivariate Cox regression analysis showed that poor differentiation(HR=1.707, 95%CI1.134-2.956,P=0.023), D-D>2.35 mg/L(HR=1.378, 95%CI1.064-2.013,P=0.045) were independent risk factors for death in patients with esophageal cancer, and GNRI>85(HR=0.456, 95%CI0.137-0.727,P=0.010) was the protective factor.Conclusion Elevated GNRI is a protective factor for the prognosis of patients with radical esophageal cancer, and D-D is its risk factor. The combined detection of the two indicators can accurately predict the risk of death in patients with esophageal cancer.
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Key words:
- esophageal cancer /
- radiotherapy /
- chemotherapy /
- geriatric nutritional risk index /
- D-dimer
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表 1 存活组和死亡组临床资料比较
例 临床资料 例数 死亡组
(205例)存活组
(73例)χ2 P 年龄/岁 >70 151 117 34 2.391 0.122 ≤70 127 88 39 性别 男 137 106 31 1.839 0.175 女 141 99 42 高血压 有 96 73 23 0.401 0.527 无 182 132 50 糖尿病 有 58 45 13 0.560 0.454 无 220 160 60 肿瘤部位 食管上段 46 30 16 食管中段 183 138 45 2.068 0.356 食管下段 49 37 12 肿瘤最大径/cm >4 134 102 32 0.756 0.385 ≤4 144 103 41 TNM分期 Ⅰ~Ⅱ期 140 91 49 11.128 0.001 Ⅲ期 138 114 24 分化程度 低分化 68 58 10 6.205 0.013 中高分化 210 147 63 治疗方式 放化疗 62 42 20 1.483 0.223 单纯放疗 216 163 53 CRP/(mg·L-1) >5 135 101 34 0.156 0.693 ≤5 143 104 39 D-D/(mg·L-1) >2.35 187 156 31 27.653 < 0.001 ≤2.35 91 49 42 NLR >2.95 176 138 38 5.398 0.020 ≤2.95 102 67 35 GNRI >85 86 45 41 29.462 < 0.001 ≤85 192 160 32 
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表 2 食管癌患者死亡危险因素的多因素Cox回归分析结果
危险因素 β SE Wald χ2 HR(95%CI) P TNM分期(Ⅲ期vsⅠ~Ⅱ期) 0.627 0.323 3.768 1.872(0.782~3.153) 0.056 分化程度(低分化vs中高分化) 0.535 0.236 5.139 1.707(1.134~2.956) 0.023 D-D(>2.35 mg/L vs ≤2.35 mg/L) 0.320 0.159 4.050 1.378(1.064~2.013) 0.045 NLR(>2.95 vs
≤2.95)0.269 0.180 2.233 1.309(0.796~2.351) 0.153 GNRI(>85 vs ≤85) -0.786 0.305 6.641 0.456(0.137~0.727) 0.010
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