摘要
目的基于术前中心粒细胞/淋巴细胞比值(NLR)及预后营养指数(PNI)探讨影响胰腺癌根治术预后的危险因素,建立预后预测模型并对其效能进行评价。方法回顾性分析2013年1月-2019年12月于兰州大学第二医院确诊为胰腺导管腺癌(PDAC)患者的临床资料,使用Kaplan-Meier法进行生存分析,采用X-tile软件确定NLR及PNI的最佳截断值,采用Cox风险比例模型分析胰腺癌根治术的预后影响因素,使用R 4.0.3软件绘制1、2、3年生存率的nomogram临床预测模型,评价其效能并建立网页计算器。结果共纳入148例PDAC患者,中位生存时间18.2个月,术后1、2、3年生存率分别为70.8%、35.8%、12.2%。术前NLR及PNI的最佳截断值分别为1.85和44.13,结合二者形成NLRP评分(0、1、2分),评分越高预后越差(P<0.05)。Cox多因素分析结果显示,年龄>65岁、N分期高、TNM分期高、术后未行化疗、术后胰漏、NLRP评分高是胰腺癌预后不佳的独立危险因素(P<0.05)。据此建立的预测模型内部验证一致性指数(C-index)为0.710,校准曲线贴合良好,决策曲线显示nomogram具有更广的临床净获益,网页计算器运行良好。结论结合NLR及PNI形成的NLRP评分可能是PDAC根治术后一种新的独立预后评分。通过将NLRP评分纳入nomogram,可获得一个更精确、更先进的预测模型,而网页计算器更方便医师和患者使用。
Objective To explore the factors affecting the prognosis of pancreatic cancer after radical resection for establishing a prognostic prediction model, based on the preoperative neutrophil to lymphocyte ratio(NLR) and prognostic nutritional index(PNI). Methods The clinical data of patients diagnosed with pancreatic ductal adenocarcinoma(PDAC) from January 2013 to December 2019 were retrospectively analyzed. The Kaplan-Meier method was used for survival analysis, the NLR and PNI cut-off values were determined by X-tile software, and the Cox risk ratio model was used to analyze the factors affecting the prognosis of pancreatic cancer. R 4.0.3 software was used to draw a nomogram clinical prediction model of 1, 2, and 3-year survival rates, to evaluate the effectiveness of the prediction model and to establish a web calculator. Results A total of 148 patients were enrolled in the study. The median survival time was 18.2 months. The 1, 2, and 3-year survival rates were 70.8%, 35.8%, and 12.2%, respectively. The cut-off values of NLR and PNI before operation were 1.85 and 44.13, respectively. Combining the two to form NLRP score: 0, 1, and 2. The higher the score, the worse the prognosis(P<0.05). Cox multivariate analysis suggests age >65 years old, high N stage, high TNM stage, no postoperative chemotherapy, postoperative pancreatic fistula and high NLRP score were independent factors affecting the prognosis of pancreatic cancer(P<0.05). The internal verification consistency index(C-index) of the prediction model was 0.710, the calibration curve fitted well, the decision curve showed that the nomogram had a wider clinical net benefit, and the web calculator worked well. Conclusions The NLRP score combined with NLR and PNI can be considered as a new independent prognostic biomarker after radical resection of PDAC. By incorporating the NLRP score into the nomogram,a more accurate and advanced predictive model will be obtained, and the web calculator will be more convenient for doctors and patients to use.
作者
邵全年
周辉年
肖竞英
李向阳
郭亚
柴春
焦作义
Shao Quan-Nian;Zhou Hui-Nian;Xiao Jing-Ying;Li Xiang-Yang;Guo Ya;Chai Chun;Jiao Zuo-Yi(Department of General Surgery,the Second Hospital of Lanzhou University,Lanzhou 730030,China)
出处
《解放军医学杂志》
CAS
CSCD
北大核心
2021年第10期1009-1017,共9页
Medical Journal of Chinese People's Liberation Army
基金
甘肃省高等学校创新能力提升项目(2019B-019)。
