Objective:Albumin-globulin ratio(AGR),prognostic nutritional index(PNI),and platelet to-lymphocyte ratio(PLR)have been validated as prognostic factors for gastric cancer(GC).However,significant gender differences exis...Objective:Albumin-globulin ratio(AGR),prognostic nutritional index(PNI),and platelet to-lymphocyte ratio(PLR)have been validated as prognostic factors for gastric cancer(GC).However,significant gender differences exist in albumin levels and inflammatory cell counts,and further research is required to understand how these differences influence GC prognosis.This study aims to investigate the prognostic impact of nutritional and inflammatory indicators on GC patients undergoing radical surgery,as well as the influence of gender on these indicators’prognostic value.Methods:The study included 596 patients with advanced GC hospitalized in the Department of Gastrointestinal Surgery,General Surgery,Xiangya Hospital of Central South University from January 2012 to December 2016.Receiver operating characteristic(ROC)analysis was performed to determine cutoff values for nutritional and inflammatory factors.Univariate analysis was used to identify factors significantly affecting survival in GC patients,while multivariate and Kaplan-Meier analyses determined independent prognostic factors for GC.Results:Multivariate analysis revealed that postsurgical tumor node metastasis(pTNM)stage[stage II:hazard ratio(HR)=3.284,P=0.012;stage III:HR:8.062,P<0.001],low preoperative AGR(HR=1.499,P=0.012),and postoperative PNI(HR=1.503,P=0.008)were risk factors for overall survival in male patients after radical GC surgery.For female patients,pN2-3(HR=3.185,P<0.001),total gastrectomy(HR=2.286,P=0.004),low preoperative PLR(HR=1.702,P=0.027),and postoperative PNI(HR=1.943,P=0.011)were identified as risk factors for overall survival.Conclusion:Postoperative PNI is an independent risk factor for all advanced GC patients.Preoperative PLR is an independent prognostic factor only for female patients,while preoperative AGR is an independent prognostic factor only for male patients.Further research is warranted to investigate the gender-specific differences in GC prognosis.展开更多
背景心血管疾病(CVD)是腹膜透析(PD)患者死亡的主要原因,而营养不良是PD患者发生CVD及死亡的重要危险因素之一。预后营养指数(PNI)作为一种综合评估患者免疫、炎症和营养状态的指标,因其具有便利性与可靠性等优点,在肿瘤等多种疾病的预...背景心血管疾病(CVD)是腹膜透析(PD)患者死亡的主要原因,而营养不良是PD患者发生CVD及死亡的重要危险因素之一。预后营养指数(PNI)作为一种综合评估患者免疫、炎症和营养状态的指标,因其具有便利性与可靠性等优点,在肿瘤等多种疾病的预后评估中得到了广泛应用。然而,不同时间点的营养状态与PD患者预后之间的关系仍有待进一步探究。目的探讨PD患者首年PNI与CVD死亡之间的关系。方法本研究为多中心、回顾性观察性队列研究,纳入2000-01-01—2019-07-01在南方医科大学南方医院、南方医科大学顺德医院、佛山市第一人民医院以及赣州市人民医院4所中心置管并开始接受PD治疗的1640例PD患者作为研究对象。对患者进行随访,随访截止时间为2021-07-01,终点事件为CVD死亡并记录患者生存时间及具体死亡原因。应用限制性立方条图(RCS)分析PNI与PD患者CVD死亡风险之间的非线性关联;采用Kaplan-Meier法绘制PD患者的生存曲线,绘制PNI预测PD患者CVD死亡的受试者工作特征(ROC)曲线,并根据最佳截断值(cut-off=40.46)将患者分为低PNI组703例与高PNI组937例;采用Log-rank检验和Cox风险回归模型分析探讨PNI对PD患者CVD死亡的影响。结果本研究中位随访时间为30个月,随访期间共148例患者死亡,其中CVD死亡73例(49.32%)。RCS结果表明,PNI与CVD死亡事件呈线性关联(P for Nonlinear=0.655)。ROC曲线显示,PNI预测PD患者CVD死亡的曲线下面积(AUC)为0.717(95%CI=0.659~0.775,P<0.001),灵敏度为74.0%,特异度为58.6%。Kaplan-Meier生存分析结果显示,低PNI组CVD生存率低于高PNI组(χ^(2)=26.685,P<0.001)。多因素Cox风险回归模型分析,校正性别、年龄及CVD病史等混杂因素后,低PNI组仍是CVD死亡的独立预测因素(HR=7.76,95%CI=1.72~35.06,P=0.008),亚组分析结果仍稳健,无明显交互作用。结论PNI降低是PD患者CVD死亡的独立影响因素,PD首年PNI评分在评估PD患者预后有一定的指导意义。展开更多
基金supported by the National Natural Science Foundation of China(8197103463).
文摘Objective:Albumin-globulin ratio(AGR),prognostic nutritional index(PNI),and platelet to-lymphocyte ratio(PLR)have been validated as prognostic factors for gastric cancer(GC).However,significant gender differences exist in albumin levels and inflammatory cell counts,and further research is required to understand how these differences influence GC prognosis.This study aims to investigate the prognostic impact of nutritional and inflammatory indicators on GC patients undergoing radical surgery,as well as the influence of gender on these indicators’prognostic value.Methods:The study included 596 patients with advanced GC hospitalized in the Department of Gastrointestinal Surgery,General Surgery,Xiangya Hospital of Central South University from January 2012 to December 2016.Receiver operating characteristic(ROC)analysis was performed to determine cutoff values for nutritional and inflammatory factors.Univariate analysis was used to identify factors significantly affecting survival in GC patients,while multivariate and Kaplan-Meier analyses determined independent prognostic factors for GC.Results:Multivariate analysis revealed that postsurgical tumor node metastasis(pTNM)stage[stage II:hazard ratio(HR)=3.284,P=0.012;stage III:HR:8.062,P<0.001],low preoperative AGR(HR=1.499,P=0.012),and postoperative PNI(HR=1.503,P=0.008)were risk factors for overall survival in male patients after radical GC surgery.For female patients,pN2-3(HR=3.185,P<0.001),total gastrectomy(HR=2.286,P=0.004),low preoperative PLR(HR=1.702,P=0.027),and postoperative PNI(HR=1.943,P=0.011)were identified as risk factors for overall survival.Conclusion:Postoperative PNI is an independent risk factor for all advanced GC patients.Preoperative PLR is an independent prognostic factor only for female patients,while preoperative AGR is an independent prognostic factor only for male patients.Further research is warranted to investigate the gender-specific differences in GC prognosis.
文摘背景心血管疾病(CVD)是腹膜透析(PD)患者死亡的主要原因,而营养不良是PD患者发生CVD及死亡的重要危险因素之一。预后营养指数(PNI)作为一种综合评估患者免疫、炎症和营养状态的指标,因其具有便利性与可靠性等优点,在肿瘤等多种疾病的预后评估中得到了广泛应用。然而,不同时间点的营养状态与PD患者预后之间的关系仍有待进一步探究。目的探讨PD患者首年PNI与CVD死亡之间的关系。方法本研究为多中心、回顾性观察性队列研究,纳入2000-01-01—2019-07-01在南方医科大学南方医院、南方医科大学顺德医院、佛山市第一人民医院以及赣州市人民医院4所中心置管并开始接受PD治疗的1640例PD患者作为研究对象。对患者进行随访,随访截止时间为2021-07-01,终点事件为CVD死亡并记录患者生存时间及具体死亡原因。应用限制性立方条图(RCS)分析PNI与PD患者CVD死亡风险之间的非线性关联;采用Kaplan-Meier法绘制PD患者的生存曲线,绘制PNI预测PD患者CVD死亡的受试者工作特征(ROC)曲线,并根据最佳截断值(cut-off=40.46)将患者分为低PNI组703例与高PNI组937例;采用Log-rank检验和Cox风险回归模型分析探讨PNI对PD患者CVD死亡的影响。结果本研究中位随访时间为30个月,随访期间共148例患者死亡,其中CVD死亡73例(49.32%)。RCS结果表明,PNI与CVD死亡事件呈线性关联(P for Nonlinear=0.655)。ROC曲线显示,PNI预测PD患者CVD死亡的曲线下面积(AUC)为0.717(95%CI=0.659~0.775,P<0.001),灵敏度为74.0%,特异度为58.6%。Kaplan-Meier生存分析结果显示,低PNI组CVD生存率低于高PNI组(χ^(2)=26.685,P<0.001)。多因素Cox风险回归模型分析,校正性别、年龄及CVD病史等混杂因素后,低PNI组仍是CVD死亡的独立预测因素(HR=7.76,95%CI=1.72~35.06,P=0.008),亚组分析结果仍稳健,无明显交互作用。结论PNI降低是PD患者CVD死亡的独立影响因素,PD首年PNI评分在评估PD患者预后有一定的指导意义。
