Okada Satoru, Shimada Junichi, Kato Daishiro, Tsunezuka Hiroaki, Teramukai Satoshi, Inoue Masayoshi
Division of Thoracic Surgery, Department of Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Department of Biostatistics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Ann Thorac Surg. 2017 Jul;104(1):296-302. doi: 10.1016/j.athoracsur.2017.01.085. Epub 2017 Apr 19.
The prognostic nutritional index (PNI), calculated as 10 × serum albumin (g/dL) + 0.005 × total lymphocyte count (cells/mm), can reportedly predict postoperative complications and prognosis for various types of malignancy. However, the clinical significance and prognostic value of the PNI for both short- and long-term outcomes remains uncertain in patients with lung cancer.
We retrospectively reviewed 248 patients with completely resected non-small cell lung cancer (NSCLC). Clinicopathologic characteristics were evaluated according to the PNI, and the prognostic significance for postoperative outcomes was assessed using Cox proportional regression analysis. The survival rate was calculated using the Kaplan-Meier method.
An optimal cutoff of 48 for recurrence-free survival (RFS) was determined using the minimum p value approach. Old age, low body mass index, large tumor size, and elevated C-reactive protein levels correlated significantly with low PNI. Logistic regression analysis demonstrated that low PNI status was statistically related to postoperative complications (Clavien-Dindo grade ≥II) and pulmonary air leakage. Five-year overall survival (OR) rates in the high- and low-PNI groups were 80.6% and 58.5%, respectively (p = 0.002). Five-year RFS rates were 73.6% and 48.6%, respectively (p < 0.001). Furthermore, PNI was identified as an independent prognostic factor for OS (hazard ratio [HR], 2.18; 95% confidence interval [CI], 1.08-4.21) and RFS (HR, 2.57; 95% CI, 1.46-4.38) by multivariate analysis.
The PNI could represent a useful biomarker to predict postoperative complications and survival in patients with completely resected NSCLC.
据报道，预后营养指数（PNI）的计算方法为10×血清白蛋白（g/dL）+0.005×总淋巴细胞计数（细胞/mm），可预测各种恶性肿瘤的术后并发症和预后。然而，肺癌患者PNI对短期和长期预后的临床意义和预后价值仍不确定。
我们回顾性分析了248例完全切除的非小细胞肺癌（NSCLC）患者。根据PNI评估临床病理特征，并使用Cox比例回归分析评估术后预后的意义。采用Kaplan-Meier法计算生存率。
采用最小p值法确定无复发生存期（RFS）的最佳临界值为48。老年、低体重指数、肿瘤体积大以及C反应蛋白水平升高与低PNI显著相关。逻辑回归分析表明，低PNI状态与术后并发症（Clavien-Dindo分级≥II）和肺漏气在统计学上相关。高PNI组和低PNI组的5年总生存率（OR）分别为80.6%和58.5%（p = 0.002）。5年RFS率分别为73.6%和48.6%（p < 0.001）。此外，多因素分析确定PNI是总生存期（OS）（风险比[HR]，2.18；95%置信区间[CI]，1.08 - 4.21）和RFS（HR，2.57；95%CI，1.46 - 4.38）的独立预后因素。
PNI可能是预测完全切除NSCLC患者术后并发症和生存的有用生物标志物。
