术后预后营养指数预测米兰标准内合并脾功能亢进的肝细胞癌患者的生存情况。
Postoperative Prognostic Nutritional Index Predicts Survival of Patients with Hepatocellular Carcinoma within Milan Criteria and Hypersplenism.
机构信息
Department of Liver Surgery and Liver Transplantation Center, West China Hospital of Sichuan University, Guoxuexiang 37, Chengdu, Sichuan Province, 610041, China.
出版信息
J Gastrointest Surg. 2017 Oct;21(10):1626-1634. doi: 10.1007/s11605-017-3414-1. Epub 2017 May 18.
BACKGROUND
To investigate the predictable value of postprognostic nutritional index (PNI) for patients who are suffering hepatocellular carcinoma (HCC) within Milan criteria and hypersplenism with well-preserved liver function after curative resection.
METHODS
Patients were divided into two groups: group A (postoperative PNI < 53.05, n = 280) and group B (postoperative PNI ≥ 53.05, n = 109), according to cutoff value of receiver-operating characteristic curve. Clinical data, overall survival (OS), and disease-free survival (DFS) were statistically compared between the two groups, and a multivariate analysis was used to identify prognostic factors.
RESULTS
The 1-, 3-, 5-, 7-, and 9-year OS of patients in group A were 93.3, 74.2, 53.6, 39.6, and 33.0%, respectively, and 98.9, 89.5, 79.7, 63.9, and 63.9%, respectively, for patients in group B (P = 0.001). The corresponding 1-, 3-, 5-, 7-, and 9-year DFS was 74.1, 51.1, 41.5, 30.1, 24.0, and 83.8, 64.6, 79.7, 54.0, and 49.9% for patients in the two groups, respectively (P = 0.009). Multivariable analysis revealed postoperative PNI as independent predictors of OS (P = 0.004) and DFS (P = 0.007) in patients with HCC within Milan criteria and hypersplenism after liver resection.
CONCLUSIONS
Postoperative PNI, not preoperative PNI, could predict survival of patients with HCC within Milan criteria and hypersplenism after surgical resection.
背景
研究米兰标准内患有肝细胞癌（HCC）和切脾术后肝功能良好的患者的预后营养指数（PNI）对预测术后的价值。
方法
根据受试者工作特征曲线（ROC）的截断值，将患者分为两组：A 组（术后 PNI＜53.05，n＝280）和 B 组（术后 PNI≥53.05，n＝109）。比较两组患者的临床资料、总生存（OS）和无病生存（DFS），并进行多因素分析以确定预后因素。
结果
A 组患者的 1、3、5、7 和 9 年 OS 分别为 93.3%、74.2%、53.6%、39.6%和 33.0%，B 组患者的相应 OS 分别为 98.9%、89.5%、79.7%、63.9%和 63.9%（P＝0.001）。A 组患者的 1、3、5、7 和 9 年 DFS 分别为 74.1%、51.1%、41.5%、30.1%和 24.0%，B 组患者的相应 DFS 分别为 83.8%、64.6%、79.7%、54.0%和 49.9%（P＝0.009）。多因素分析显示，术后 PNI 是米兰标准内 HCC 合并切脾术后肝功能良好患者 OS（P＝0.004）和 DFS（P＝0.007）的独立预测因素。
结论
术后 PNI 而不是术前 PNI 可预测米兰标准内 HCC 合并切脾术后肝功能良好患者的生存情况。
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