术前那不勒斯预后评分对壶腹癌胰十二指肠切除术后短期和长期结局的预后意义。
Prognostic significance of preoperative Naples prognostic score on short- and long-term outcomes after pancreatoduodenectomy for ampullary carcinoma.
作者信息
Jin Jikuan, Wang Hebin, Peng Feng, Wang Xiaoxiang, Wang Min, Zhu Feng, Xiong Guangbing, Qin Renyi
机构信息
Department of Biliary-Pancreatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
出版信息
Hepatobiliary Surg Nutr. 2021 Dec;10(6):825-838. doi: 10.21037/hbsn-20-741.
BACKGROUND
The Naples prognostic score (NPS) is an effective and objective tool to assess the immune-nutritional status of patients with malignant tumors. The aim of this study was to investigate the clinical significance of preoperative NPS on short- and long-term outcomes after pancreatoduodenectomy (PD) for ampullary carcinoma.
METHODS
We retrospectively analyzed 404 consecutive patients with ampullary carcinoma who underwent PD between January 2012 and June 2018. Preoperative NPS was calculated from serum albumin and total cholesterol concentrations, and the neutrophil-lymphocyte ratio and lymphocyte-monocyte ratio (LMR). Patients were then divided into three groups according to their NPS. Clinicopathological variables, postoperative outcomes, and survival data were compared between the three groups. Univariate and multivariate Cox analysis of overall survival (OS) and recurrence-free survival (RFS) were also conducted, and time-dependent receiver operating characteristic (ROC) curves were created to evaluate the discriminatory ability of the prognostic scoring systems.
RESULTS
Patients with higher NPS had worse prognosis, and significant OS difference (group 0 1, P=0.02; group 1 2, P<0.001; group 0 2, P<0.001) and RFS difference (group 0 1, P=0.088; group 1 2, P<0.001; group 0 2, P<0.001). Multivariate analysis revealed that NPS was an independent significant predictor of OS (grade 2 grade 1 or 0, hazard ratio: 3.067; P<0.001) and RFS (grade 2 grade 1 or 0, hazard ratio: 2.732; P<0.001). The time-dependent receiver operating curve analysis showed that NPS had better prognostic performance for OS and RFS than other prognostic models. Additionally, significant differences in the incidence of postoperative morbidity were observed between the three groups, and the NPS was an independent risk factor of overall postoperative complications (grade 2 grade 1 or 0, odds ratio: 1.692; P=0.02).
CONCLUSIONS
The NPS was an independent predictor of overall- and RFS in patients undergoing PD for ampullary carcinoma, and was independently associated with the incidence of postoperative complications.
背景
那不勒斯预后评分（NPS）是评估恶性肿瘤患者免疫营养状况的有效且客观的工具。本研究旨在探讨术前NPS对壶腹癌胰十二指肠切除术（PD）后短期和长期预后的临床意义。
方法
我们回顾性分析了2012年1月至2018年6月期间连续接受PD的404例壶腹癌患者。术前NPS根据血清白蛋白、总胆固醇浓度、中性粒细胞与淋巴细胞比值以及淋巴细胞与单核细胞比值（LMR）计算得出。然后根据患者的NPS将其分为三组。比较三组之间的临床病理变量、术后结局和生存数据。还对总生存期（OS）和无复发生存期（RFS）进行了单因素和多因素Cox分析，并绘制了时间依赖性受试者工作特征（ROC）曲线以评估预后评分系统的辨别能力。
结果
NPS较高的患者预后较差，OS（0组与1组，P = 0.02；1组与2组，P < 0.001；0组与2组，P < 0.001）和RFS（0组与1组，P = 0.088；1组与2组，P < 0.001；0组与2组，P < 0.001）存在显著差异。多因素分析显示，NPS是OS（2级与1级或0级，风险比：3.067；P < 0.001）和RFS（2级与1级或0级，风险比：2.732；P < 0.001）的独立显著预测因子。时间依赖性受试者工作曲线分析表明，NPS在OS和RFS方面的预后性能优于其他预后模型。此外，三组之间术后发病率存在显著差异，NPS是术后总体并发症的独立危险因素（2级与1级或0级，比值比：1.692；P = 0.02）。
结论
NPS是接受壶腹癌PD患者OS和RFS的独立预测因子，且与术后并发症的发生率独立相关。
Zotero 插件