联合全身炎症免疫指数和预后营养指数评分作为局部进展期胃癌患者肌肉减少症的筛查标志物

Combined systemic inflammatory immunity index and prognostic nutritional index scores as a screening marker for sarcopenia in patients with locally advanced gastric cancer.

作者信息

Ding Ping'an, Lv Jingxia, Sun Chenyu, Chen Shuya, Yang Peigang, Tian Yuan, Zhou Qin, Guo Honghai, Liu Yang, Zhao Qun

机构信息

The Third Department of Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China.

Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric Cancer, Shijiazhuang, China.

出版信息

Front Nutr. 2022 Aug 15;9:981533. doi: 10.3389/fnut.2022.981533. eCollection 2022.

BACKGROUND

Sarcopenia is associated with poor clinical outcomes in patients with locally advanced gastric cancer (LAGC). Currently, the diagnostic criteria for sarcopenia are complex and laborious. Increased evidence suggests the inflammatory state of the body is closely associated with the development of sarcopenia. The systemic immune-inflammatory index (SII) and the prognostic nutritional index (PNI) are representative blood indicators of the status of the systemic inflammatory response, but the clinical significance of the combined testing of these two indicators remains unclear. We aimed to develop a simple and practical risk score (SII-PNI score) to screen patients with LAGC for sarcopenia on admission for early diagnosis.

METHODS

We registered a prospective clinical study from January 2011 to May 2016 involving 134 patients with LAGC undergoing radical surgical resection. All patients followed the definition of sarcopenia in the Asian Working Group on Sarcopenia (AWGS) guidelines and were divided into sarcopenia and non-sarcopenia groups. SII-PNI score 0-2 was scored as 2 for high SII (≥432.9) and low PNI ( ≤ 49.5); score 1, either high SII or low PNI; score 0, no high SII or low PNI.

RESULTS

All patients underwent radical surgery, including 31 patients (23.13%) with sarcopenia according to AWGS criteria. The SII-PNI score was significantly lower in the non-sarcopenic patients than in the sarcopenic patients ( < 0.001). Logistic multivariate analysis showed that the SII-PNI score predicted an independent prognostic factor for sarcopenia ( < 0.001). Patients with high SII-PNI scores had significantly worse prognosis than those with low SII-PNI scores ( < 0.001). The SII-PNI score was an independent prognostic factor for predicting overall survival and disease-free survival ( = 0.016, 0.023).

CONCLUSION

Peripheral blood parameters SII-PNI scores accurately identify sarcopenia in patients with LAGC and could be used as potential systemic markers.

背景

肌肉减少症与局部晚期胃癌（LAGC）患者的不良临床结局相关。目前，肌肉减少症的诊断标准复杂且繁琐。越来越多的证据表明，机体的炎症状态与肌肉减少症的发生密切相关。全身免疫炎症指数（SII）和预后营养指数（PNI）是全身炎症反应状态的代表性血液指标，但这两项指标联合检测的临床意义仍不明确。我们旨在制定一个简单实用的风险评分（SII-PNI评分），用于筛查LAGC患者入院时是否存在肌肉减少症，以便早期诊断。

方法

我们登记了一项前瞻性临床研究，该研究从2011年1月至2016年5月，纳入134例行根治性手术切除的LAGC患者。所有患者均遵循亚洲肌肉减少症工作组（AWGS）指南中肌肉减少症的定义，分为肌肉减少症组和非肌肉减少症组。SII-PNI评分0-2分：高SII（≥432.9）且低PNI（≤49.5）得2分；评分为1分，即高SII或低PNI；评分为0分，即无高SII或低PNI。

结果

所有患者均接受了根治性手术，根据AWGS标准，其中31例（23.13%）患者存在肌肉减少症。非肌肉减少症患者的SII-PNI评分显著低于肌肉减少症患者（<0.001）。多因素Logistic分析显示，SII-PNI评分是肌肉减少症的独立预后预测因素（<0.001）。SII-PNI评分高的患者预后明显比评分低的患者差（<0.001）。SII-PNI评分是预测总生存和无病生存的独立预后因素（=0.016，0.023）。