HPV 阴性头颈部鳞状细胞癌行 upfront 手术治疗患者的预后营养指数：多机构系列研究。
The prognostic-nutritional index in HPV-negative head and neck squamous cell carcinoma treated with upfront surgery: a multi-institutional series.
机构信息
Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, School of Medicine, Brescia, Italy.
Unit of Medical Oncology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, School of Medicine, Brescia, Italy.
出版信息
Acta Otorhinolaryngol Ital. 2023 Jun;43(3):170-182. doi: 10.14639/0392-100X-N2358.
OBJECTIVES
To evaluate the prognostic value of pre-treatment prognostic-nutritional index (PNI) in patients with HPV-negative head and neck squamous cell carcinoma (HNSCC).
METHODS
A multi-institutional retrospective series of HPV-negative, Stages II-IVB, HNSCCs treated with upfront surgery was evaluated. Correlation of pre-operative blood markers and PNI with 5-year overall (OS) and relapse-free (RFS) survival was tested using linear and restricted cubic spline models, as appropriate. The independent prognostic effect of patient-related features was assessed with multivariable models.
RESULTS
The analysis was conducted on 542 patients. PNI ≥ 49.6 (HR = 0.52; 95% CI, 0.37-0.74) and Neutrophil-to-Lymphocyte Ratio (NLR) > 4.2 (HR = 1.58; 95% CI, 1.06-2.35) confirmed to be independent prognosticators of OS, whereas only PNI ≥ 49.6 (HR = 0.44; 95% CI, 0.29-0.66) was independently associated with RFS. Among pre-operative blood parameters, only higher values of albuninaemia and lymphocyte count (> 1.08 x 10/microL), and undetectable basophile count (= 0 10/microL) were independently associated with better OS and RFS.
CONCLUSIONS
PNI represents a reliable prognostic tool providing an independent measure of pre-operative immuno-metabolic performance. Its validity is supported by the independent prognostic role of albuminaemia and lymphocyte count, from which it is derived.
目的
评估治疗前预后营养指数（PNI）在 HPV 阴性头颈部鳞状细胞癌（HNSCC）患者中的预后价值。
方法
评估了多机构 HPV 阴性、II-IVB 期、接受直接手术治疗的 HNSCC 的回顾性系列。使用线性和限制性立方样条模型适当评估术前血液标志物和 PNI 与 5 年总生存期（OS）和无复发生存期（RFS）的相关性。使用多变量模型评估患者相关特征的独立预后作用。
结果
对 542 名患者进行了分析。PNI≥49.6（HR=0.52；95%CI，0.37-0.74）和中性粒细胞与淋巴细胞比值（NLR）>4.2（HR=1.58；95%CI，1.06-2.35）被确认为 OS 的独立预后因素，而只有 PNI≥49.6（HR=0.44；95%CI，0.29-0.66）与 RFS 独立相关。在术前血液参数中，只有更高的白蛋白血症和淋巴细胞计数值（>1.08×10/μL）和无法检测到的嗜碱性粒细胞计数（=0 10/μL）与更好的 OS 和 RFS 独立相关。
结论
PNI 是一种可靠的预后工具，提供了术前免疫代谢性能的独立衡量标准。其有效性得到白蛋白血症和淋巴细胞计数的独立预后作用的支持，这是它所衍生的。
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