Deliktaş Onur İlknur, Fırat Hatice Gülgün, Sertesen Çamöz Elif, Yildiz Fatih
Department of Medical Oncology, University of Health Sciences, Dr. Abdurrahman Yurtaslan, Ankara Oncology Education and Research Hospital, Ankara, TUR.
Department of Internal Medicine, University of Health Sciences, Dr. Abdurrahman Yurtaslan, Ankara Oncology Education and Research Hospital, Ankara, TUR.
Cureus. 2024 Jul 20;16(7):e65003. doi: 10.7759/cureus.65003. eCollection 2024 Jul.
Gallbladder and biliary tract tumors are rare but highly fatal cancers. In patients diagnosed with unresectable/metastatic gallbladder cancer and cholangiocarcinomas, systemic chemotherapy is recommended if the patient's performance is good. Randomized studies on this subject are limited, and there is no standard treatment choice. The prognostic nutritional index (PNI) is a measurement calculated using albumin and absolute lymphocyte value, reflecting the immunological and nutritional status of the cancer patient. The aim of our study is to evaluate the prognostic effectiveness of PNI in unresectable/metastatic gallbladder and biliary tract cancers. The PNI was calculated using albumin and lymphocyte values at the time of diagnosis (10 x albumin g/dL + 0.005 x total lymphocyte/mm). The relationship between PNI and overall survival (OS) and progression-free survival was examined. The prognostic nutritional index means of the patients included in the study was 44.8 (95% CI: 42.9-46.7), and the median was 44.77 (minimum: 22, maximum: 61.4). Receiver operating characteristic (ROC) analysis demonstrated a statistically significant prediction of patients' OS when the prognostic nutritional index was < 44 (AUC: 0.715, sensitivity: 54.8%, specificity: 33.3%; p=0.08). We evaluated the prognostic effectiveness of PNI in the subgroup of patients who could receive chemotherapy. In patients receiving chemotherapy, median survival was found to be 8.93 months in the PNI < 44 groups, while median survival was found to be 12.58 months in the PNI ≥ 44 group. The difference between both groups was statistically significant (p = 0.01). In univariate analysis, the Eastern Cooperative Oncology Group (ECOG) performance status, cancer antigen 19.9 (Ca 19.9), and PNI were statistically significant variables in predicting OS (p < 0.05). In multivariate analysis, the ECOG performance status, cancer antigen 19.9 (Ca 19.9), and PNI were found to be independent factors in predicting OS (p < 0.05). We believe that PNI can be used as a marker to assist the clinician in evaluating the prognosis of patients in the clinic and predicting treatment tolerance.
胆囊和胆道肿瘤是罕见但致命性很高的癌症。对于诊断为不可切除/转移性胆囊癌和胆管癌的患者，如果其身体状况良好，建议进行全身化疗。关于这一主题的随机研究有限，且没有标准的治疗选择。预后营养指数（PNI）是一种利用白蛋白和绝对淋巴细胞值计算得出的指标，反映癌症患者的免疫和营养状况。我们研究的目的是评估PNI在不可切除/转移性胆囊和胆道癌中的预后有效性。PNI是在诊断时使用白蛋白和淋巴细胞值计算得出的（10×白蛋白克/分升 + 0.005×总淋巴细胞数/立方毫米）。研究了PNI与总生存期（OS）和无进展生存期之间的关系。纳入研究的患者的预后营养指数均值为44.8（95%置信区间：42.9 - 46.7），中位数为44.77（最小值：22，最大值：61.4）。受试者工作特征（ROC）分析表明，当预后营养指数 < 44时，对患者的OS有统计学意义的预测（曲线下面积：0.715，敏感性：54.8%，特异性：33.3%；p = 0.08）。我们评估了PNI在可接受化疗的患者亚组中的预后有效性。在接受化疗的患者中，PNI < 44组的中位生存期为8.93个月，而PNI≥44组的中位生存期为12.58个月。两组之间的差异具有统计学意义（p = 0.01）。在单因素分析中，东部肿瘤协作组（ECOG）体能状态、癌抗原19.9（Ca 19.9）和PNI是预测OS的统计学显著变量（p < 0.05）。在多因素分析中，ECOG体能状态、癌抗原19.9（Ca 19.9）和PNI被发现是预测OS的独立因素（p < 0.05）。我们认为PNI可作为一种标志物，协助临床医生在临床上评估患者的预后并预测治疗耐受性。
