术前免疫营养状况对卵巢癌术后并发症的影响。
The impact of preoperative immunonutritional status on postoperative complications in ovarian cancer.
作者信息
Liu Xingyu, Li Ming, Zhao Yingjun, Jiao Xiaofei, Yu Yang, Li Ruyuan, Zeng Shaoqing, Chi Jianhua, Ma Guanchen, Huo Yabing, Peng Zikun, Liu Jiahao, Zhou Qi, Zou Dongling, Wang Li, Li Qingshui, Wang Jing, Yao Shuzhong, Chen Youguo, Ma Ding, Hu Ting, Gao Qinglei
机构信息
Department of Gynecological Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
National Clinical Research Center for Obstetrics and Gynecology, Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave, Wuhan, 430000, China.
出版信息
J Ovarian Res. 2025 Apr 29;18(1):88. doi: 10.1186/s13048-025-01624-3.
BACKGROUND
Preoperative immunonutritional status can influence postoperative complications. Malnutrition in ovarian cancer patients diminishes the body's resilience to abdominal surgery, resulting in inferior surgical outcomes and increased postoperative complications. We aim to investigate the effect of preoperative immunonutritional status, including NLR, PLR, LMR, TCLR, FAR, FLR, SII, PNI and CONUT on postoperative complications in epithelial ovarian cancer (EOC) in a large population.
METHODS
A multicenter real-world study included 922 patients with histologically confirmed EOC who received comprehensive staged surgery or debulking surgery at seven tertiary hospitals in China between 2012 and 2023. Logistic regression and Lasso regression analyses were employed to identify variables associated with postoperative complications. A predictive nomogram model was developed based on multivariate modeling.
RESULTS
The study included a total of 922 patients diagnosed with epithelial ovarian cancer across seven medical centers with 565 (61.3%) patients experiencing postoperative complications. Significant differences were found in the distribution of inflammatory and nutritional risk indicators, including NLR, PLR, LMR, TCLR, FAR, FLR, SII, PNI and CONUT between the two groups (all P < 0.01). A multivariable model identified several predictive factors for postoperative complications: PNI > 46.73 (odds ratio [OR] = 0.49, P < 0.001), FAR > 10.77 (OR = 1.60, P = 0.019), LMR > 3.70 (OR = 0.68, P = 0.044), hydrothorax (OR = 2.60, P = 0.005), laparoscopy (OR = 0.59, P = 0.010 vs. laparotomy), enterectomy (OR = 2.50, P = 0.001).
CONCLUSION
Poor immunonutritional status can increase the risk of postoperative complications. These findings suggest that prompt nutritional interventions may reduce the incidence of postoperative complications and improve surgical outcomes. The risk prediction model, including PNI, FAR, LMR, hydrothorax, laparoscopy vs. laparotomy, and enterectomy, might facilitate patient-centered decision-making and risk stratification.
CLINICAL TRIAL REGISTRATION
The study was registered in the Clinical trial registry: NCT06483399. ( https://clinicaltrials.gov/study/NCT06483399 ).
背景
术前免疫营养状态可影响术后并发症。卵巢癌患者的营养不良会削弱机体对腹部手术的耐受力，导致手术效果欠佳及术后并发症增加。我们旨在调查术前免疫营养状态，包括中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）、淋巴细胞与单核细胞比值（LMR）、肿瘤细胞与淋巴细胞比值（TCLR）、纤维蛋白原与白蛋白比值（FAR）、前清蛋白与淋巴细胞比值（FLR）、全身炎症反应指数（SII）、预后营养指数（PNI）和营养风险控制指标（CONUT）对大量上皮性卵巢癌（EOC）患者术后并发症的影响。
方法
一项多中心真实世界研究纳入了922例经组织学确诊为EOC的患者，这些患者于2012年至2023年期间在中国7家三级医院接受了全面分期手术或肿瘤细胞减灭术。采用逻辑回归和套索回归分析来确定与术后并发症相关的变量。基于多变量建模开发了预测列线图模型。
结果
该研究共纳入了7个医学中心诊断为上皮性卵巢癌的922例患者，其中565例（61.3%）患者出现术后并发症。两组之间在炎症和营养风险指标的分布上存在显著差异，包括NLR、PLR、LMR、TCLR、FAR、FLR、SII、PNI和CONUT（所有P<0.01）。多变量模型确定了术后并发症的几个预测因素：PNI>46.73（比值比[OR]=0.49，P<0.001），FAR>10.77（OR=1.60，P=0.019），LMR>3.70（OR=0.68，P=0.044），胸腔积液（OR=2.60，P=0.005），腹腔镜手术（OR=0.59，P=0.010与开腹手术相比），肠切除术（OR=2.50，P=0.001）。
结论
免疫营养状态差会增加术后并发症的风险。这些发现表明，及时的营养干预可能会降低术后并发症的发生率并改善手术效果。包括PNI、FAR、LMR、胸腔积液、腹腔镜手术与开腹手术以及肠切除术在内的风险预测模型可能有助于以患者为中心的决策制定和风险分层。
临床试验注册
该研究已在临床试验注册中心注册：NCT06483399。（https://clinicaltrials.gov/study/NCT06483399）
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