| 贺园,杨宇航,成鹏飞,等.术前炎症反应及营养状态指标对结直肠癌术后生存的预测价值及预测模型研究[J].安徽医药,2026,30(2):359-365. |
| 术前炎症反应及营养状态指标对结直肠癌术后生存的预测价值及预测模型研究 |
| Clinical prediction model study on survival prognosis of colorectal cancer patients constructed based on preoperative inflammatory and nutritional indicators |
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| DOI：10.3969/j.issn.1009-6469.2026.02.028 |
| 中文关键词: 结直肠肿瘤 炎症反应 营养状况 预测模型 预后价值 |
| 英文关键词: Colorectal neoplasms Inflammatory response Nutritional status Predictive modelling Prognostic value |
| 基金项目:山西省卫生健康委员会重点研发计划( 201603D321082) |
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| 中文摘要: |
| 目的研究结直肠癌病人术前炎症反应及营养状态对其术后生存的预测价值，并建立预测模型。方法回顾性分析山西白求恩医院 2017年 1月至 2018年 12月 208例结直肠癌手术治疗病人的临床资料。通过单因素及多因素 Cox回归分析确定影响结直肠癌病人术后生存的独立临床病理因素。单因素 Cox回归分析确定影响结直肠癌病人术后生存的炎症反应指标及营养状态指标。采用多因素 Cox回归分析构建 3种不同的预测模型: ①独立临床病理因素 +单因素分析有意义的炎症反应指标； ②独立临床病理因素 +单因素分析有意义的营养状态指标； ③独立临床病理因素 +单因素分析有意义的炎症反应指标和营养状态指标。模型的评价包括:赤池信息量标准( AIC)分析模型拟合性能；受试者操作特征曲线下面积( AUC)和 C指数(C-index)评估模型的区分度；校准曲线评估 3年、 5年生存预测概率和实际概率的一致性。结果共纳入 208例病人，年龄为(63.7±12.3)岁，其中男性有 113例， ≥60岁有 133例。单因素 Cox回归分析显示，年龄、肿瘤长径、是否行术后辅助治疗、送检淋巴结数目、 T分期、 N分期以及是否有脉管、神经侵犯与结直肠癌病人术后 5年生存率相关( P<0.05)，进一步行多因素 Cox回归分析发现年龄、 T分期、 N分期及是否侵犯神经是结直肠癌病人术后生存的独立相关因素( P<0.05)；术前炎症反应标志物中白细胞计数、中性粒细胞计数、中性粒细胞百分比、淋巴细胞计数、淋巴细胞百分比、中性粒细胞 /淋巴细胞比值、血小板与淋巴细胞比值、血小板 /中性粒细胞比值和营养指标中的血红蛋白、血清白蛋白、身体质量指数与病人预后有关(P<0.05)。构建的 3种模型变量包括: ①炎症反应模型是年龄、 T分期、 N分期、是否有神经侵犯、中性粒细胞计数、淋巴细胞计数； ②营养模型是年龄、 T分期、 N分期、是否有神经侵犯、身体质量指数； ③炎症反应 -营养模型是年龄、 T分期、 N分期、是否有神经侵犯、中性粒细胞计数、淋巴细胞计数、身体质量指数。模型预测结果显示炎症 -营养模型［AUC=0.92，95%CI:(0.89，0.96)； C-index为 0.87］、炎症模型［ AUC=0.91，95%CI:(0.87，0.95)； C-index为 0.86］、营养模型［ AUC=0.91，95%CI:(0.87，0.95)； C-index为 0.85］，同时炎症 -营养模型的拟合度( AIC为 588.90)要优于炎症模型( AIC为 593.98)和营养模型( AIC为 606.78)。结论炎症 -营养模型可用于个体化预测结直肠癌病人的生存预后。 |
| 英文摘要: |
| Objective To investigate the predictive value of preoperative inflammatory and nutritional status of colorectal cancer pa-tients on their postoperative survival and to develop a predictive model.Methods Retrospective analysis of clinical data of 208 pa-tients with colorectal cancer undergoing surgical treatment at Shanxi Norman Bethune Hospital from January 2017 to December 2018.Independent clinicopathological factors affecting postoperative survival of colorectal cancer patients were determined by unifactorialand multifactorial Cox regression analyses. Univariate Cox regression analysis was performed to determine the indicators of inflammato-ry response and nutritional status affecting postoperative survival in patients with colorectal cancer. Multifactorial Cox regression analy-sis was used to construct three different prediction models:①independent clinicopathological factors + single factor analysis of mean-ingful inflammatory response indicators;②independent clinicopathological factors + single factor analysis of meaningful nutritional sta-tus indicators;③independent clinicopathological factors + single factor analysis of meaningful inflammatory response indicators and nu-tritional status indicators. The evaluation of the model included: the Akaike informativeness criterion (AIC) to analyse the model fitting performance; the integrated area under the working curve (AUC) and the C-index of the subjects to assess the differentiation of the mod-el; and the calibration curve to assess the consistency between the predicted probability of survival at 3 years and 5 years and the actualprobability.Results A total of 208 patients aged (63.7±12.3) years were included, of whom 113 were male and 133 were ≥60 yearsold. Univariate Cox regression analysis showed that age, tumour diameter, whether postoperative adjuvant therapy was performed, thenumber of lymph nodes sent for examination, T-stage, N-stage, and whether there was vascular or nerve invasion were correlated with 5-year postoperative survival in colorectal cancer patients (P<0.05), and further multivariate Cox regression analysis revealed that age, T-stage, N-stage and whether there was nerve invasion were independent survival in colorectal cancer patients after surgery associated fac-tors (P<0.05); Leukocyte count, neutrophil count, neutrophil percentage, lymphocyte count, lymphocyte percentage, neutrophil/lympho-cyte ratio, platelet/lymphocyte ratio, platelet/neutrophil ratio in preoperative markers of inflammatory response and haemoglobin, serumalbumin, and body mass index in nutritional indices were associated with the prognosis of the patients (P<0.05). The 3 medium modelvariables constructed included: i) Inflammatory response model: age, T stage, N stage, presence of nerve invasion, neutrophil count,lymphocyte count; ii) Nutritional model: age,T stage,N stage,presence of nerve invasion, and body mass index; and iii) Inflammatory re-sponse-nutritional model:age,T stage,N stage, presence of nerve invasion, neutrophil count, lymphocyte count, body mass index. Modelprediction results showed that the inflammatory-nutritional model [AUC=0.92, 95%CI: (0.89, 0.96); C-index: 0.87], the inflammatory model [AUC=0.91, 95%CI:(0.87,0.95); C-index: 0.86], and the nutritional model [AUC=0.91, 95%CI:(0.87,0.95); C-index: 0.85], while the inflammatory-nutritional model had a better fit (AIC:588.90) than the inflammatory model (AIC:593.98) and the nutritional model (AIC: 606.78). Conclusion Inflammatory nutrition model can be used for personalized prediction of survival prognosis in colorectal cancer patients. |
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