目的:因为营养不良会对癌症患者的预后产生不利影响,准确的营养状况评估很重要。因此,本研究旨在验证各种营养评估工具的预后价值,并比较其可预测性.
方法:我们回顾性纳入了2018年4月至2021年12月间因泌尿生殖系统癌症住院的200例患者。四个营养风险标记,即,主观整体评估(SGA)得分,迷你营养评估简表(MNA-SF)评分,控制营养状况(CONUT)评分,和老年营养风险指数(GNRI),在入院时测量。终点是全因死亡率。
结果:SGA,MNA-SF,CONUT,和GNRI值都是全因死亡率的独立预测因子(风险比[HR]=7.72,95%置信区间[CI]:1.75-34.1,P=0.007;HR=0.83,95%CI:0.75-0.93,P=0.001;HR=1.29,95%CI:1.16-1.43,P<0.001;HR=0.95,95%CI:0.93-0.98,甚至调整后P<0.001)性别,癌症阶段,手术或药物治疗。然而,在模型判别分析中,CONUT模型的净重新分类改进(与SGA:0.420,P=0.006和vs.MNA-SF:0.57,P<0.001)和GNRI模型(vs.SGA:0.59,P<0.001和vs.MNA-SF:0.671,P<0.001)与SGA和MNA-SF模型相比有显著改善,分别。CONUT和GNRI模型的组合也具有最高的可预测性(C指数=0.892)。
结论:在预测泌尿生殖系统癌症住院患者的全因死亡率方面,客观营养评估工具优于主观营养工具。CONUT评分和GNRI两者的测量可能有助于更准确的预测。
Because malnutrition adversely affects the prognosis of patients with cancer, accurate nutritional status assessment is important. Therefore, this
study aimed to verify the prognostic value of various nutritional assessment tools and compare their predictability.
We retrospectively enrolled 200 patients hospitalized for genitourinary cancer between April 2018 and December 2021. Four nutritional risk markers, namely, Subjective Global Assessment (SGA) score, Mini-Nutritional Assessment-Short Form (MNA-SF) score, Controlling Nutritional Status (CONUT) score, and Geriatric Nutritional Risk Index (GNRI), were measured at admission. The endpoint was all-cause mortality.
SGA, MNA-SF, CONUT, and GNRI values were all independent predictors of all-cause mortality (hazard ratio [HR] = 7.72, 95% confidence interval [CI]: 1.75-34.1, P = 0.007; HR = 0.83, 95% CI: 0.75-0.93, P = 0.001; HR = 1.29, 95% CI: 1.16-1.43, P < 0.001; and HR = 0.95, 95% CI: 0.93-0.98, P < 0.001, respectively) even after adjustment for age, sex, cancer stage, and surgery or medication. However, in the model discrimination analysis, the net reclassification improvement of the CONUT model (vs. SGA: 0.420, P = 0.006 and vs. MNA-SF: 0.57, P < 0.001) and GNRI model (vs. SGA: 0.59, P < 0.001 and vs. MNA-SF: 0.671, P < 0.001) were significantly improved compared to the SGA and MNA-SF models, respectively. The combination of CONUT and GNRI models also had the highest predictability (C-index = 0.892).
Objective nutritional assessment tools were superior to subjective nutritional tools in predicting all-cause mortality in inpatients with genitourinary cancer. Measurement of both the CONUT score and GNRI might contribute to a more accurate prediction.