目的:评价预后营养指数(PNI)联合C反应蛋白(CRP)和白蛋白(ALB)对胃癌根治术后吻合口瘘的预测价值。
方法:对兰州市第二人民医院2019年9月至2022年10月收治的275例胃癌患者进行回顾性病例对照研究。将患者分为吻合口漏组(n=31)或非泄漏组。临床,外科,和病理数据使用逻辑回归分析,以建立两种风险模型:联合临床-实验室指数(RISK1)和独立实验室指数(RISK2).使用受试者工作特征(ROC)曲线比较模型有效性。
结果:11.27%的患者发生吻合口漏,主要发生在TNM分期晚期患者(P=0.006)。值得注意的是,较高的手术时间(P=0.049)和术中出血增加(P=0.027)与渗漏组相关.ALB的显著差异,PNI,观察组间CRP水平。RISK1和RISK2都鉴定了ALB,CRP,PNI,手术时间,术中出血作为渗漏的独立预测因子,表现出高预测精度(RISK1AUC=0.937,RISK2AUC=0.911),模型间性能差异无统计学意义(P=0.245)。
结论:ALB的组合,CRP,和PNI能有效预测胃癌手术患者吻合口瘘的风险。这些生物标志物可以显着增强术后管理并改善患者预后。
OBJECTIVE: To evaluate the predictive value of the Prognostic Nutritional Index (PNI) combined with C-reactive protein (CRP) and albumin (
ALB) for anastomotic leakage following radical gastric cancer surgery.
METHODS: A retrospective case-control study was conducted with 275 gastric cancer patients at the Second People\'s Hospital of Lanzhou City from September 2019 to October 2022. Patients were categorized into an anastomotic leakage group (n=31) or a non-leakage group. Clinical, surgical, and pathological data were analyzed using logistic regression to develop two risk models: a combined clinical-laboratory index (RISK1) and a separate laboratory index (RISK2). Model effectiveness was compared using Receiver Operating Characteristic (ROC) curves.
RESULTS: Anastomotic leakage occurred in 11.27% of patients, predominantly in those with advanced TNM stages (P=0.006). Notably, higher operative times (P=0.049) and increased intraoperative bleeding (P=0.027) were associated with the leakage group. Significant differences in
ALB, PNI, and CRP levels were observed between the groups. Both RISK1 and RISK2 identified
ALB, CRP, PNI, operative time, and intraoperative bleeding as independent predictors of leakage, demonstrating high predictive accuracy (RISK1 AUC=0.937, RISK2 AUC=0.911), with no significant difference in performance between the models (P=0.245).
CONCLUSIONS: The combination of
ALB, CRP, and PNI effectively predicts the risk of anastomotic leakage in patients undergoing gastric cancer surgery. These biomarkers can significantly enhance postoperative management and improve patient outcomes.