预后营养指数和中性粒细胞/淋巴细胞比值在根治性膀胱切除加尿流改道术后早期并发症风险评估中的应用研究
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摘要
目的探讨预后营养指数(OPNI)及中性粒细胞/淋巴细胞比值(NLR)在评估根治性膀胱切除加尿流改道术后早期并发症风险中的应用价值。方法回顾性分析行腹腔镜下根治性全膀胱切除术加尿流改道术的155例膀胱癌患者,根据患者术前1周内的外周血化验结果计算OPNI及NLR,采用受试者工作特征曲线(ROC)计算Youden指数,得到具有最佳敏感度及特异度组合的OPNI值及NLR值作为高低组的分界值进行分组,统计所有患者术后90 d内并发症,并根据Clavien-Dindo严重程度分级系统进行分级,分析OPNI与NLR对术后并发症的影响,并分析其相关性,采用Logistic回归分析评估各临床变量与发生术后肠梗阻的相对危险系数。结果根据ROC计算分别得到OPNI临界值为45.87、NLR临界值为2.49,以此分组,术后早期共有78例患者发生并发症,OPNI低组Clavien-Dindo并发症分级高于OPNT高组,NLR高组并发症分级显著高于NLR低组,NLR高组急性肾功能不全发生率显著高于NLR低组(P=0.03),OPNI高组肠梗阻发生率显著低于OPNI低组(P<0.01),NLR高组肠梗阻发生率显著高于NLR低组(P=0.025),采用Logistic回归分析术后肠梗阻的发生与患者年龄(95%CI=1.26,95%CI:0.648～2.463,P=0.042)、BMI(95%CI=0.43,95%CI:0.221～0.837,P=0.013)、OPNI(95%CI=0.307,95%CI:0.15～0.627,P=0.001)、NLR(95%CI=1.30,95%CI:0.663～2.547,P=0.045)有显著相关性,与有无腹部手术史、手术时间、尿流改道方式及病理分期无相关性,Spearman相关性分析OPNI与NLR呈明显负相关(ρ=-0.557,P<0.001)。结论术前OPNI及NLR值的检测可评估患者根治性膀胱切除加尿流改道术后早期并发症发生情况,高NLR、低OPNI能明显增加术后并发症发生的严重程度;高龄、低BMI、低OPNI、高NLR为术后肠梗阻发生的高危因素,OPNI与NLR呈显著负相关性,两者联合应用是较好的预测指标,指导膀胱癌患者术前纠正炎症和全身营养状态,降低术后并发症。
Objective To investigate the value of prognostic nutritional index(OPNI) and neutrophil-to-lymphocyte ratio(NLR) in evaluating the risk of early complications after radical cystectomy. Methods A retrospective analysis of 155 patients with bladder cancer who underwent laparoscopic radical cystectomy from March 2012 to July 2017 was performed. OPNI and NLR were calculated according to the results of peripheral blood test within one week before operation. The distributions of OPNI and NLR in clinical features were analyzed. The receiver operating characteristic(ROC) curve and Youden index were used to determine the cutoff values for OPNI and NLR, which had the best sensitivity and specificity. According to the cutoff values, the patients were divided into high group and low group. Complications of all patients within 90 days after operation were counted and classified according to Clavien-Dindo severity classification system. The effects of OPNI and NLR on postoperative complications were analyzed and their correlation was analyzed. Logistic regression analysis was used to evaluate the relative risk factors of clinical variables and postoperative intestinal obstruction. Results According to ROC calculation, the OPNI and NLR critical values were 45.87 and 2.49 respectively. There were 78 patients with complications in the early postoperative period. The Clavien-Dindo complication classification in the low OPNI group was higher than that in the high OPNI group, the complication classification in the high NLR group was significantly higher than that in the low NLR group, and the incidence of acute renal insufficiency in the high NLR group was significantly higher than that in the low NLR group(P=0.03). The incidence of intestinal obstruction in high OPNI group was significantly lower than that in low OPNI group(P<0.01). The incidence of intestinal obstruction in high NLR group was significantly higher than that in low NLR group(P=0.025). Logistic regression analysis showed that the incidence of postoperative intestinal obstruction was significantly correlated with age(95%CI=1.26, 95%CI: 0.648～2.463, P=0.042), BMI(95%CI=0.43,95%CI: 0.221～0.837,P=0.013), OPNI(95%CI=0.307, 95%CI: 0.15～0.627, P=0.001), NLR(95%CI=1.30, 95%CI: 0.663～2.547, P=0.045). However,there was no correlation between time, urinary diversion, and pathological stage. Spearman correlation analysis showed significant negative correlation between OPNI and NLR. Conclusion Preoperative detection of OPNI and NLR can evaluate the early complications after radical cystectomy and urinary diversion. High NLR and low OPNI can significantly increase the severity of postoperative complications. Old age, low BMI, low OPNI and high NLR are high risk factors for postoperative intestinal obstruction, OPNI and NLR are negatively correlated. Combined use is a good predictor of bladder cancer patients to correct inflammation and nutritional status, reduce postoperative complications.
Objective To investigate the value of prognostic nutritional index(OPNI) and neutrophil-to-lymphocyte ratio(NLR) in evaluating the risk of early complications after radical cystectomy. Methods A retrospective analysis of 155 patients with bladder cancer who underwent laparoscopic radical cystectomy from March 2012 to July 2017 was performed. OPNI and NLR were calculated according to the results of peripheral blood test within one week before operation. The distributions of OPNI and NLR in clinical features were analyzed. The receiver operating characteristic(ROC) curve and Youden index were used to determine the cutoff values for OPNI and NLR, which had the best sensitivity and specificity. According to the cutoff values, the patients were divided into high group and low group. Complications of all patients within 90 days after operation were counted and classified according to Clavien-Dindo severity classification system. The effects of OPNI and NLR on postoperative complications were analyzed and their correlation was analyzed. Logistic regression analysis was used to evaluate the relative risk factors of clinical variables and postoperative intestinal obstruction. Results According to ROC calculation, the OPNI and NLR critical values were 45.87 and 2.49 respectively. There were 78 patients with complications in the early postoperative period. The Clavien-Dindo complication classification in the low OPNI group was higher than that in the high OPNI group, the complication classification in the high NLR group was significantly higher than that in the low NLR group, and the incidence of acute renal insufficiency in the high NLR group was significantly higher than that in the low NLR group(P=0.03). The incidence of intestinal obstruction in high OPNI group was significantly lower than that in low OPNI group(P<0.01). The incidence of intestinal obstruction in high NLR group was significantly higher than that in low NLR group(P=0.025). Logistic regression analysis showed that the incidence of postoperative intestinal obstruction was significantly correlated with age(95%CI=1.26, 95%CI: 0.648～2.463, P=0.042), BMI(95%CI=0.43,95%CI: 0.221～0.837,P=0.013), OPNI(95%CI=0.307, 95%CI: 0.15～0.627, P=0.001), NLR(95%CI=1.30, 95%CI: 0.663～2.547, P=0.045). However,there was no correlation between time, urinary diversion, and pathological stage. Spearman correlation analysis showed significant negative correlation between OPNI and NLR. Conclusion Preoperative detection of OPNI and NLR can evaluate the early complications after radical cystectomy and urinary diversion. High NLR and low OPNI can significantly increase the severity of postoperative complications. Old age, low BMI, low OPNI and high NLR are high risk factors for postoperative intestinal obstruction, OPNI and NLR are negatively correlated. Combined use is a good predictor of bladder cancer patients to correct inflammation and nutritional status, reduce postoperative complications.
引文
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[2] Stimson C J,Chang S S,Barocas D A,et al.Early and late perioperative outcomes following radical cystectomy:90-day readmissions,morbidity and mortality in a contemporary series[J].J Urol,2010,184(4):1296-300.
[3] Svatek R S,Fisher M B,Williams M B,et al.Age and body mass index are independent risk factors for the development of postoperative paralytic ileus after radical cystectomy[J].Urology,2010,76(6):1419-24.
[4] Takahashi Y,Horio H,Hato T,et al.Prognostic significance of preoperative neutrophil-lymphocyte ratios in patients with stage I non-small cell lung cancer after complete resection[J].Ann Surg Oncol,2015,22(Suppl3):S1324-31.
[5] Broggi M S,Patil D,Baum Y,et al.Onodera’s prognostic nutritional index as an independent prognostic factor in clear cell renal cell carcinoma[J].Urology,2016,96:99-105.
[6] Siegel R L,Miller K D,Jemal A.Cancer statistics,2017[J].CA Cancer J Clin,2017,67(1):7-30.
[7] Mcmillan D C.Systemic inflammation,nutritional status and survival in patients with cancer[J].Curr Opin Clin Nutr Metab Care,2009,12(3):223-6.
[8] Watanabe M,Iwatsuki M,Iwagami S,et al.Prognostic nutritional index predicts outcomes of gastrectomy in the elderly[J].World J Surg,2012,36(7):1632-9.
[9] Imtiaz F,Shafique K,Mirza S S,et al.Neutrophil lymphocyte ratio as a measure of systemic inflammation in prevalent chronic diseases in Asian population[J].Int Arch Med,2012,5(1):2.
[10] Zahorec R.Ratio of neutrophil to lymphocyte counts-rapid and simple parameter of systemic inflammation and stress in critically ill[J].Bratisl Lek Listy,2001,102(1):5-14.
[11] Svatek R S,Fisher M B,Williams M B,et al.Age and body mass index are independent risk factors for the development of postoperative paralytic ileus after radical cystectomy[J].Urology,2010,76(6):1419-24.
[12] Gangadharan A,Choi S E,Hassan A,et al.Protein calorie malnutrition,nutritional intervention and personalized cancer care[J].Oncotarget,2017,8(14):24009-30.