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术前控制营养状态评分与宫颈癌患者术后复发、转移的关系

Relationships of preoperative Controlling Nutritional Status with tumor postoperative recurrence and metastasis in cervical cancer patients

    摘要
  • 摘要:
    目的 探讨术前控制营养状态(CONUT)评分对宫颈癌患者术后复发、转移的预测价值。
    方法 回顾性分析2017年1月—2019年4月接受根治性手术治疗的134例宫颈癌患者的临床与随访数据。根据患者的血清白蛋白水平、外周血淋巴细胞总数及总胆固醇浓度计算CONUT评分。通过时依性受试者工作特征(tROC)曲线确定CONUT评分预测宫颈癌术后复发、转移的最佳截断值，并采用Kaplan-Meier曲线评估CONUT评分与宫颈癌患者无复发生存率的关系。通过单变量和多变量Cox回归分析确定影响宫颈癌患者术后复发、转移的独立风险因素。
    结果 tROC曲线显示, CONUT评分预测宫颈癌术后复发、转移的最佳截断值为3分，曲线下面积(AUC)为0.709 (95%CI: 0.587~0.830)。基于最佳截断值，将所有患者分为高CONUT评分组(≥3分)与低CONUT评分组(< 3分)，结果表明，高CONUT评分与宫颈癌盆腔淋巴结转移风险及国际妇产科联合会(FIGO)肿瘤分期显著相关。随访期内共22例(16.4%)患者出现复发、转移。生存曲线表明，高CONUT评分组与低CONUT评分组患者的3年无复发生存率分别为69.5%和89.3%, 差异有统计学意义(P=0.007)。单变量、多变量Cox回归分析证实, CONUT评分高(HR=2.771, 95%CI: 1.158~6.626, P=0.022)、FIGO肿瘤分期高(HR=2.968, 95%CI: 1.183~7.444, P=0.020)和淋巴血管间隙浸润(HR=2.589, 95%CI: 1.031~6.499, P=0.043)是宫颈癌患者术后复发、转移的独立预测因素。
    结论 CONUT评分可作为预测宫颈癌术后复发、转移的有效指标，术前CONUT评分≥3分提示患者预后不佳。

     

    Abstract:
    Objective To investigate the predictive value of preoperative Controlling Nutritional Status (CONUT) score for tumor postoperative recurrence and metastasis in cervical cancer patients.
    Methods The clinical and follow-up data of 134 cervical cancer patients who underwent curative resection at the Department of Gynecology in our hospital from January 2017 to April 2019 were retrospectively analyzed. The preoperative CONUT score of each patient was calculated according to the serum level of albumin, peripheral lymphocytes counts and total cholesterol level. The best cut-off point of preoperative CONUT score for the prediction of tumor recurrence and metastasis in cervical cancer patients was identified by time-dependent receiver operation characteristics (tROC) curve, and the correlation between preoperative CONUT and recurrence free survival rate of cervical cancer patients was evaluated by Kaplan-Meier method. The univariate and multivariate Cox regression analysis was used to identify the independent risk factors for postoperative recurrence and metastasis in cervical cancer patients.
    Results The tROC curve showed that the best cut-off point of preoperative CONUT score for the prediction of tumor recurrence and metastasis in cervical cancer patients was 3 points, with an area under curve (AUC) value of 0.709 (95%CI, 0.587 to 0.830). All patients were divided into high CONUT score group(≥3)and low CONUT score group(< 3) based on the best cut-off value. The results showed that high CONUT was significantly correlated with higher risk of pelvic lymph node metastasis and advanced International Federation of Gynecology and Obstetrics (FIGO) staging. During the follow-up period, tumor recurrence and metastasis were observed in 22 patients (16.4%). The survival curves showed that the 3-year recurrence free survival rate of patients in the high CONUT score group and low CONUT score group were 69.5% and 89.3%, respectively (P=0.007). The univariate and multivariate Cox regression analysis demonstrated that higher preoperative CONUT score(HR=2.771; 95%CI, 1.158 to 6.626; P=0.022), higher FIGO staging (HR=2.968; 95%CI, 1.183 to 7.444; P=0.020) and lymphovascular space invasion (HR=2.589; 95%CI, 1.031 to 6.499; P=0.043) were independent predictors of RFS for cervical cancer patients.
    Conclusion CONUT score might be used as an effective indicator in prediction of tumor recurrence and metastasis, and preoperative CONUT score ≥3 suggests a poor prognosis for cervical cancer patients.

     

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