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NRS-2002营养评估与肝细胞癌患者肝切除术后无复发生存时间及总生存时间的关系
Association of Nutritional Risk Assessment 2002 score with recurrence-free survival time and overall survival time in patients undergoing hepatectomy
文章发布日期:2019年08月19日  来源:  作者:田甜,张姮,姜挺  点击次数:117次  下载次数:17次

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【摘要】:目的探讨营养风险评估表(NRS-2002)与肝细胞癌(HCC)肝切除术患者无复发生存时间及总生存时间之间的关系。方法选取2013年1月-2017年1月在武汉中心医院首次行肝切除术治疗的HCC患者。采用NRS-2002评分评估HCC患者术前的营养状态。所有患者均随访,根据随访结果记录无复发生存时间及总生存时间。计数资料2组间比较采用χ2检验。采用Kaplan-Meier检验对无复发生存时间及总体生存时间进行分析。复发及死亡的独立危险因素采用多因素Cox比例风险模型分析。结果根据NRS-2002评分筛查结果显示,230例HCC患者术前存在营养风险72例,营养正常158例,营养风险发生率31.3%。随访时间7~80个月,平均随访(46.14±10.52)个月。所有患者中,复发91例(39.6%),死亡43例(18.7%),1年复发率10%(23/230)、3年复发率28.3%(65/230)、5年复发率35.2%(81/230);1年病死率1.7%(4/230)、3年病死率12.2%(28/230)、5年病死率16.1%(37/230)。其中营养风险患者复发37例(51.4%),死亡20例(27.8%);营养正常患者复发54例(34.2%),死亡23例(14.6%)。营养正常患者总生存时间及无复发生存时间均高于营养风险患者(P值均<0.05)。肿瘤个数[风险比(HR)=1682,95%可信区间(95%CI):1.161~2438]、血管侵犯(HR=1.996,95%CI:1.372~2.904)、营养风险(HR=2.186,95%CI:1517~3150)是HCC患者复发的独立危险因素(P值均<005);血管侵犯(HR=1.823,95%CI:1.265~2.627)、营养风险(HR=2.068,95%CI:1.431~2.990)是HCC患者死亡的独立危险因素(P值均<005)。结论根据NRS-2002评分的营养筛查结果,HCC患者术前营养风险比例较高且与术后复发及死亡存在联系。
【Abstract】:ObjectiveTo investigate the association of Nutritional Risk Assessment 2002 (NRS-2002) score with recurrence-free survival time and overall survival time in hepatocellular carcinoma (HCC) patients undergoing hepatectomy. MethodsThe HCC patients who underwent hepatectomy for the first time in Wuhan Central Hospital from January 2013 to January 2017 were enrolled. The NRS-2002 score was used to evaluate nutritional status before surgery. All patients were followed up, and recurrence-free survival time and overall survival time were recorded. The chi-square test was used for comparison of categorical data between groups. The Kaplan-Meier method was used to analyze recurrence-free survival time and overall survival time. The multivariate Cox proportional hazard model was used to investigate the independent risk factors for recurrence and death. ResultsAccording to the NRS-2002 score, 72 HCC patients had nutritional risk and 158 patients had normal nutrition before surgery, with an incidence rate of nutritional risk of 31.3%. The patients were followed up for 7-80 months (mean 46.14±10.52 months). Of all patients, 91 (39.6%) experienced recurrence and 43 (18.7%) died. The 1-, 3-, and 5-year recurrence rates were 10% (23/230), 28.3% (65/230), and 35.2% (81/230), respectively, and the 1-, 3-, and 5-year mortality rates were 1.7% (4/230), 12.2% (28/230), and 16.1% (37/230), respectively. Among the 72 patients with nutritional risk, 37 (51.4%) experienced recurrence and 20 (27.8%) died, and among the 158 patients with normal nutrition, 54 (34.2%) experienced recurrence and 23 (14.6%) died. The patients with normal nutrition had significantly longer overall survival time and recurrence-free survival time than those with nutritional risk (P<0.05). The number of tumors (hazard ratio [HR]=1.682, 95% confidence interval [CI]: 1.161-2.438), vascular invasion (HR=1.996, 95%CI: 1.372-2.904), and nutritional risk (HR=2.186, 95%CI: 1.517-3.150) were independent risk factors for recurrence in HCC patients, and vascular invasion (HR=1.823, 95%CI: 1.265-2627) and nutritional risk (HR=2.068, 95%CI: 1.431-2.990) were independent risk factors for death in HCC patients. Conclusion According to the nutritional screening results based on the NRS-2002 score, there is a high proportion of HCC patients with nutritional risk before surgery, which is associated with postoperative recurrence and death.
【关键字】:癌,肝细胞; 营养风险评估表; 肝切除术; 预后
【Key words】:carcinoma, hepatocellular; nutritional risk assessment scale; hepatectomy; prognosis
【引证本文】:TIAN T, ZHANG H, JIANG T. Association of Nutritional Risk Assessment 2002 score with recurrence-free survival time and overall survival time in patients undergoing hepatectomy[J]. J Clin Hepatol, 2019, 35(9): 1970-1974. (in Chinese)
田甜, 张姮, 姜挺. NRS-2002营养评估与肝细胞癌患者肝切除术后无复发生存时间及总生存时间的关系[J]. 临床肝胆病杂志, 2019, 35(9): 1970-1974.

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