广西医学

目的探讨术前预后营养指数（PNI）和系统免疫炎症指数（SII）预测肾透明细胞癌术后患者预后的价值。方法回顾性分析263例肾透明细胞癌患者的临床资料，根据预后情况将患者分为死亡组与存活组。比较两组患者术前PNI、SII及一般临床资料，采用COX回归模型分析影响肾透明细胞癌术后患者预后的危险因素，并采用受试者工作特征（ROC）曲线分析术前PNI与SII预测肾透明细胞癌术后患者预后的效能。结果死亡组患者术前SII高于存活组，术前PNI低于存活组（P＜0.05）。死亡组和存活组患者的年龄、体质指数、临床症状情况、血红蛋白水平、血小板计数、淋巴细胞计数、中性粒细胞计数、血清白蛋白水平、血清肌酐水平、TNM分期、手术方式、肿瘤坏死情况比较，差异有统计学意义（P＜0.05）。多因素COX回归分析结果显示，术前高PNI是肾透明细胞癌术后患者预后的保护因素，而术前高SII、较高的T分期及M分期是其危险因素（P＜0.05）。ROC曲线分析结果显示，术前SII、PNI单独及联合预测肾透明细胞癌术后患者预后的曲线下面积分别为0.775、0.783、0.829，敏感度分别为65.9%、70.7%、73.2%，特异度分别为81.5%、75.2%、85.6%。结论术前高PNI是肾透明细胞癌术后患者预后的保护因素，术前高SII、较高的T分期及M分期是肾透明细胞癌术后患者预后的危险因素，术前SII、PNI对肾透明细胞癌术后患者预后有一定的预测效能，且二者联合预测的效能更佳。

ObjectiveTo investigate the value of preoperative prognostic nutritional index (PNI) and systemic immune-inflammation index (SII) for predicting postoperative prognosis of patients with clear cell carcinoma of kidney. MethodsThe clinical data of 263 patients with clear cell carcinoma of kidney were retrospectively analyzed, and they were assigned to death group or survival group according to patients′ prognosis. The preoperative PNI, SII, and general clinical data were compared between patients of the two groups. The risk factors for affecting postoperative prognosis in patients with clear cell carcinoma of kidney were analyzed by employing the COX regression model. The efficiency of preoperative PNI and SII for predicting postoperative prognosis in patients with clear cell carcinoma of kidney was analyzed by using the receiver operating characteristic (ROC) curve. ResultsThe death group exhibited a higher preoperative SII, a lower preoperative PNI as compared with the survival group (P＜0.05). There were statistically significant differences in age, body mass index, clinical symptom conditions, hemoglobin level, platelet counts, lymphocyte counts, neutrophil counts, serum albumin level, serum creatinine level, TNM stage, operative methods, and tumor necrosis between the death group and the survival group (P＜0.05). The results of multivariate COX regression analysis indicated that high preoperative PNI was the protective factor for postoperative prognosis in patients with clear cell carcinoma of kidney, whereas high preoperative SII, relatively high T stage and M stage were its risk factors (P＜0.05). The results of ROC curve analysis interpreted that areas under the curve of preoperative SII and PNI for alone and jointly predicting postoperative prognosis in patients with clear cell carcinoma of kidney were 0.775, 0.783, and 0.829, respectively, the sensitivities were 65.9%, 70.7%, and 73.2%, respectively, and the specificities were 81.5%, 75.2%, and 85.6%, respectively.ConclusionHigh preoperative PNI is the protective factor for postoperative prognosis in patients with clear cell carcinoma of kidney, while high preoperative SII, relatively high T stage and M stage are the risk factors for postoperative prognosis in patients with clear cell carcinoma of kidney. Preoperative SII and PNI exert prediction efficiency on postoperative prognosis in patients with clear cell carcinoma of kidney to a certain extent, and the combined prediction of the two interprets superior efficiency.