| Objective: The aim of this study was to explore the predictive value of preoperative prognostic nutritional index(PNI)in patients with advanced gastric cancer by retrospectively analyzing the relationship between PNI and clinicopathological features of patients.We established a nomogram prediction model based on the multivariate analysis results of Cox model.In order to provide reference for clinicians to individually predict the survival rate of patients.Methods: The clinicopathological data of 170 patients with advanced gastric cancer who underwent radical D2 operation in the First Affiliated Hospital of Guangxi Medical University from 2015 to 2016 were retrospectively analyzed.The preoperative PNI was calculated based on the results of blood sampling and liver function within one week before operation.And then,we drew the receiver operating characteristic curve to calculate the cut-off value of PNI.The counting data were compared by chi square test.Kaplan Meier method was used to draw the survival curve and calculate the survival rate of patients with advanced gastric cancer.Log rank test was used to compare the differences between the groups.Cox proportional hazard regression model was used for multivariate analysis.P <0.05 was statistically significant.According to the multivariate analysis results of Cox risk regression model,the nomogram was established,and bootstrap selfhelp sampling method was used to verify the nomogram internally,and then calibration curve is used to judge the prediction accuracy of the modelResults: 1.A total of 170 patients with advanced gastric cancer were included in this study,including 114 male patients(67.1%),56 female patients(32.9%),64 patients over 60 years old(37.6%),106 patients under 60 years old(62.4%).The results showed that the best cut-off value of PNI was 46.8.When PNI value < 46.8,it was low PNI group,but PNI value ≥ 46.8,it was high PNI group.There were 67 patients in low PNI group(39.4%),and 103 patients in high PNI group(60.6%).The chi square test results showed that PNI was correlated with age(P =0.012),hemoglobin(P=0.000),lymph node metastasis stage(P=0.002)and TNM stage(P=0.036),vessel invasion(P=0.012),and the difference was statistically significant.2.A total of 170 patients were returned in the survival analysis,of whom 103 died and 67 survived,with the median survival time of 37 months,the minimum of 10 months and the minimum of 10 months big value 70 months.67 patients in the low PNI group were returned with a five-year survival rate of 20%,and 103 patients in the high PNI group with a five-year survival rate of 52.4%.PNI was correlated with the overall survival time of patients with advanced gastric cancer by Log-Rank test(P<0.05).3.Multivariate analysis showed that the age(HR=1.560,95%CI=1.040-2.340,P=0.032),PNI(HR=2.186,95%CI=1.451-3.293,P=0.020),tumor location(HR=1.641,95%CI=1.050-2.563,P=0.030),lymph node metastasis stage(HR=1.712,95%CI=1.003-2.922,P=0.049),TNM stage(HR=2.564,95%CI=1.258-5.228,P=0.010)were independent risk factors affecting the prognosis of patients with gastric cancer.4.Independent risk factors were included to construct a nomogram prediction model for survival rate of patients with advanced gastric cancer.The model consistency index(C index)was 0.766,and the calibration curve in the graphic calibration method was close to the standard curve,indicating that the prediction model had high accuracy.Conclusions: 1.PNI is correlated with age,hemoglobin,lymph node metastasis stage,TNM stage and vessel invasion.2.PNI is an independent risk factor for the prognosis of patients with advanced gastric cancer the overall survival time of patients with advanced gastric cancer is shorter in the low PNI group.3.The nomogram model is established based on patients’ age,PNI,tumor location,lymph node metastasis stage and TNM stage,which has high prediction compliance and accuracy. |
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