摘要目的:研究老年营养风险指数(GNRI)与接受根治性放疗或放化疗的老年食管癌患者预后间的关系。方法:回顾性分析河北医科大学第四医院2007年1月至2013年12月197例接受根治性放疗或放化疗且年龄≥75岁的食管鳞癌患者的临床资料，计算患者放疗前后老年营养风险指数(GNRI)、体质量指数(BMI)并进行分组。Kaplan-Meier法对生存时间行单因素预后分析，Cox回归模型行多因素预后分析。结果:放疗前GNRI评分正常组139例，异常组58例，两组5年生存率及无进展生存率分别为11.08%、9.82%和8.73%、6.18%( P>0.05)。放疗后GNRI评分正常组68例，异常组129例，5年生存率及无进展生存率分别为17.04%、7.42%和16.17%、3.65%(χ 2＝12.316、14.617， P<0.05)。单因素分析显示，T分期、N分期、TNM分期、大体肿瘤体积(GTV)、放疗前中性粒细胞与淋巴细胞比值(NLR)及放疗后BMI、放疗后血红蛋白水平、放疗后GNRI与总生存时间(OS)相关( χ2＝6.569～22.434， P<0.05)；T分期、GTV、放疗前NLR及放疗后的BMI、放疗后血红蛋白水平、放疗后GNRI与无进展生存时间(PFS)相关( χ2＝4.579～18.990， P<0.05)。多因素分析显示，T分期、N分期、放疗前NLR、放疗后血红蛋白水平、放疗后GNRI为患者OS的独立影响因素( P<0.05)。放疗前NLR、放疗后血红蛋白水平、放疗后GNRI为患者PFS的独立影响因素( P<0.05)。多因素分析显示，T分期、放疗后的血红蛋白水平、GNRI均为影响患者近期疗效的独立相关因素(χ 2＝4.716、13.083、4.519， P<0.05)。 结论:营养指标GNRI可作为老年食管鳞癌患者的有效预后指标。临床工作中对GNRI评分风险较高的老年患者可积极行营养干预以改善患者预后。

abstractsObjective:To evaluate the prognostic value of the Geriatric Nutritional Risk Index (GNRI) in elderly patients with esophageal squamous cell carcinoma (ESCC) accepting radical radiotherapy or radiochemotherapy.Methods:Clinicopathological and laboratory data of 197 patients aged over 75 years old with ESCC who accepted radical radiotherapy or radiochemotherapy from January 2007 to December 2013 were retrospectively analyzed. GNRI and body mass index (BMI) were calculated and grouped. Univariate analysis was performed by Kaplan-Meier and multivariate analysis was performed by a Cox regression model.Results:There were 139 patients in the normal GNRI group (GNRI>98) and 58 patients in the abnormal GNRI group (GNRI≤98) before radiotherapy. The 5-year overall survival (OS) rates and progression-free survival (PFS) rates in the normal and abnormal GNRI groups were 11.08%, 9.82% and 8.73%, 6.18%, respectively, without statistically significant difference ( P>0.05). There were 68 patients in the normal GNRI group and 129 patients in the abnormal GNRI group after radiotherapy. The 5-year OS rates and PFS rates in the normal and abnormal GNRI groups were 17.04%, 7.42% and 16.17%, 3.65%, respectively, with statistically significant difference ( χ2=12.316, 14.617, P<0.05). Univariate analysis showed that T stage, N stage, TNM stage, GTV, NLR before radiotherapy, BMI after radiotherapy, hemoglobin level after radiotherapy and GNRI after radiotherapy were significantly correlated with OS ( χ2=6.569-22.434, P<0.05). And T stage, GTV, NLR before radiotherapy, BMI after radiotherapy, hemoglobin level after radiotherapy and GNRI after radiotherapy were significantly correlated with PFS ( χ2=4.579-18.990, P<0.05). Multivariate analysis showed that T stage, N stage, NLR before radiotherapy, hemoglobin level after radiotherapy and GNRI after radiotherapy were independent factors for OS ( P<0.05). And NLR before radiotherapy, hemoglobin level after radiotherapy and GNRI after radiotherapy were independent factors for PFS ( P<0.05). Multivariate analysis showed that T stage, hemoglobin level after radiotherapy and GNRI after radiotherapy were independent factors for short-term effects (χ 2=4.716, 13.083, 4.519, P<0.05). Conclusions:The GNRI after radiotherapy can be used as a useful indicator for predicting survival in elderly patients with ESCC receiving radiotherapy or radiochemotherapy. Nutritional intervention should be carried out for elderly patients of abnormal GNRI with ESCC to improve survival.