摘要目的 探讨术前控制营养状况(controlling nutritional status,CONUT)评分对接受根治性切除术后辅助化疗胃癌患者预后的影响.方法 回顾性分析1998年7月至2014年12月在广西医科大学第三附属医院接受根治性切除术后辅助化疗的536例Ⅱ～Ⅲ期胃癌患者.以CONUT评分3分为临界值,将患者分为高CONUT组(≥3分)和低CONUT组(≤2分).结果 高CONUT组胃癌患者的5年生存率低于低CONUT组胃癌患者(37.3％比55.7％,P＜0.001).单因素分析显示,高CONUT组胃癌患者与较大的肿瘤、较多的淋巴结转移、较低的BMI、较高的预后营养指数及术前贫血均有关(均P ＜0.05).多因素分析显示,CONUT评分是胃癌患者的独立预后因素(HR:1.564,95％CI:1.090～2.321,P=0.016).不同TNM分期高CONUT组胃癌患者的5年生存率低于低CONUT组胃癌患者(P＜0.05).结论 CONUT评分是预测根治性切除术后辅助化疗的Ⅱ～Ⅲ期胃癌患者预后的指标,营养评价有助于制定术前营养干预的计划.

abstractsObjectives To elucidate the prognostic impact of preoperative control of nutritional status (CONUT) scores on gastric cancer patients undergoing adjuvant chemotherapy after radical gastrectomy.Methods A retrospective analysis of 536 stage Ⅱ-Ⅲ gastric cancer patients undergoing adjuvant chemotherapy after radical resection from Jul 1998 to Dec 2014 was performed.Patients were divided into high (≥ 3) and low (≤ 2) CONUT groups with a CONUT score of 3 divided into critical values.Results The 5-year survival rate of the high CONUT group was significantly lower than that of the low CONUT group (37.3 ％ vs.55.7％,P ＜0.001).Univariate analysis showed that the high CONUT group was associated with larger tumors,more lymph node metastasis,lower body mass index,higher prognostic nutritional index,and preoperative anemia (all P ＜ 0.05).Multivariate analysis showed that the CONUT score was an independent prognostic factor for patients with gastric cancer (HR:1.564,95％ CI:1.090-2.321,P =0.016).The 5-year survival rate of the high CONUT group was significantly lower than that of the low CONUT group (P ＜ 0.05).Conclusion The CONUT score is an indicator for predicting the prognosis of patients with stage Ⅱ-Ⅲ gastric cancer after adjuvant chemotherapy.The nutritional evaluation is helpful to develop a plan for preoperative nutritional intervention.