【摘要】 目的 探讨那不勒斯预后评分（NPS）对临床Ⅲ期食管癌患者生存预后的预测价值。方法 回顾性分析行根治性放疗的163例临床Ⅲ期食管癌患者。根据放疗前血常规及生化结果计算每例患者NPS，然后依据NPS分值分为低危组（0分）、中危组（1～2分）以及高危组（3～4分）并比较3组生存预后差异。应用Kaplan-Meier法及Cox比例风险模型进行单因素和多因素预后分析，绘制受试者工作特征（ROC）曲线并计算曲线下面积（AUC），比较NPS与预后营养指数（PNI）、中性粒细胞/淋巴细胞比值（NLR）、淋巴细胞/单核细胞比值（LMR）等其他营养及炎症指标对生存预后的预测价值。结果 依据放疗前NPS结果，将163例患者分为低危组38例、中危组71例及高危组54例。对低、中、高危组生存状况的分析显示，1年总生存率分别为89.7%、78.3%、66.9%,3年总生存率分别为60.1%、40.7%、26.6%,5年总生存率分别为48.1%、25.2%、17.1%(Log-rankχ2=16.398,P<0.01);1年无进展生存率分别为76.7%、52.7%、50.8%;3年无进展生存率分别为50.1%、25.3%、19.4%,5年无进展生存率分别为42.0%、21.1%、12.9%(Logrankχ2=16.852,P<0.01)。多因素分析显示，NPS中、高危组和同期未化疗为影响患者总生存及无进展生存的独立危险因素。NPS预测生存的AUC值（0.658）优于PNI(0.581)、NLR(0.561)、LMR(0.578)，差异有统计学意义（Z分别为1.938、2.016、1.950,P<0.05）。结论 放疗前NPS是接受根治性放疗的临床Ⅲ期食管癌患者预后的独立影响因素，其对生存预后的预测价值优于其他营养及炎症指标，NPS较高的患者预后相对较差。更多还原

【Abstract】 Objective prognosis of esophageal cancer patients with clinical stage Ⅲ.Methods clinical stage Ⅲ who received radical radiotherapy were retrospectively analyzed. According to the blood routine and biochemical test results before radiotherapy, NPS was calculated for each patient, and patients were divided into the low-risk group(NPS=0), the medium-risk group(NPS=1-2) and the high-risk group(NPS=3-4) for survival comparison. KaplanMeier method and Cox proportional risk model were used for univariate and multivariate analysis. The receiver operating characteristic curve(ROC) was plotted and the area under curve(AUC) was calculated. The predictive value of NPS for survival was compared with other nutritional and inflammatory indicators, such as the prognostic nutritional index(PNI),neutrophil/lymphocyte ratio(NLR) and lymphocyte/monocyte ratio(LMR).ResultsAccording to NPS before radiotherapy,the 163 patients were divided into the low-risk group(n=38), the medium-risk group(n=71) and the high-risk group(n=54).Analysis of survival in the three groups showed that the 1-, 3-and 5-year overall survival rates(OS) were 89.7%, 60.1%,48.1%, 78.3%, 40.7%, 25.2% and 66.9%, 26.6%, 17.1% in the low-risk group, the medium-risk group and the high-risk group(χ2=16.398, P<0.01), respectively. The 1-, 3-and 5-year progression-free survival rates(PFS) were 76.7%, 50.1%,42.0%, 52.7%, 25.3%, 21.1% and 50.8%, 19.4%, 12.9%(χ2=16.852, P<0.01), respectively. Multivariate analysis showed that NPS high-risk group and no chemotherapy were independent risk factors for OS and PFS. The AUC value of NPS(0.658) was larger than that of PNI(0.581), NLR(0.561) and LMR(0.578)(Z=1.938, 2.016, 1.950, P<0.05).Conclusion NPS before radiotherapy is an independent prognostic factor for esophageal cancer patients with clinical stage Ⅲ, and its predictive value for survival is better than other nutritional and inflammatory indicators. Patients with high NPS have a relatively poor prognosis.更多还原