患者主观整体营养评估表对恶性肿瘤患者生存结局的预测价值研究

张会; 何荣芬; 刘群; 邵明莉

doi:10.16766/j.cnki.issn.1674-4152.004107

患者主观整体营养评估表对恶性肿瘤患者生存结局的预测价值研究

doi: 10.16766/j.cnki.issn.1674-4152.004107

张会¹,
何荣芬²,
刘群^2, ,,
邵明莉²

1.
淮北市人民医院临床营养科，安徽淮北 235000
2.
淮北市人民医院肿瘤科
3.
淮北市人民医院科教科

基金项目:

安徽省高等学校科学研究项目 2022AH051431

详细信息

通讯作者:
刘群，E-mail：yyk5044@126.com

中图分类号: R459.3 R730.7
计量
- 文章访问数: 11
- HTML全文浏览量: 5
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- 被引次数: 0
出版历程
- 收稿日期: 2025-02-03
- 网络出版日期: 2025-10-25

Study on the predictive value of patient-generated subjective nutrition assessment in the survival outcomes of cancer patients

1.
Department of Clinical Nutrition, Huaibei People ' s Hospital, Huaibei, Anhui 235000, China

摘要

摘要: 目的通过系统探究患者主观整体营养评估(PG-SGA)评分与肿瘤患者全因死亡风险之间的关联，明确其在评估患者预后时的价值。方法回顾性收集2020年8月1日—2022年8月31日在淮北市人民医院肿瘤科住院患者的数据, 包括人口统计学资料、生化检查、PG-SGA评分等指标。通过查阅病历或电话等方式随访患者的临床结局，随访时间为2年，主要结局为全因死亡。使用ROC曲线评估PG-SGA评分预测2年生存情况的能力，采用Cox比例风险模型分析肿瘤患者全因死亡风险的影响因素。结果 2组年龄、性别、高血压、肿瘤分期、BMI、营养风险筛查2002(NRS-2002)分级、PG-SGA评分、NRS-2002评分、PG-SGA分级、白蛋白比较，差异均有统计学意义(P < 0.05)。多因素Cox分析结果表明PG-SGA评分是肿瘤患者生存结局的独立影响因素。PG-SGA评分预测患者全因死亡的ROC曲线下面积为0.821(95% CI：0.757~0.885，P < 0.001)，灵敏度为0.853，特异度为0.656，最佳截点值为5.5分，即PG-SGA评分超过6分(包括6分)时，患者全因死亡风险明显增加。结论 PG-SGA评分是肿瘤患者生存结局的影响因素。PG-SGA评分5分以上的患者全因死亡风险明显增加，应给予充分重视并进行积极的营养干预。
- 患者主观整体营养评估 /
- 预后 /
- 肿瘤
Abstract: Objective To systematically investigate the association between patient-generated subjective global assessment (PG-SGA) and the risk of all-cause death in cancer patients, and to clarify its prognostic value. Methods A retrospective analysis was conducted on data from patients admitted to the Oncology Department of Huaibei People ' s Hospital from August 1, 2020, to August 31, 2022. Collected data included demographic data, biochemical examination, patient generated subjective global assessment, and other indicators. The clinical outcomes of the patients were obtained through case review or telephone follow-up, with a follow-up duration of 2 years. The main outcome was all-cause death. ROC curve was used to assess the ability of PG-SGA to predict 2-year survival, the and Cox proportional risk model was used to identify factors associated with all-cause death in cancer patients. Results Significant differences were found between the survival and non-survival groups in age, sex, hypertension, tumor stage, body mass index, nutritional risk screening 2002 (NRS-2002) grade, PG-SGA, and albumin levels (P < 0.05). Multivariate Cox analysis identified the PG-SGA score as independent risk factor for all-cause mortality in patients. The area under ROC curve for PG-SGA in predicting all-cause death was 0.821 (95% CI: 0.757-0.885, P < 0.001), with a sensitivity of 0.853, specificity of 0.656, and an optimal cut-off value of 5.5. Patients with PG-SGA score ≥6 had a significantly higher risk of mortality. Conclusion The PG-SGA is a significant predictor of survival outcomes in cancer patients. Patients with PG-SGA score greater than 5 is associated with an increased risk of all-cause death, highlighting the importance of early identification and timely nutritional intervention.
- Patient-generated subjective global assessment /
- Prognosis /
- Tumor

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图 1 NRS-2002、PG-SGA评分预测肿瘤患者2年生存状态的ROC曲线

Figure 1. ROC curves for predicting 2-year survival status in cancer patients using NRS-2002 and PG-SGA scores

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表 1 2组肿瘤患者一般资料、营养评估指标及实验室指标比较

Table 1. Comparison of general information, laboratory indicators, and nutritional assessment indicators between two groups of patients with tumors

项目	存活组(n=90)	死亡组(n=75)	统计量	P值
性别(例)			5.602^a	0.020
女性	49	27
男性	41	48
教育程度(例)			1.156^b	0.248
小学及以下	35	36
中学	46	33
大学及以上	9	6
高血压(例)			9.990^a	0.002
是	17	31
否	73	44
糖尿病(例)			0.886^a	0.352
是	5	7
否	85	68
肿瘤分期(例)			3.883^b	< 0.001
Ⅰ期	4	1
Ⅱ期	13	7
Ⅲ期	31	8
Ⅳ期	42	59
NRS-2002分级(例)			41.031^a	< 0.001
营养良好	63	15
营养风险	27	60
NRS-2002评分(x ± s，分)	2.16±0.95	3.35±1.12	7.399^c	< 0.001
PG-SGA分级[例(%)]			42.992^b	< 0.001
营养良好	1	0
可疑营养不良	22	2
中度营养不良	55	29
重度营养不良	12	44
PG-SGA评分(x ± s，分)	5.20±2.42	8.99±3.16	8.706^c	< 0.001
CONUT得分[M(P₂₅, P₇₅)，分]	3.00(2.00，4.00)	4.00(2.00，5.00)	-0.787^b	0.431
PNI得分(x ± s，分)	47.97±5.58	46.21±6.06	1.897^c	0.060
年龄(x ± s，岁)	57.53±11.68	63.37±10.8	3.309^c	0.001
BMI(x ± s)	23.98±3.37	22.49±2.74	3.085^c	0.002
白细胞[M(P₂₅, P₇₅)，×10⁹/L]	4.95(3.83，6.43)	5.30(4.10，6.90)	-1.106^b	0.269
红细胞(x ± s, ×10¹²/L)	4.10±0.65	3.90±0.63	1.938^c	0.054
血红蛋白(x ± s，g/L)	122.72±22.12	118.88±21.22	1.117^c	0.266
C反应蛋白[M(P₂₅, P₇₅)，mg/L]	3.12(1.45，5.96)	4.30(1.51，15.55)	-1.682^b	0.093
空腹血糖(x ± s, mmol/L)	5.12±0.86	5.13±1.32	0.073^c	0.942
总胆固醇(x ± s, mmol/L)	4.39±0.84	4.28±1.06	0.739^c	0.461
甘油三酯[M(P₂₅, P₇₅)，mmol/L]	1.32(1.05，1.75)	1.25(0.98，1.73)	0.795^b	0.427
高密度脂蛋白(x ± s, mmol/L)	1.20±0.28	1.23±0.35	0.622^c	0.535
低密度脂蛋白(x ± s, mmol/L)	2.65±0.71	2.48±0.84	1.330^c	0.185
总蛋白(x ± s, g/L)	67.26±6.45	66.00±7.10	1.185^c	0.238
白蛋白(x ± s, g/L)	41.51±4.59	39.44±4.88	2.770^c	0.006
前白蛋白(x ± s, mg/dL)	29.74±8.83	28.15±9.56	1.101^c	0.272
注：^a为χ²值，^b为Z值，^c为t值。

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表 2 相关变量赋值

Table 2. Assignment of relevant variables

变量	赋值方法
性别	女性=0，男性=1
教育程度	小学及以下=0，中学=2，大学及以上=2
高血压	否=0，是=1
糖尿病	否=0，是=1
肿瘤分期	Ⅰ期=0，Ⅱ期=1，Ⅲ期=2，Ⅳ期=3
NRS-2002分级	营养良好=0，营养风险=1
PG-SGA分级	营养良好=0，可疑营养不良=1，中度营养不良=2，重度营养不良=3
注：其余连续性变量均以实际值赋值。

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表 3 肿瘤患者2年生存结局的Cox单因素分析

Table 3. Cox univariate analysis of 2-year survival outcomes in cancer patients

变量	B	SE	Waldχ²	P值	HR(95% CI)
年龄	0.035	0.011	10.837	0.001	1.035(1.014~1.057)
性别	0.559	0.241	5.393	0.020	1.750(1.091~2.805)
BMI	-0.108	0.037	8.495	0.004	0.898(0.835~0.966)
高血压	0.728	0.235	9.583	0.002	2.071(1.306~3.283)
肿瘤分期	0.572	0.189	9.200	0.002	1.772(1.224~2.564)
白细胞	0.049	0.021	5.276	0.022	1.050(1.007~1.095)
白蛋白	-0.081	0.026	9.978	0.002	0.923(0.878~0.970)
C反应蛋白	0.014	0.005	6.382	0.012	1.014(1.003~1.025)
NRS 2002分级	1.647	0.290	32.203	< 0.001	5.192(2.940~9.172)
PNI得分	-0.047	0.022	4.617	0.032	0.954(0.914~0.996)
PG-SGA评分	0.299	0.037	64.712	< 0.001	1.349(1.254~1.451)
注：本表仅列出差异有统计学意义的结果。

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表 4 ROC曲线评价NRS-2002分级、PG-SGA评分预测患者死亡风险的效能

Table 4. Evaluation of the predictive ability of NRS-2002 and PG-SGA for patient mortality risk using ROC curves

项目	AUC	P值	灵敏度	特异度	截断值	约登指数
PG-SGA评分	0.821	< 0.001	0.853	0.656	5.5	1.509
NRS-2002分级	0.792	< 0.001	0.800	0.700		1.500

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