预后营养指数与中性粒细胞淋巴细胞比值复合评分预测手术切除胸腺上皮肿瘤患者的生存率:一项回顾性单中心队列研究OA

Objective:To investigate the prognostic impact of the preoperative prognostic nutritional index(PNI)and neutrophil-to-lymphocyte ratio(NLR)in thymic epithelial tumors(TETs),and to develop a composite score of NLR and PNI(CNP)for predicting survival in patients undergoing surgical resection for TETs.Methods:We retrospectively reviewed the clinical data of 239 patients with TETs who underwent surgical treatment at Sichuan Cancer Hospital between 2013 and 2022.The PNI and NLR were calculated from preoperative peripheral blood test results.A CNP integrating PNI and NLR was further developed:PNI and NLR were first standardized using Z-scores(PNIz and NLRz),after which PNIz and NLRz were simultaneously entered into a Cox proportional hazards model to obtain the regression coefficients(β).These coeffi-cients were used as weights to construct the composite formula:CNP=βPNI×PNIz+βNLR×NLRz.Time-dependent re-ceiver operating characteristic(ROC)analysis was applied to determine the optimal cutoff for predicting 5-year overall sur-vival(OS),and PNI,NLR,and CNP were subsequently dichotomized according to their respective cutoffs.Kaplan-Meier curves were generated to estimate OS and compared between groups using the Log-rank test.Univariate and multivariable Cox proportional hazards models were performed to evaluate the independent prognostic value of these biomarkers.Results:Time-dependent ROC analysis identified the optimal cutoff values for predicting 5-year OS as 47.9 for PNI,2.81 for NLR,and 0.57 for CNP.Analysis of baseline clinicopathological characteristics showed that PNI was associated with TNM stage(P<0.001),Masaoka-Koga stage(P<0.001),and tumor size(P=0.025);the proportion of patients with tumors>5 cm was higher in the low-PNI group than in the high-PNI group(63.6%vs 47.4%).NLR was associated with TNM stage(P<0.001),Masaoka-Koga stage(P<0.001),and sex(P=0.020);the proportion of male patients was higher in the high-NLR group than in the low-NLR group(60.6%vs 44.0%).CNP was associated with both TNM stage and Masaoka-Koga stage(both P<0.001).In the multivariable Cox model,low PNI(HR=2.29,95%CI:1.03～5.10,P=0.043),high NLR(HR=2.55,95%CI:1.16～5.62,P=0.020),and high CNP(HR=3.85,95%CI:1.67～9.09,P=0.002)were all independent risk factors for OS.Conclusion:The CNP score,constructed by combining PNI and NLR,en-ables simple and reproducible preoperative risk stratification in patients with TETs and may help inform individualized follow-up and multimodal treatment strategies.