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Dong L, Ma Y, Cao G, Chen D, Dong F, Jiao X, Cao Y, Liu C, Wang Y, Zhuo N, Wang F, Guo Y, Dai T, Zhang S, Jiao H, Zou X, Li J, Shen L, He Z, Zhang Y, Lu Z. An integrated prognosis prediction model based on real-word clinical characteristics for immunotherapy in advanced esophageal squamous cell carcinoma. Cancer Immunol Immunother 2025; 74:112. [PMID: 39998564 PMCID: PMC11861846 DOI: 10.1007/s00262-025-03963-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2025] [Accepted: 01/29/2025] [Indexed: 02/27/2025]
Abstract
INTRODUCTION Immune checkpoint inhibitors (ICIs) benefit only a subset of patients in advanced esophageal squamous cell carcinoma (ESCC). Our study aims to develop and validate a clinically accessible model to better identify those who may respond to ICIs. METHODS This study enrolled advanced ESCC patients treated with ICIs at Peking University Cancer Hospital from January 14, 2016, to January 26, 2024 for the training cohort and at Harbin Medical University Cancer Hospital between January 10, 2019, and July 6, 2022 for the validation cohort. Combined positive score (CPS) was recorded to assess the predictive value of programmed cell death ligand-1 (PD-L1). Baseline clinical and laboratory characteristics were identified as predictors through Akaike information criterion (AIC) and Cox proportional hazards regression. The prediction model underwent internal validation through bootstrapping and was externally validated in the validation cohort. RESULTS The training cohort consisted of 430 patients, while the validation cohort included 184 patients. PD-L1 expression failed to discriminate survival outcomes. The prediction model incorporates 10 variables: stage, bone metastasis, line of therapy, treatment, lactate dehydrogenase, carcinoembryonic antigen, carbohydrate antigen 199, systemic immune-inflammation index, lymphocyte count and prognostic nutritional index. The model achieved a C-index of 0.725 in the training cohort, 0.722 following bootstrapping, and 0.691 in the external validation cohort. An interactive online prediction tool ( https://escc-survival.shinyapps.io/shiny_app/ ) was subsequently developed. CONCLUSIONS This is the first large-scale, real-world model for individualized survival prediction for advanced ESCC patients treated with ICIs, offering a practical tool for optimizing clinical decisions.
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Affiliation(s)
- Liyuan Dong
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Gastrointestinal Oncology, Peking University Cancer Hospital & Institute, Beijing, 100142, China
| | - Yue Ma
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Gastrointestinal Oncology, Peking University Cancer Hospital & Institute, Beijing, 100142, China
- Department of Gastrointestinal Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, 150081, China
| | - Guang Cao
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Interventional Therapy, Peking University Cancer Hospital & Institute, Beijing, 100142, China
| | - Dongze Chen
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Genetics, Peking University Cancer Hospital & Institute, Beijing, 100142, China
| | - Fengxiao Dong
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Gastrointestinal Oncology, Peking University Cancer Hospital & Institute, Beijing, 100142, China
| | - Xi Jiao
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Gastrointestinal Oncology, Peking University Cancer Hospital & Institute, Beijing, 100142, China
| | - Yanshuo Cao
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Gastrointestinal Oncology, Peking University Cancer Hospital & Institute, Beijing, 100142, China
| | - Chang Liu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Gastrointestinal Oncology, Peking University Cancer Hospital & Institute, Beijing, 100142, China
| | - Yanni Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Gastrointestinal Oncology, Peking University Cancer Hospital & Institute, Beijing, 100142, China
| | - Na Zhuo
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Gastrointestinal Oncology, Peking University Cancer Hospital & Institute, Beijing, 100142, China
| | - Fengyuan Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Gastrointestinal Oncology, Peking University Cancer Hospital & Institute, Beijing, 100142, China
| | - Yixuan Guo
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Gastrointestinal Oncology, Peking University Cancer Hospital & Institute, Beijing, 100142, China
| | - Tingting Dai
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Gastrointestinal Oncology, Peking University Cancer Hospital & Institute, Beijing, 100142, China
| | - Shuwei Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Gastrointestinal Oncology, Peking University Cancer Hospital & Institute, Beijing, 100142, China
| | - Hao Jiao
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Gastrointestinal Oncology, Peking University Cancer Hospital & Institute, Beijing, 100142, China
| | - Xingyue Zou
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Gastrointestinal Oncology, Peking University Cancer Hospital & Institute, Beijing, 100142, China
| | - Jian Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Gastrointestinal Oncology, Peking University Cancer Hospital & Institute, Beijing, 100142, China
| | - Lin Shen
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Gastrointestinal Oncology, Peking University Cancer Hospital & Institute, Beijing, 100142, China
| | - Zhonghu He
- State Key Laboratory of Molecular Oncology, Beijing Key Laboratory of Carcinogenesis and Translational Research, Department of Genetics, Peking University Cancer Hospital & Institute, Beijing, 100142, China.
| | - Yanqiao Zhang
- Department of Gastrointestinal Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, 150081, China.
| | - Zhihao Lu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Gastrointestinal Oncology, Peking University Cancer Hospital & Institute, Beijing, 100142, China.
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Shan J, Yang Y, Liu H, Sun Z, Chen M, Zhu Z. Machine Learning Differentiates Between Benign and Malignant Parotid Tumors With Contrast-Enhanced Ultrasound Features. J Oral Maxillofac Surg 2025; 83:208-221. [PMID: 39557074 DOI: 10.1016/j.joms.2024.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 10/07/2024] [Accepted: 10/22/2024] [Indexed: 11/20/2024]
Abstract
BACKGROUND Contrast-enhanced ultrasound (CEUS) is frequently used to distinguish benign parotid tumors (BPTs) from malignant parotid tumors (MPTs). Introducing machine learning may enable clinicians to preoperatively diagnose parotid tumors precisely. PURPOSE We aimed to estimate the diagnostic capability of machine learning in differentiating BPTs from MPTs. STUDY DESIGN, SETTING, AND SAMPLE A retrospective cohort study was conducted at the Third Affiliated Hospital of Soochow University. Patients who underwent parotidectomy and CEUS for untreated parotid tumors were included. Patients with recurrent tumors, inadequate specimens, or chemoradiotherapy were excluded. PREDICTOR VARIABLE Predictor variable was preoperative diagnosis coded as BPTs and MPTs based on the support vector machine (SVM) algorithms, laboratory, and CEUS variables. MAIN OUTCOME VARIABLE(S) Outcome variable was pathological diagnosis coded as BPTs and MPTs. COVARIATES Covariate was demographics. ANALYSES A senior surgeon labeled patients' tumors as BPTs or MPTs, creating a clinical diagnosis. Patients were randomly divided into training (70%) and testing (30%) sets. After developing the SVM models using the training set, we evaluated their diagnostic performance on the testing set with the area under the receiver-operating characteristic curve (AUC), accuracy, positive predictive value, negative predictive value, sensitivity, and specificity. Delong's test was used to compare the AUC of SVM models, laboratory, and CEUS variables. RESULTS The sample included 48 patients, and the testing set comprised 12 (25%) BPTs and 3 (6.25%) MPTs. Three CEUS variables (width, arrival time, and time to peak) and 3 laboratory variables (lymphocyte count, D-dimer, prognostic nutritional index) were identified through recursive feature elimination. Tested on the testing set, the SVM models with linear, polynomial, and radial kernels showed identical performance (AUC = 0.972, accuracy = 93.3%, positive predictive value = 75%, negative predictive value = 100%, sensitivity = 100%, specificity = 91.7%). They had larger AUC than SVM with sigmoid kernel (P = .18), width (P = .03), lymphocyte count (P = .02), D-dimer (P < .01), prognostic nutritional index (P = .03), arrival time (P = .02), time to peak (P = .04), CEUS diagnosis (P < .01), and clinical diagnosis (P < .01). CONCLUSION AND RELEVANCE The SVM algorithm differentiated BPTs from MPTs better than laboratory and CEUS variables.
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Affiliation(s)
- Jie Shan
- Resident, Department of Oral and Maxillofacial Surgery, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Yifei Yang
- Associate Chief Physician, Department of Oral and Maxillofacial Surgery, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Hualian Liu
- Associate Chief Physician, Department of Oral and Maxillofacial Surgery, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Zhaoyao Sun
- Attending Physician, Department of Oral and Maxillofacial Surgery, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Mingming Chen
- Attending Physician, Department of Ultrasound, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Zhichao Zhu
- Associate Chief Physician, Department of Oral and Maxillofacial Surgery, The Third Affiliated Hospital of Soochow University, Changzhou, China.
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Xu Y, Zhang L, Huang Q, Yin Z, Zhang W. Nutritional Risk Index (NRI) predicts the clinical outcomes of patients with gastric cancer who received immune checkpoint inhibitors (PD-1/PD-L1). Medicine (Baltimore) 2025; 104:e40898. [PMID: 40184134 PMCID: PMC11709187 DOI: 10.1097/md.0000000000040898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 11/18/2024] [Accepted: 11/22/2024] [Indexed: 04/05/2025] Open
Abstract
Numerous studies have consistently indicated a connection between the clinical results of individuals who receive immunotherapy and their nutritional condition. This study aims to evaluate the predictive capacity of the Nutritional Risk Index (NRI) in gastric cancer patients who are undergoing treatment with immune checkpoint inhibitors (ICIs). This study included a total of 146 individuals diagnosed with gastric cancer and received a combination of chemotherapy and immunotherapy using PD-1/PD-L1 inhibitors. The threshold was established by utilizing the receiver operating characteristic (ROC) curve. To analyze the clinical and pathological characteristics of the 2 groups, we performed Chi-square test or Fisher exact test. Univariate and multivariate analyses were performed to assess the factors influencing progression-free survival (PFS) and overall survival (OS) rates. Additionally, we developed nomograms to accurately predict the probability of 1- year and 3-year survival in these patients. According to the threshold, there were 38 (26.0%) patients in the low NRI category and 108 (74.0%) patients in the high NRI category. In the high NRI group, the median survival PFS was 32.50 months, while it was 11.77 months in the low NRI group. Likewise, the average survival OS in the 2 categories was 18.57 months compared to an indefinite duration. Individuals classified in the low NRI category encountered reduced PFS and OS, with a hazard ratio (HR) of 2.015 and 2.093 respectively, along with corresponding P-values of .009 and .006. The analysis of multiple variables showed that the number of platelets and TNM stage were separate factors that predicted both PFS and OS. Additionally, NRI was further recognized as a separate predictive factor for overall survival. The analysis of a specific subgroup revealed that individuals in the low NRI category experienced worse PFS and OS, especially within the group receiving ICIs. The C-index and the respective 95% CI of the nomograms to forecast the likelihood of PFS and OS survival were 0.646 (0.583-0.709) and 0.693 (0.635-0.751). NRI has the capability to forecast the clinical results of individuals who were diagnosed with gastric cancer and have received ICIs. This makes it a feasible biomarker for identifying patients who could benefit from ICIs.
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Affiliation(s)
- Yuehua Xu
- Harbin Medical University Cancer Hospital, Harbin Medical University, Harbin, Heilongjiang, China
| | - Limin Zhang
- Harbin Medical University Cancer Hospital, Harbin Medical University, Harbin, Heilongjiang, China
| | - Qi Huang
- Harbin Medical University Cancer Hospital, Harbin Medical University, Harbin, Heilongjiang, China
| | - Zhidong Yin
- Harbin Medical University Cancer Hospital, Harbin Medical University, Harbin, Heilongjiang, China
| | - Wei Zhang
- Harbin Medical University Cancer Hospital, Harbin Medical University, Harbin, Heilongjiang, China
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Ürün YY, Ürün M. Do Nutritional and Inflammatory Indices Predict Response in Geriatric Gastric Cancer Patients Treated with Neoadjuvant FLOT Regimen? Cancer Control 2025; 32:10732748251335367. [PMID: 40250473 PMCID: PMC12035122 DOI: 10.1177/10732748251335367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2024] [Revised: 03/24/2025] [Accepted: 03/25/2025] [Indexed: 04/20/2025] Open
Abstract
Introduction: Docetaxel-based chemotherapy is a standardized neoadjuvant treatment for gastric cancer. There are still no reliable indicators to predict tumor response and prognosis of geriatric patients prior to chemotherapy. The aim of our study was to investigate the value of pretreatment prognostic nutritional index (PNI), serum albumin, total lymphocyte, neutrophil-lymphocyte ratio (NLR), and platelet-lymphocyte ratio (PLR) in predicting the response to treatment in geriatric gastric cancer patients treated with FLOT (5-Fluorouracil, leucovorin, oxaliplatin, and docetaxel) regimen as neoadjuvant chemotherapy.Methods: A total of 91 geriatric gastric cancer patients (≥65-year-old) who received a neoadjuvant FLOT regimen were retrospectively analyzed. Pretreatment data, including demographic characteristics, complete blood count, serum albumin level (g/dL), serum tumor markers (CEA and CA19-9), PNI values and other clinicopathological parameters, were collected. Independent sample t-tests and Mann-Whitney U tests were used to analyze quantitative independent data. In the analysis of independent qualitative data, the chi-squared test and Fischer's exact test were used when the chi-squared test conditions were not met.Results: The mean age was 69.9 ± 4. There were 22 patients in the treatment-responsive group and 69 in the treatment-nonresponsive group. Serum albumin levels were significantly higher in the treatment-responsive group. The lymphocyte counts were significantly lower in the treatment-responsive group. Additionally, both disease-free survival and overall survival were significantly extended in patients who responded to treatment.Conclusion: We demonstrated that serum albumin and total lymphocyte counts, which are easily accessible blood parameters routinely examined before treatment, may predict the response in geriatric gastric cancer patients receiving neoadjuvant FLOT treatment. However, larger prospective, multicenter studies are required to confirm this relationship.
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Affiliation(s)
- Yonca Yılmaz Ürün
- Department of Gastroenterology and Hepatology, Van Yüzüncü Yıl University Medical Faculty, Van, Turkey
| | - Muslih Ürün
- Department of Medical Oncology, Van Yüzüncü Yıl University Medical Faculty, Van, Turkey
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Kim KT, Lee MH, Shin SJ, Cho I, Kuk JC, Yun J, Choi YY. Decorin as a key marker of desmoplastic cancer-associated fibroblasts mediating first-line immune checkpoint blockade resistance in metastatic gastric cancer. Gastric Cancer 2025; 28:12-26. [PMID: 39520589 DOI: 10.1007/s10120-024-01567-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2024] [Accepted: 10/29/2024] [Indexed: 11/16/2024]
Abstract
BACKGROUND Gastric cancer (GC) remains a significant cause of cancer-related mortality worldwide. Despite the transformative impact of immune checkpoint blockade (ICB) therapies across various cancers, only a minority of patients with metastatic GC (mGC) benefit, emphasizing the urgent need for precise biomarkers to predict therapeutic responses and optimize patient selection. METHODS In this multi-omics study, we conducted whole exome and transcriptome sequencing on 12 tumors from mGC patients treated with nivolumab as first-line therapy. To validate our findings, we performed whole transcriptome sequencing on 17 additional tumors and analyzed 45 tumors from public dataset (PRJEB25780) of patients who received ICB therapy as second or third-line treatment. Comprehensive multi-omics analyses were conducted using single-cell RNA sequencing (n = 5, GSE167297) and spatial transcriptome sequencing (n = 2, independent internal dataset). RESULTS ICB-sensitive tumors exhibited robust activation of the interferon response pathway, while ICB-resistant tumors displayed epithelial-mesenchymal transition signatures. Intriguingly, at the single-cell level, genes associated with ICB sensitivity were predominantly expressed in immune cells, whereas genes associated with resistance were primarily found in cancer-associated fibroblasts (CAFs), particularly the desmoplastic CAF (dCAF) subtype. We identified DCN as a hallmark dCAF marker, and high DCN expression was inversely correlated with PD-L1 levels, ICB resistance, and poor prognosis in mGC (log-rank p = 0.027). CONCLUSION This study elucidates the critical influence of the tumor microenvironment, specifically dCAFs, in mediating ICB resistance in mGC. Our findings highlight DCN as a representative marker for dCAF and a promising negative predictive biomarker for ICB response. These findings highlight the complex stromal-immune interactions and open avenues for personalized treatment for mGC.
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Affiliation(s)
- Ki Tae Kim
- Department of Molecular Genetics & Dental Pharmacology, School of Dentistry, Seoul National University, Seoul, Korea
- Dental Research Institute and Dental Multi-omics Center, Seoul National University, Seoul, South Korea
| | - Min Hee Lee
- Department of Radiology, Soonchunhyang Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Su-Jin Shin
- Department of Pathology, Yonsei University Health System, Yonsei University College of Medicine, Seoul, Korea
| | - In Cho
- Department of Surgery, Soonchunhyang Bucheon Hospital, Soonchunhyang University College of Medicine, 170 Jomaru-ro, Wonmi-gu, Bucheon-si, Gyeonggi-do, Republic of Korea
| | - Jung Cheol Kuk
- Department of Surgery, Soonchunhyang Bucheon Hospital, Soonchunhyang University College of Medicine, 170 Jomaru-ro, Wonmi-gu, Bucheon-si, Gyeonggi-do, Republic of Korea
| | - Jina Yun
- Department of Medicine, Division of Hematology/Oncology, Soonchunhyang Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Yoon Young Choi
- Department of Surgery, Soonchunhyang Bucheon Hospital, Soonchunhyang University College of Medicine, 170 Jomaru-ro, Wonmi-gu, Bucheon-si, Gyeonggi-do, Republic of Korea.
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Tang W, Li C, Huang D, Zhou S, Zheng H, Wang Q, Zhang X, Fu J. NRS2002 score as a prognostic factor in solid tumors treated with immune checkpoint inhibitor therapy: a real-world evidence analysis. Cancer Biol Ther 2024; 25:2358551. [PMID: 38813753 PMCID: PMC11141475 DOI: 10.1080/15384047.2024.2358551] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 05/17/2024] [Indexed: 05/31/2024] Open
Abstract
To observe the antitumour efficacy of programmed death 1 (PD-1) inhibitors in the real world and explore the relationship between NRS2002 score or other clinical characteristics and immunotherapy efficacy, we retrospectively analyzed 341 tumor patients who received immune checkpoint inhibitor (ICI) treatment at one center. A total of 341 solid tumor patients treated with ICIs from June 2018 to December 2021 were retrospectively included in this study. Patient characteristics, ICI responses, and survival status were documented, and the relationships between clinical factors and survival were analyzed. Among all patients, the median progression-free survival (PFS) was 5.8 months, and the median overall survival (OS) was 12.5 months. The Performance Status (PS), NRS2002 score, The Naples Prognostic Score (NPS), Lymphocyte and C-reactive protein ratio (LCR), line of therapy, and nutritional support were significantly related to PFS or OS according to univariate analysis. The median PFS and OS were significantly better in the group without nutritional risk (NRS2002 0-2) than those with nutritional risk (NRS2002 ≥ 3) (PFS: HR = 1.82, 95% CI 1.30-2.54, p value < .001; OS: HR = 2.49, 95% CI 1.73-3.59, p value < .001). Cox regression analysis revealed that the NRS2002 score was an independent prognostic factor for both PFS and OS. The objective response rate (ORR) in the group at nutritional risk was lower than that in the group without nutritional risk (8.33% and 19.71%, respectively, p value = .037). Patients at nutritional risk according to the NRS2002 score at initial treatment had a poorer prognosis than those without nutritional risk. The NRS2002 could be used as a preliminary index to predict the efficacy of immune checkpoint inhibitor therapy.
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Affiliation(s)
- Wanfen Tang
- Department of Medical Oncology, Jinhua Municipal Central Hospital, Hangzhou, China
| | - Chenghui Li
- Department of Medical Oncology, Jinhua Municipal Central Hospital, Hangzhou, China
| | - Dong Huang
- Department of Colorectal Surgery, Jinhua Municipal Central Hospital, Hangzhou, China
| | - Shishi Zhou
- Department of Medical Oncology, Jinhua Municipal Central Hospital, Hangzhou, China
| | - Hongjuan Zheng
- Department of Medical Oncology, Jinhua Municipal Central Hospital, Hangzhou, China
| | - Qinghua Wang
- Department of Medical Oncology, Jinhua Municipal Central Hospital, Hangzhou, China
| | - Xia Zhang
- Department of Medical Oncology, Jinhua Municipal Central Hospital, Hangzhou, China
| | - Jianfei Fu
- Department of Medical Oncology, Jinhua Municipal Central Hospital, Hangzhou, China
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Ou Y, Yang Y, Yang W, Pan Y, Tian W, Wang Z, Yu X, Luo J, Wang L. Analysis of risk factors and establishment of early warning model for recent postoperative complications of colorectal cancer. Front Oncol 2024; 14:1411817. [PMID: 39568563 PMCID: PMC11576315 DOI: 10.3389/fonc.2024.1411817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 10/17/2024] [Indexed: 11/22/2024] Open
Abstract
Objective This study aimed to analyze factors associated with recent complications after colorectal cancer surgery, constructing a nomogram to aid gastrointestinal surgeons in preoperative decision-making for patients at risk of such complications. Methods In this retrospective study, clinical data were collected from patients undergoing radical colorectal cancer surgery at the Department of Gastrointestinal Surgery of the Affiliated Cancer Hospital of Guizhou Medical University and the Second People's Hospital of Chengdu from November 1, 2021, to January 26, 2024. Univariable and multivariable logistic regression analyses were conducted to assess risk factors for recent postoperative complications and develop a prediction model. External validation was performed using data from 48 postoperative colorectal cancer patients in the Second People's Hospital of Chengdu City from January 1, 2023, to May 30, 2023. Evaluation included receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis using R4.2.2 statistical software. Results A total of 324 patients who underwent radical colorectal cancer surgery were enrolled. The training cohort (n=176) identified four independent risk factors for recent complications: PNI ≥45 (OR=4.17, P<0.001), Albumin <40 g/L (OR=3.9, P<0.001), ASA score III-IV (OR=6.29, P<0.001), and Tumor diameter ≥5 cm (OR=4.24, P<0.001). A nomogram was constructed incorporating these factors. The AUC of the nomogram model in the training cohort was 0.835, with subsequent internal and external validation cohort AUCs of 0.815 and 0.819, respectively, indicating strong discriminatory ability. The calibration curve demonstrated good consistency, and decision curve analysis indicated high clinical utility. Conclusion PNI ≥45, Albumin <40 g/L, ASA score III-IV, and Tumor diameter ≥5 cm emerged as independent risk factors for recent complications following colorectal cancer surgery. We developed a nomogram model for these complications, potentially aiding gastrointestinal surgeons in preoperative patient evaluation and treatment planning for colorectal cancer surgery.
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Affiliation(s)
- Yang Ou
- Surgery, Beijing Jishuitan Hospital Guizhou Hospital, Guiyang, China
- Surgery, Guizhou Orthopaedic Hospital, Guiyang, China
| | - Yang Yang
- Department of Anesthesiology, Affiliated Cancer Hospital of Guizhou Medical University, Guiyang, China
| | - Weimin Yang
- Surgery, Beijing Jishuitan Hospital Guizhou Hospital, Guiyang, China
- Surgery, Guizhou Orthopaedic Hospital, Guiyang, China
| | - Yulin Pan
- Hangzhou Litchi Medical Beauty Clinic, Hangzhou, China
| | - Wu Tian
- Surgery, Beijing Jishuitan Hospital Guizhou Hospital, Guiyang, China
- Surgery, Guizhou Orthopaedic Hospital, Guiyang, China
| | - Zejun Wang
- Department of Gastrointestinal Surgery, Affiliated Cancer Hospital of Guizhou Medical University, Guiyang, China
| | - Xianzhe Yu
- Department of Gastrointestinal Surgery, Chengdu Second People's Hospital, Chengdu, China
| | - Jihang Luo
- Department of Infection, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Leibo Wang
- Surgery, Beijing Jishuitan Hospital Guizhou Hospital, Guiyang, China
- Surgery, Guizhou Orthopaedic Hospital, Guiyang, China
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Wu ZJ, Lan B, Luo J, Ameti A, Wang H, Hu QY. Impact of preoperative inflammatory and nutritional markers on the prognosis of patients with peritoneal metastasis of colorectal cancer. World J Gastrointest Oncol 2024; 16:3865-3874. [PMID: 39350999 PMCID: PMC11438771 DOI: 10.4251/wjgo.v16.i9.3865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 06/10/2024] [Accepted: 07/16/2024] [Indexed: 09/09/2024] Open
Abstract
BACKGROUND Identifying patients with peritoneal metastasis (PMs) of colorectal cancer (CRC) who will benefit from cytoreductive surgery and hyperthermic intraperitoneal chemotherapy is crucial before surgery. Inflammatory and nutritional indicators play essential roles in cancer development and metastasis. AIM To investigate the association of preoperative inflammatory and nutritional markers with prognosis in patients with CRC-PM. METHODS We included 133 patients diagnosed with CRC-PM between July 2012 and July 2018. Patients' demographics, overall survival (OS), and preoperative inflammatory and nutritional markers were evaluated. The Kaplan-Meier method and log-rank test were used to estimate differences. RESULTS Of the 133 patients, 94 (70.6%) had normal hemoglobin (Hb) and 54 (40.6%) had a high neutrophil-to-lymphocyte ratio (NLR). The median OS (mOS) was significantly lower for patients with high NLR (7.9 months) than for those with low NLR (25.4 months; P = 0.002). Similarly, patients with normal Hb had a longer mOS (18.5 months) than those with low Hb (6.3 months; P < 0.001). Multivariate analysis identified age, carbohydrate antigen 199 levels, NLR, Hb, and peritoneal cancer index as independent predictors of OS. Based on these findings, a nomogram was constructed, which demonstrated a good capacity for prediction, with a C-index of 0.715 (95% confidence interval: 0.684-0.740). Furthermore, the 1- and 2-year survival calibration plots showed good agreement between predicted and actual OS rates. The areas under the curve for the 1- and 2-year survival predictions of the nomogram were 0.6238 and 0.6234, respectively. CONCLUSION High NLR and low Hb were identified as independent predictive risk factors for poor prognosis in patients with CRC-PM. The established nomogram demonstrated high accuracy in predicting OS for patients with CRC-PM, indicating its potential as a valuable prognostic tool for this patient population.
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Affiliation(s)
- Zhi-Jie Wu
- Department of General Surgery (Colorectal Surgery), The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
| | - Bing Lan
- Department of General Surgery (Colorectal Surgery), The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
| | - Jian Luo
- Department of General Surgery (Colorectal Surgery), The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
| | - Ayniyazi Ameti
- Department of Anesthesiology, Kashgar First People’s Hospital, Kashgar 844000, Xinjiang Uygur Autonomous Region, China
| | - Hui Wang
- Department of General Surgery (Colorectal Surgery), The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
| | - Qiong-Yu Hu
- Department of General Surgery (Colorectal Surgery), The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
- Department of Anesthesiology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510000, Guangdong Province, China
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9
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Zhang X, Wei X, Lin S, Sun W, Wang G, Cheng W, Shao M, Deng Z, Jiang Z, Gong G. Predictive model for prolonged hospital stay risk after gastric cancer surgery. Front Oncol 2024; 14:1382878. [PMID: 39165684 PMCID: PMC11333226 DOI: 10.3389/fonc.2024.1382878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 07/16/2024] [Indexed: 08/22/2024] Open
Abstract
Background Prolonged postoperative hospital stay following gastric cancer (GC) surgery is an important risk factor affecting patients' mood and increasing complications. We aimed to develop a nomogram to predict risk factors associated with prolonged postoperative length of stay (PLOS) in patients undergoing gastric cancer resection. Methods Data were collected from 404 patients. The least absolute shrinkage and selection operator (LASSO) was used for variable screening, and a nomogram was designed. The nomogram performance was evaluated by the area under the receiver operating characteristic curve (AUC). The consistency between the predicted and actual values was evaluated via a calibration map, and the clinical application value was evaluated via decision curve analysis (DCA) and clinical impact curve analysis (CICA). Results A total of 404 patients were included in this study. Among these patients, 287 were assigned to the training cohort, and 117 were assigned to the validation cohort. According to the PLOS quartile distance, 103 patients were defined as having prolonged PLOS. LASSO regression and logistic multivariate analysis revealed that 4 clinical characteristics, the neutrophil-lymphocyte ratio (NLR) on postoperative day one, the NLR on postoperative day three, the preoperative prognostic nutrition index and the first time anal exhaust was performed, were associated with the PLOS and were included in the construction of the nomogram. The AUC of the nomogram prediction model was 0.990 for the training set and 0.983 for the validation set. The calibration curve indicated good correlation between the predicted results and the actual results. The Hosmer-Lemeshow test revealed that the P values for the training and validation sets were 0.444 and 0.607, respectively, indicating that the model had good goodness of fit. The decision curve analysis and clinical impact curve of this model showed good clinical practicability for both cohorts. Conclusion We explored the risk factors for prolonged PLOS in GC patients via the enhanced recovery after surgery (ERAS) program and developed a predictive model. The designed nomogram is expected to be an accurate and personalized tool for predicting the risk and prognosis of PLOS in GC patients via ERAS measures.
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Affiliation(s)
- Xiaochun Zhang
- The First Clinical College of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
- Department of General Surgery, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Xiao Wei
- The First Clinical College of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
- Department of General Surgery, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Siying Lin
- The First Clinical College of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
- Department of General Surgery, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Wenhao Sun
- The First Clinical College of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
- Department of General Surgery, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Gang Wang
- Department of General Surgery, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Wei Cheng
- Department of General Surgery, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Mingyue Shao
- Department of General Surgery, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Zhengming Deng
- Department of General Surgery, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Zhiwei Jiang
- Department of General Surgery, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Guanwen Gong
- Department of General Surgery, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
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Zhao XN, Lu J, He HY, Ge SJ. Clinical significance of preoperative nutritional status in elderly gastric cancer patients undergoing radical gastrectomy: A single-center retrospective study. World J Gastrointest Surg 2024; 16:2211-2220. [PMID: 39087115 PMCID: PMC11287666 DOI: 10.4240/wjgs.v16.i7.2211] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Revised: 05/23/2024] [Accepted: 06/12/2024] [Indexed: 07/22/2024] Open
Abstract
BACKGROUND The population of elderly patients with gastric cancer is increasing, which is a major public health issue in China. Malnutrition is one of the greatest risk factors for adverse clinical outcomes in elderly patients with gastric cancer. AIM To investigate the preoperative nutritional status and its association with delayed discharge of elderly gastric cancer patients following radical gastrectomy. METHODS A total of 783 patients aged 65 years and older harboring gastric adenocarcinoma and following radical gastrectomy were retrospectively analyzed from the prospectively collected database of Zhongshan Hospital of Fudan University between January 2018 and May 2020. RESULTS The overall rate of malnutrition was 31.8%. The incidence of postoperative complications was significantly higher in the malnourished group compared to the well-nourished group (P < 0.001). Nutritional characteristics in the malnourished group, including body mass index, prognostic nutritional index (PNI), albumin, prealbumin, and hemoglobin, were all significantly lower than those in the well-nourished group. The percentage of patients who received postoperative total nutrient admixture was lower in the malnourished group compared to the well-nourished group (22.1% vs 33.5%, P = 0.001). Age ≥ 70 years (HR = 1.216, 95%CI: 1.048-1.411), PNI < 44.5 (HR = 1.792, 95%CI: 1.058-3.032), operation time ≥ 160 minutes (HR = 1.431, 95%CI: 1.237-1.656), and postoperative complications grade III or higher (HR = 2.191, 95%CI: 1.604-2.991) were all recognized as independent risk factors associated with delayed discharge. CONCLUSION Malnutrition is relatively common in elderly patients undergoing gastrectomy. Low PNI is an independent risk factor associated with delay discharge. More strategies are needed to improve the clinical outcome of these patients.
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Affiliation(s)
- Xi-Ning Zhao
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Jing Lu
- Department of Nursing, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Hong-Yong He
- Department of General Surgery/Emergency Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Sheng-Jin Ge
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
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Hashimoto I, Tanabe M, Onuma S, Morita J, Nagasawa S, Maezawa Y, Kanematsu K, Aoyama T, Yamada T, Ogata T, Yukawa N, Rino Y, Saito A, Oshima T. A propensity‑matched analysis of the prognostic value of advanced lung cancer inflammation index in patients with gastric cancer after curative resection. Oncol Lett 2024; 27:285. [PMID: 38736744 PMCID: PMC11083996 DOI: 10.3892/ol.2024.14418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 04/04/2024] [Indexed: 05/14/2024] Open
Abstract
The prognostic significance of inflammation, immune response and nutritional status in patients with cancer is well-documented. The advanced lung cancer inflammation index (ALI) has emerged as a novel prognostic indicator, reflecting both inflammation and nutritional status. This study aimed to assess the prognostic relevance of preoperative ALI in patients with gastric cancer (GC). Data of 459 patients who underwent curative gastrectomy for GC between December 2013 and November 2017 at the Kanagawa Cancer Center (Yokohama, Japan) were retrospectively analyzed. Preoperative ALI was calculated from blood tests. Patients were divided into the high- and low-ALI groups. This study investigated the association between preoperative ALI, clinicopathological features, overall survival (OS) and relapse-free survival (RFS) after propensity-matched analysis. Comparative analysis revealed that patients in the low-ALI group tended to be older, were predominantly female, had lower body mass index and had a higher incidence of lymphatic invasion compared with those in the high-ALI group before propensity-matched analysis. Notably, the low-ALI group exhibited significantly reduced OS and RFS post-gastrectomy (85.5% vs. 93.8%, P=0.01; and 82.1% vs. 91.8%, P=0.02, respectively). Multivariate analysis identified low ALI as an independent prognostic factor for both OS and RFS. In conclusion, preoperative ALI could provide a valuable prognostic tool for patients with GC undergoing curative resection, offering insights into patient survival outcomes based on their inflammatory and nutritional status.
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Affiliation(s)
- Itaru Hashimoto
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Kanagawa 241-8515, Japan
- Department of Surgery, Yokohama City University, Yokohama, Kanagawa 236-0004, Japan
| | - Mie Tanabe
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Kanagawa 241-8515, Japan
- Department of Surgery, Yokohama City University, Yokohama, Kanagawa 236-0004, Japan
| | - Shizune Onuma
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Kanagawa 241-8515, Japan
- Department of Surgery, Yokohama City University, Yokohama, Kanagawa 236-0004, Japan
| | - Junya Morita
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Kanagawa 241-8515, Japan
- Department of Surgery, Yokohama City University, Yokohama, Kanagawa 236-0004, Japan
| | - Shinsuke Nagasawa
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Kanagawa 241-8515, Japan
- Department of Surgery, Yokohama City University, Yokohama, Kanagawa 236-0004, Japan
| | - Yukio Maezawa
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Kanagawa 241-8515, Japan
- Department of Surgery, Yokohama City University, Yokohama, Kanagawa 236-0004, Japan
| | - Kyohei Kanematsu
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Kanagawa 241-8515, Japan
| | - Toru Aoyama
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Kanagawa 241-8515, Japan
- Department of Surgery, Yokohama City University, Yokohama, Kanagawa 236-0004, Japan
| | - Takanobu Yamada
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Kanagawa 241-8515, Japan
- Department of Surgery, Yokohama City University, Yokohama, Kanagawa 236-0004, Japan
| | - Takashi Ogata
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Kanagawa 241-8515, Japan
| | - Norio Yukawa
- Department of Surgery, Yokohama City University, Yokohama, Kanagawa 236-0004, Japan
| | - Yasushi Rino
- Department of Surgery, Yokohama City University, Yokohama, Kanagawa 236-0004, Japan
| | - Aya Saito
- Department of Surgery, Yokohama City University, Yokohama, Kanagawa 236-0004, Japan
| | - Takashi Oshima
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Kanagawa 241-8515, Japan
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Wang Q, Zhang Q, Zhu J, Li L, Zeng R, Ding H, Li Z, Feng T, Hao R, Zhang G. Nomogram for predicting overall survival after curative gastrectomy using inflammatory, nutritional and pathological factors. Clin Transl Oncol 2024; 26:1001-1011. [PMID: 37996667 DOI: 10.1007/s12094-023-03340-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 10/20/2023] [Indexed: 11/25/2023]
Abstract
PURPOSE To establish a nomogram for predicting the overall survival (OS) in patients with gastric cancer (GC) based on inflammatory, nutritional and pathological factors. METHODS GC patients underwent curative gastrectomy from January 2012 to June 2017 in our hospital were included, and were classified into training set and validation set with a ratio of 7:3. Then variables associated with OS were analyzed using univariate and multivariate Cox regression analysis. Nomograms predicting OS were built using variables from multivariable Cox models. Finally, Kaplan-Meier curve and Log-rank test were also conducted to analyze the 1-yr, 3-yr and 5-yr OS to validate the efficiency of risk stratification of the nomogram. RESULTS A total of 366 GC patients were included. After univariate and multivariate Cox regression analysis, age (HR = 1.52, 95% CI = 1.01-2.30, P = 0.044), CA50 (HR = 1.90, 95% CI = 1.12-3.21, P = 0.017), PNI (HR = 1.65, 95% CI = 1.13-2.39, P = 0.009), SII (HR = 1.46, 95% CI = 1.03-2.08, P = 0.036), T stage (HR = 2.26, 95% CI = 1.01-5.05, P = 0.048; HR = 7.24, 95% CI = 3.64-14.40, P < 0.001) were independent influencing factors on the survival time of GC patients. Five factors including CEA, prognostic nutritional index (PNI), systemic immune-inflammation index (SII), ln (tumor size), T stage, and N stage were identified and entered the nomogram, which showed good discrimination and calibration in both sets. On internal validation, 1-yr, 3-yr and 5-yr nomogram demonstrated a good discrimination with an area under the ROC curve (AUC) of 0.77, 0.84 and 0.86, respectively. The AUC for 1-yr, 3-yr and 5-yr nomogram in validation set was 0.77, 0.79 and 0.81, respectively. The OS in low risk group of training cohort and validation cohort was significantly higher than that of intermediate risk group and high risk group, respectively. CONCLUSIONS We established a nomogram based on PNI, SII and pathological factors for predicting OS in GC patients. In addition, its efficiency was validated by validation set and stratified analysis.
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Affiliation(s)
- Qi Wang
- Department of General Surgery, The First Affiliated Hospital of Shandong First Medical University, Jinan, 250100, China
| | - Qiang Zhang
- Department of General Surgery, Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), Qingdao, 266000, China
| | - Jiankang Zhu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Shandong First Medical University, No. 16766 Jingshi Road, Jinan, 250100, China
| | - Linchuan Li
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Shandong First Medical University, No. 16766 Jingshi Road, Jinan, 250100, China
| | - Runzhi Zeng
- Department of General Surgery, Shandong Provincial Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250014, China
| | - Huanxin Ding
- Department of General Surgery, Shandong Provincial Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250014, China
| | - Zhenmin Li
- Department of General Surgery, The First Affiliated Hospital of Shandong First Medical University, Jinan, 250100, China
| | - Tianyi Feng
- Department of General Surgery, Shandong Provincial Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250014, China
| | - Ruiqi Hao
- Department of General Surgery, The First Affiliated Hospital of Shandong First Medical University, Jinan, 250100, China
| | - Guangyong Zhang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Shandong First Medical University, No. 16766 Jingshi Road, Jinan, 250100, China.
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Fiflis S, Christodoulidis G, Papakonstantinou M, Giakoustidis A, Koukias S, Roussos P, Kouliou MN, Koumarelas KE, Giakoustidis D. Prognostic nutritional index in predicting survival of patients with gastric or gastroesophageal junction adenocarcinoma: A systematic review. World J Gastrointest Oncol 2024; 16:514-526. [PMID: 38425390 PMCID: PMC10900152 DOI: 10.4251/wjgo.v16.i2.514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 12/16/2023] [Accepted: 01/15/2024] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND Gastric cancer is the third most common cause of cancer related death worldwide. Surgery with or without chemotherapy is the most common approach with curative intent; however, the prognosis is poor as mortality rates remain high. Several indexes have been proposed in the past few years in order to estimate the survival of patients undergoing gastrectomy. The preoperative nutritional status of gastric cancer patients has recently gained attention as a factor that could affect the postoperative course and various indexes have been developed. The aim of this systematic review was to assess the role of the prognostic nutritional index (PNI) in predicting the survival of patients with gastric or gastroesophageal adenocarcinoma who underwent gastrectomy with curative intent. AIM To investigate the role of PNI in predicting the survival of patients with gastric or gastroesophageal junction adenocarcinoma. METHODS A thorough literature search of PubMed and the Cochrane library was performed for studies comparing the overall survival (OS) of patients with gastric or gastroesophageal cancer after surgical resection depending on the preoperative PNI value. The PRISMA algorithm was used in the screening process and finally 16 studies were included in this systematic review. The review protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO). RESULTS Sixteen studies involving 14551 patients with gastric or esophagogastric junction adenocarcinoma undergoing open or laparoscopic or robotic gastrectomy with or without adjuvant chemotherapy were included in this systematic review. The patients were divided into high- and low-PNI groups according to cut-off values that were set according to previous reports or by using receiver operating characteristic curve analysis in each individual study. The 5-year OS of patients in the low-PNI groups ranged between 39% and 70.6%, while in the high-PNI groups, it ranged between 54.9% and 95.8%. In most of the included studies, patients with high preoperative PNI showed statistically significant better OS than the low PNI groups. In multivariate analyses, low PNI was repeatedly recognised as an independent prognostic factor for poor survival. CONCLUSION According to the present study, low preoperative PNI seems to be an indicator of poor OS of patients undergoing gastrectomy for gastric or gastroesophageal cancer.
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Affiliation(s)
- Stylianos Fiflis
- First Department of Surgery, General Hospital Papageorgiou, Thessaloniki 56429, Greece
| | | | | | | | - Stergos Koukias
- First Department of Surgery, General Hospital Papageorgiou, Thessaloniki 56429, Greece
| | - Paraskevi Roussos
- First Department of Surgery, General Hospital Papageorgiou, Thessaloniki 56429, Greece
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Yamamoto M, Omori T, Shinno N, Hara H, Mukai Y, Sugase T, Takeoka T, Kanemura T, Mikamori M, Hasegawa S, Akita H, Haraguchi N, Nishimura J, Wada H, Matsuda C, Yasui M, Miyata H, Ohue M. Prognostic Value of a Novel Index Combining the Prognostic Nutritional Index and D-Dimer Levels for Gastric Cancer after Gastrectomy. Oncology 2023; 103:1-10. [PMID: 38160660 PMCID: PMC11731837 DOI: 10.1159/000533150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 07/09/2023] [Indexed: 01/03/2024]
Abstract
INTRODUCTION The prognostic nutritional index (PNI) and D-dimer level are two useful measures for gastric cancer prognosis. As they each comprise different factors, it is possible to employ a more useful combined indicator. This study therefore aimed to establish a PNI-D score - which combines the PNI and D-dimer level - and validate its usefulness as a prognostic marker. METHODS We collected data from 1,218 patients with gastric cancer who had undergone radical gastrectomy (R0) between January 2004 and December 2015. Patients were divided into three PNI-D score groups based on the following criteria: score 2, low-PNI (≤46) and high D-dimer levels (>1.0 µg/mL); score 1, either low-PNI or high D-dimer levels; and score 0, no abnormality. We defined the PNI-D score as low (score 0 or 1) and high (score 2), respectively. RESULTS The PNI-D score was significantly associated with overall, recurrence-free, and disease-specific survival (all log-rank p < 0.0001). The 5-year overall survival rates of patients with PNI-D scores of low and high were 88.1% and 64.7%, respectively; their 5-year recurrence-free survival rates were 86.7% and 61.3%, respectively; and their 5-year disease-specific survival rates were 99.3% and 76.5%, respectively. Cox multivariate analysis revealed that a high-PNI-D score was an independent, statistically significant prognostic factor for poor overall (p = 0.01) survival in patients with gastric cancer. CONCLUSIONS The PNI-D is an independent prognostic factor for patients with gastric cancer.
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Affiliation(s)
- Masaaki Yamamoto
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Takeshi Omori
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Naoki Shinno
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Hisashi Hara
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Yosuke Mukai
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Takahito Sugase
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Tomohira Takeoka
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Takashi Kanemura
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Manabu Mikamori
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Shinichiro Hasegawa
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Hirofumi Akita
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Naotsugu Haraguchi
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Junichi Nishimura
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Hiroshi Wada
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Chu Matsuda
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Masayoshi Yasui
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Hiroshi Miyata
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Masayuki Ohue
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka, Japan
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Liang Y, Guo H, Man Q, Chang S, Wang E, Gao S. Prognostic nutritional score based on pretreatment lymphocyte, platelet, and prealbumin predicts prognosis in patients with pancreatic cancer. J Surg Oncol 2023; 128:831-843. [PMID: 37243944 DOI: 10.1002/jso.27362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 05/02/2023] [Accepted: 05/17/2023] [Indexed: 05/29/2023]
Abstract
BACKGROUND AND OBJECTIVES Pretreatment immunological indicators and nutritional factors are associated with survival of many malignancies. This study aims to develop a prognostic nutritional score based on a combination of pretreatment lymphocyte, platelet, and prealbumin (Co-LPPa) in patients with pancreatic cancer (PC) and to investigate the prognostic significance of this score. METHODS Patients who underwent pancreatectomy with a curative intent for PC were retrospectively enrolled. A pretreatment prognostic score was established by immunological indicators and nutritional factors that were independently associated with survival. RESULTS Pretreatment lymphocyte (<1.6 × 109 /L), platelet (<160 × 109 /L) and prealbumin (<0.23 g/L) were independently associated with poorer overall survival (OS) and recurrence-free survival (RFS), and were used to create the Co-LPPa score. The Co-LPPa scores were inversely related to OS and RFS, and were able to stratify survival into four groups. The survival differences among the four groups were all significant. Besides, the Co-LPPa scores could stratify survival independently of pathological prognostic factors. The Co-LPPa score was superior to prognostic nutritional index and carbohydrate antigen 19-9 in predicting OS and RFS. CONCLUSION The Co-LPPa score could accurately predict the prognosis of PC patients who underwent curative resection. The score may be helpful for preoperative therapeutic strategies.
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Affiliation(s)
- Yuexiang Liang
- Department of Pancreatic Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Tianjin's Clinical Research Center For Cancer, Tianjin, China
- Department of Gastrointestinal Oncology, The First Affiliated Hospital of Hainan Medical University, Haikou, Hainan Province, China
| | - Hanhan Guo
- Department of Gastrointestinal Oncology, The First Affiliated Hospital of Hainan Medical University, Haikou, Hainan Province, China
| | - Quan Man
- Department of Pancreatic Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Tianjin's Clinical Research Center For Cancer, Tianjin, China
- Department of Hepatobiliary Surgery, Tongliao City Hospital, Tongliao, Inner Mongolia, China
| | - Shaofei Chang
- Department of Pancreatic Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Tianjin's Clinical Research Center For Cancer, Tianjin, China
- Department of Gastrointestinal Pancreatic Surgery, Shanxi Provincial People's Hospital, Taiyuan, Shanxi Province, China
| | - Erpeng Wang
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Song Gao
- Department of Pancreatic Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Tianjin's Clinical Research Center For Cancer, Tianjin, China
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Kakiuchi Y, Kuroda S, Choda Y, Otsuka S, Ueyama S, Tanaka N, Muraoka A, Hato S, Kamikawa Y, Fujiwara T. Prognostic nutritional index is a prognostic factor for patients with gastric cancer and esophagogastric junction cancer undergoing proximal gastrectomy with esophagogastrostomy by the double-flap technique: A secondary analysis of the rD-FLAP study. Surg Oncol 2023; 50:101990. [PMID: 37717376 DOI: 10.1016/j.suronc.2023.101990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/29/2023] [Accepted: 09/07/2023] [Indexed: 09/19/2023]
Abstract
PURPOSE Although proximal gastrectomy (PG) is commonly used in patients with upper gastric cancer (GC) and esophagogastric junction (EGJ) cancer, long-term prognostic factors in these patients are poorly understood. The double-flap technique (DFT) is an esophagogastrostomy with anti-reflux mechanism after PG; we previously conducted a multicenter retrospective study (rD-FLAP) to evaluate the short-term outcomes of DFT reconstruction. Here, we evaluated the long-term prognostic factors in patients with upper GC and EGJ cancer. METHODS The study was conducted as a secondary analysis of the rD-FLAP Study, which enrolled patients who underwent PG with DFT reconstruction, irrespective of disease type, between January 1996 and December 2015. RESULTS A total of 509 GC and EGJ cancer patients were enrolled. Univariate and multivariate analyses of overall survival demonstrated that a preoperative prognostic nutritional index (PNI) < 45 (p < 0.001, hazard ratio [HR]: 3.59, 95% confidential interval [CI]: 1.93-6.67) was an independent poor prognostic factor alongside pathological T factor ([pT] ≥2) (p = 0.010, HR: 2.29, 95% CI: 1.22-4.30) and pathological N factor ([pN] ≥1) (p = 0.001, HR: 3.27, 95% CI: 1.66-6.46). In patients with preoperative PNI ≥45, PNI change (<90%) at 1-year follow-up (p = 0.019, HR: 2.54, 95%CI: 1.16-5.54) was an independent poor prognostic factor, for which operation time (≥300 min) and blood loss (≥200 mL) were independent risk factors. No independent prognostic factors were identified in patients with preoperative PNI <45. CONCLUSIONS PNI is a prognostic factor in upper GC and EGJ cancer patients. Preoperative nutritional enhancement and postoperative nutritional maintenance are important for prognostic improvement in these patients.
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Affiliation(s)
- Yoshihiko Kakiuchi
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Shinji Kuroda
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
| | - Yasuhiro Choda
- Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Shinya Otsuka
- Department of Surgery, Fukuyama Medical Center, Fukuyama, Japan
| | - Satoshi Ueyama
- Department of Surgery, Mihara Red Cross Hospital, Mihara, Japan
| | - Norimitsu Tanaka
- Department of Surgery, Kagawa Prefectural Central Hospital, Takamatsu, Japan
| | - Atsushi Muraoka
- Department of Surgery, Kagawa Rosai Hospital, Marugame, Japan
| | - Shinji Hato
- Department of Surgery, Shikoku Cancer Center, Matsuyama, Japan
| | | | - Toshiyoshi Fujiwara
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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Shen H, Dang W, Su R, Zhang Z, Wu S, Li M, Liu X, He Y. Pretreatment lymphocyte-monocyte ratio (LMR) as a superior predictor of short-term progression outcomes in patients with gastric cancer receiving second- and later-line apatinib regimens. J Cancer Res Clin Oncol 2023; 149:10715-10726. [PMID: 37308747 DOI: 10.1007/s00432-023-04976-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 06/04/2023] [Indexed: 06/14/2023]
Abstract
PURPOSE Lymphocyte-monocyte ratio (LMR) has previously been used as a prognostic predictor in various solid tumors. This research aims in comparing the prognostic predictive Please check and conability of several inflammatory parameters and clinical parameters to validate further the excellent prognostic value of LMR in patients with gastric cancer treated with apatinib. METHODS Monitor inflammatory, nutritional parameters and tumor markers. Cutoff values of the parameters concerned were identified with the X-tile program. Subgroup analysis was made via Kaplan-Meier curves, and univariate and multivariate Cox regression analyses were used to find independent prognostic factors. The nomogram of logistic regression models was constructed according to the results. RESULTS A total of 192 patients (115 divided into training group and 77 into validation group) who received the second- or later-line regimen of apatinib were retrospectively analyzed. The optimal cutoff value for LMR was 1.33. Patients with high LMR (LMR-H) were significantly longer than those with low LMR (LMR-L) in progression-free survival (median 121.0 days vs. median 44.5 days, P < 0.001). The predictive value of LMR was generally uniform across subgroups. Meanwhile, LMR and CA19-9 were the only hematological parameters with significant prognostic value in multivariate analysis. The area under the LMR curve (0.60) was greatest for all inflammatory indices. Adding LMR to the base model significantly enhanced the predictive power of the 6-month probability of disease progression (PD). The LMR-based nomogram showed good predictive power and discrimination in external validation. CONCLUSION LMR is a simple but effective predictor of prognosis for patients treated with apatinib.
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Affiliation(s)
- Hao Shen
- Department of Medical Oncology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Luyang District, Hefei, 230001, China
| | - Wenxi Dang
- Department of Medical Oncology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Luyang District, Hefei, 230001, China
| | - Rixin Su
- Department of Medical Oncology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Luyang District, Hefei, 230001, China
| | - Zhihua Zhang
- Department of Medical Oncology, Division of Life Sciences and Medicine, The First Affiliated Hospital of University of Science and Technology of China (USTC), University of Science and Technology of China, Anhui Provincial Cancer Hospital, Hefei, 230001, China
| | - Shusheng Wu
- Department of Medical Oncology, Division of Life Sciences and Medicine, The First Affiliated Hospital of University of Science and Technology of China (USTC), University of Science and Technology of China, Anhui Provincial Cancer Hospital, Hefei, 230001, China
| | - Mengge Li
- Department of Medical Oncology, Division of Life Sciences and Medicine, The First Affiliated Hospital of University of Science and Technology of China (USTC), University of Science and Technology of China, Anhui Provincial Cancer Hospital, Hefei, 230001, China
| | - Xudong Liu
- Department of Medical Oncology, Division of Life Sciences and Medicine, The First Affiliated Hospital of University of Science and Technology of China (USTC), University of Science and Technology of China, Anhui Provincial Cancer Hospital, Hefei, 230001, China
| | - Yifu He
- Department of Medical Oncology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Luyang District, Hefei, 230001, China.
- Department of Medical Oncology, Division of Life Sciences and Medicine, The First Affiliated Hospital of University of Science and Technology of China (USTC), University of Science and Technology of China, Anhui Provincial Cancer Hospital, Hefei, 230001, China.
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Zhang L, Ma W, Qiu Z, Kuang T, Wang K, Hu B, Wang W. Prognostic nutritional index as a prognostic biomarker for gastrointestinal cancer patients treated with immune checkpoint inhibitors. Front Immunol 2023; 14:1219929. [PMID: 37545502 PMCID: PMC10401046 DOI: 10.3389/fimmu.2023.1219929] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 06/19/2023] [Indexed: 08/08/2023] Open
Abstract
Objective Our study represents the first meta-analysis conducted to evaluate the prognostic utility of the baseline prognostic nutritional index (PNI) in patients with gastrointestinal cancer (GIC) who received immune checkpoint inhibitor (ICI) therapy. Methods We searched PubMed, the Cochrane Library, EMBASE, and Google Scholar until April 23, 2023, to obtain relevant articles for this study. Our analysis examined several clinical outcomes, including overall survival (OS), progression-free survival (PFS), objective response rate (ORR), and disease control rate (DCR). Results In this analysis, a total of 17 articles with 2883 patients were included. Our pooled results indicated that patients with high PNI levels had longer OS (HR: 0.530, 95% CI: 0.456-0.616, p < 0.001) and PFS (HR: 0.740, 95% CI: 0.649-0.844, p < 0.001), as well as higher ORR (OR: 1.622, 95% CI: 1.251-2.103, p < 0.004) and DCR (OR: 1.846, 95% CI: 1.428-2.388, p < 0.001). Subgroup analysis showed that PNI cutoff values of 40 to 45 showed greater predictive potential. Subgroup analysis also confirmed that the above findings still hold true in patients with esophageal cancer, gastric cancer, and hepatocellular carcinomas. Conclusion The PNI were reliable predictors of outcomes in GIC patients treated with ICIs.
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Affiliation(s)
- Lilong Zhang
- Department of General Surgery, Renmin Hospital of Wuhan University, Wuhan, China
- Key Laboratory of Hubei Province for Digestive System Disease, Wuhan, China
| | - Wangbin Ma
- Department of General Surgery, Renmin Hospital of Wuhan University, Wuhan, China
- Key Laboratory of Hubei Province for Digestive System Disease, Wuhan, China
| | - Zhendong Qiu
- Department of General Surgery, Renmin Hospital of Wuhan University, Wuhan, China
- Key Laboratory of Hubei Province for Digestive System Disease, Wuhan, China
| | - Tianrui Kuang
- Department of General Surgery, Renmin Hospital of Wuhan University, Wuhan, China
- Key Laboratory of Hubei Province for Digestive System Disease, Wuhan, China
| | - Kunpeng Wang
- Department of General Surgery, Renmin Hospital of Wuhan University, Wuhan, China
- Key Laboratory of Hubei Province for Digestive System Disease, Wuhan, China
| | - Baohong Hu
- Department of General Surgery, Renmin Hospital of Wuhan University, Wuhan, China
- Key Laboratory of Hubei Province for Digestive System Disease, Wuhan, China
| | - Weixing Wang
- Department of General Surgery, Renmin Hospital of Wuhan University, Wuhan, China
- Key Laboratory of Hubei Province for Digestive System Disease, Wuhan, China
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Chen C, Wang Z, Qin Y. A Novel Hematological Inflammation-Nutrition Score (HINS) and Its Related Nomogram Model to Predict Survival Outcome in Advanced Gastric Cancer Patients Receiving First-Line Palliative Chemotherapy. J Inflamm Res 2023; 16:2929-2946. [PMID: 37465343 PMCID: PMC10350431 DOI: 10.2147/jir.s417798] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 07/07/2023] [Indexed: 07/20/2023] Open
Abstract
Purpose This study aims to construct a novel hematological inflammation-nutrition score (HINS) and investigate its prognostic value in patients with advanced gastric cancer (AGC). We investigated the risk stratification performance of HINS and developed a HINS-based nomogram model to predict overall survival by combining traditional predictors. Patients and Methods We conducted a retrospective study on 812 AGC patients who received first-line platinum- or fluoropyrimidine-containing chemotherapy at The First Affiliated Hospital of Zhengzhou University Hospital between 2014 and 2019. Patients were randomly divided into a training cohort (N=609) and a validation cohort (N=203). HINS (0-2) was constructed based on a pre-chemotherapy systemic immune-inflammation index (SII) and albumin (ALB). Prognostic factors were screened by univariate and multivariate COX proportional regression models. Significant factors were used to construct a nomogram model. Internal validation was performed by calibration curves, time-dependent receiver operating characteristics (ROC) curves, and decision curve analysis (DCA), evaluating its prediction consistency, discrimination ability, and clinical net benefit. Results HINS was constructed based on SII and ALB. HINS showed a better stratification ability than JCOG prognostic index, with significant differences between groups. Multivariate analysis showed that ECOG ≥1 (HR: 1.379; P=0.005), Stage IV (HR: 1.581; P <0.001), diffuse-type histology (HR: 1.586; P <0.001), number of metastases ≥2 (HR: 1.274; P=0.038), without prior gastrectomy (HR: 1.830; P <0.001), ALP ≥ULN (HR: 1.335; P=0.034), HINS (P <0.001) were independent factors of OS. We successfully established a HINS-based nomogram model that showed a strong discriminative ability, accuracy, and clinical utility in training and validation cohorts. Conclusion HINS shows a superior risk stratification ability, which might be a potential prognostic biomarker for AGC patients receiving palliative first-line palliative chemotherapy. The HINS-based nomogram model is a convenient and efficient tool for managing prognosis and follow-up treatments.
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Affiliation(s)
- Chen Chen
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People’s Republic of China
| | - Zehua Wang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People’s Republic of China
| | - Yanru Qin
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People’s Republic of China
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20
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Jeon CH, Park KB, Kim S, Seo HS, Song KY, Lee HH. Predictive model for long-term weight recovery after gastrectomy for gastric cancer: an introduction to a web calculator. BMC Cancer 2023; 23:580. [PMID: 37353748 DOI: 10.1186/s12885-023-11050-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 06/08/2023] [Indexed: 06/25/2023] Open
Abstract
BACKGROUND Weight changes after gastrectomy affect not only quality of life but also prognosis and survival. However, it remains challenging to predict the weight changes of individual patients. Using clinicopathological variables, we built a user-friendly tool to predict weight change after curative gastrectomy for gastric cancer. METHODS The clinical data of 984 patients who underwent curative gastrectomy between 2009 and 2013 were retrospectively reviewed and analyzed. Multivariate logistic regression was performed to identify variables predictive of postoperative weight change. A nomogram was developed and verified via bootstrap resampling. RESULTS Age, sex, performance status, body mass index, extent of resection, pathological stage, and postoperative weight change significantly influenced postoperative weight recovery. Postoperative levels of hemoglobin, albumin, ferritin and total iron-binding capacity were significant covariates. The nomogram performed well (concordance index = 0.637); calibration curves indicated appropriate levels of agreement. We developed an online weight prediction calculator based on the nomogram ( http://gc-weightchange.com/en/front/ ). CONCLUSIONS The novel, Web-calculator based on the predictive model allows surgeons to explore patient weight patterns quickly. The model identifies patients at high risk for weight loss after gastrectomy; such patients require multidisciplinary medical support.
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Affiliation(s)
- Chul-Hyo Jeon
- Department of Surgery, Division of Gastrointestinal Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 271, Cheonbo-ro, Uijeongbu-si, Gyeonggi-do, 11765, Republic of Korea
| | - Ki Bum Park
- Department of Surgery, Division of Gastrointestinal Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, 93, Jungbu-daero, Paldal-gu, Suwon-si, Gyeonggi-do, 16247, Republic of Korea
| | - Sojung Kim
- Department of Surgery, Division of Gastrointestinal Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-Daero, Seocho-Gu, Seoul, 06591, Republic of Korea
| | - Ho Seok Seo
- Department of Surgery, Division of Gastrointestinal Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-Daero, Seocho-Gu, Seoul, 06591, Republic of Korea
| | - Kyo Young Song
- Department of Surgery, Division of Gastrointestinal Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-Daero, Seocho-Gu, Seoul, 06591, Republic of Korea
| | - Han Hong Lee
- Department of Surgery, Division of Gastrointestinal Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-Daero, Seocho-Gu, Seoul, 06591, Republic of Korea.
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21
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Kono M, Shatila M, Xu G, Lu Y, Mathew A, Mohajir W, Varatharajalu K, Qiao W, Thomas AS, Wang Y. Obesity Measured via Body Mass Index May Be Associated with Increased Incidence but Not Worse Outcomes of Immune-Mediated Diarrhea and Colitis. Cancers (Basel) 2023; 15:2329. [PMID: 37190257 PMCID: PMC10136922 DOI: 10.3390/cancers15082329] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/07/2023] [Accepted: 04/12/2023] [Indexed: 05/17/2023] Open
Abstract
Obesity defined by high body mass index (BMI) has traditionally been associated with gastrointestinal inflammatory processes but has recently been correlated with better survival in patients receiving immune checkpoint inhibitors (ICI). We sought to investigate the association between BMI and immune-mediated diarrhea and colitis (IMDC) outcomes and whether BMI reflects body fat content on abdominal imaging. This retrospective, single-center study included cancer patients with ICI exposure who developed IMDC and had BMI and abdominal computed tomography (CT) obtained within 30 days before initiating ICI from April 2011 to December 2019. BMI was categorized as <25, ≥25 but <30, and ≥30. Visceral fat area (VFA), subcutaneous fat area (SFA), total fat area (TFA: VFA+SFA), and visceral to subcutaneous fat (V/S) ratio were obtained from CT at the umbilical level. Our sample comprised 202 patients; 127 patients (62.9%) received CTLA-4 monotherapy or a combination, and 75 (37.1%) received PD-1/PD-L1 monotherapy. Higher BMIs ≥ 30 were associated with a higher incidence of IMDC than BMIs ≤ 25 (11.4% vs. 7.9%, respectively; p = 0.029). Higher grades of colitis (grade 3-4) correlated with lower BMI (p = 0.03). BMI level was not associated with other IMDC characteristics or did not influence overall survival (p = 0.83). BMI is strongly correlated with VFA, SFA, and TFA (p < 0.0001). Higher BMI at ICI initiation was linked to a higher incidence of IMDC but did not appear to affect outcomes. BMI strongly correlated with body fat parameters measured by abdominal imaging, suggesting its reliability as an obesity index.
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Affiliation(s)
- Miho Kono
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Malek Shatila
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Guofan Xu
- Department of Nuclear Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Yang Lu
- Department of Nuclear Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Antony Mathew
- Department of Internal Medicine, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Wasay Mohajir
- Department of Internal Medicine, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Krishnavathana Varatharajalu
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Wei Qiao
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Anusha S. Thomas
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Yinghong Wang
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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22
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Zhao A, Hou C, Li Y, Liu Y. Preoperative low muscle mass and malnutrition affect the clinical prognosis of locally advanced gastric cancer patients undergoing radical surgery. Front Oncol 2023; 13:1156359. [PMID: 37182137 PMCID: PMC10171366 DOI: 10.3389/fonc.2023.1156359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 04/13/2023] [Indexed: 05/16/2023] Open
Abstract
Background Gastric cancer is a common and highly aggressive malignant tumor of the gastrointestinal tract that poses a serious threat to human life and health. As the clinical symptoms of early gastric carcinoma are not obvious, many patients are diagnosed in the middle or late stages. With the advancement of medical technology, gastrectomy has become a safer surgical procedure, but it still has a high recurrence and mortality rate after surgery. The prognosis of gastric cancer patients after surgery is not only related to tumor-related factors (i.e., tumor stage) but the patient's nutritional status. This study aimed to investigate the effect of preoperative muscle mass combined with the prognostic nutritional index (PNI) on clinical prognosis in locally advanced gastric carcinoma. Methods The clinical data of 136 patients with locally advanced gastric carcinoma diagnosed by pathology and undergoing radical gastrectomy were retrospectively reviewed. To analyze the influencing factors of preoperative low muscle mass and its correlation with the prognostic nutritional index. Patients with both low muscle mass and low PNI (≤46.55) were assigned a score of 2, and those with only one or neither of these abnormalities were assigned a score of 1 or 0, respectively, according to the new prognostic score (PNIS). The relationship between PNIS and clinicopathological characteristics was analyzed. Univariate and multivariate analyses were performed to identify risk factors for overall survival (OS). Results Low muscle mass was associated with a lower PNI (P < 0.01). The optimal cut-off value of PNI was 46.55, the sensitivity was 48%, and the specificity was 97.1%. There were 53 (38.97%), 59 (43.38%), and 24 patients (17.65%) in the PNIS 0, 1, and 2 groups, respectively. A higher PNIS and advanced age were independent risk factors for postoperative complications (P < 0.01). The overall survival rate in patients with PNIS 2 score was significantly poorer than in patients with scores of 1 or 0 (3-year OS: 45.8% vs 67.8% vs 92.4%, P < 0.001). A Multivariate Cox hazards analysis showed that PNIS 2, depth of tumor invasion, vascular invasion, and postoperative complications were independent predictors of the poor 3-year survival in patients with locally advanced gastric cancer. Conclusions The combination of muscle mass and the PNI score system can be used to predict the survival outcome of patients with locally advanced gastric cancer.
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23
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Sun H, Chen L, Huang R, Pan H, Zuo Y, Zhao R, Xue Y, Song H. Prognostic nutritional index for predicting the clinical outcomes of patients with gastric cancer who received immune checkpoint inhibitors. Front Nutr 2022; 9:1038118. [PMID: 36438745 PMCID: PMC9686298 DOI: 10.3389/fnut.2022.1038118] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 10/19/2022] [Indexed: 07/30/2023] Open
Abstract
OBJECTIVE Although the application of immunotherapy in gastric cancer has achieved satisfactory clinical effects, many patients have no response. The aim of this retrospective study is to investigate the predictive ability of the prognostic nutrition index (PNI) to the prognosis of patients with gastric cancer who received immune checkpoint inhibitors (ICIs). MATERIALS AND METHODS Participants were 146 gastric cancer patients with ICIs (PD-1/PD-L1 inhibitors) or chemotherapy. All patients were divided into a low PNI group and a high PNI group based on the cut-off evaluated by the receiver operating characteristic (ROC) curve. We contrasted the difference in progression-free survival (PFS) and overall survival (OS) in two groups while calculating the prognosis factors for PFS and OS by univariate and multivariate analyses. Moreover, the nomogram based on the results of the multivariate analysis was constructed to estimate the 1- and 3-year survival probabilities. RESULTS There were 41 (28.1%) cases in the low PNI group and 105 (71.9%) cases in the high PNI group. The median survival time for PFS in the low PNI group and high PNI group was 12.30 months vs. 33.07 months, and 18.57 months vs. not reached in the two groups for OS. Patients in low PNI group were associated with shorter PFS and OS in all patients [Hazard ratio (HR) = 1.913, p = 0.013 and HR = 2.332, p = 0.001]. Additionally, in subgroup analysis, low PNI group cases also had poorer PFS and OS, especially in patients with ICIs. In addition, the multivariate analysis found that carbohydrate antigen 724 (CA724) and TNM stage were independent prognostic factors for PFS. At the same time, indirect bilirubin (IDBIL), CA724, PNI, and TNM stage were independent prognostic factors for OS. CONCLUSION Prognostic nutrition index was an accurate inflammatory and nutritional marker, which could predict the prognosis of patients with gastric cancer who received ICIs. PNI could be used as a biomarker for ICIs to identify patients with gastric cancer who might be sensitive to ICIs.
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Affiliation(s)
- Hao Sun
- Department of Gastrointestinal Surgery, Harbin Medical University Cancer Hospital, Harbin Medical University, Harbin, China
| | - Li Chen
- Department of Thyroid and Breast Surgery, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Rong Huang
- Department of Gastrointestinal Surgery, Harbin Medical University Cancer Hospital, Harbin Medical University, Harbin, China
| | - Hongming Pan
- Department of Gastrointestinal Surgery, Harbin Medical University Cancer Hospital, Harbin Medical University, Harbin, China
| | - Yanjiao Zuo
- Department of Gastrointestinal Surgery, Harbin Medical University Cancer Hospital, Harbin Medical University, Harbin, China
| | - Ruihu Zhao
- Department of Gastrointestinal Surgery, Harbin Medical University Cancer Hospital, Harbin Medical University, Harbin, China
| | - Yingwei Xue
- Department of Gastrointestinal Surgery, Harbin Medical University Cancer Hospital, Harbin Medical University, Harbin, China
| | - Hongjiang Song
- Department of Gastrointestinal Surgery, Harbin Medical University Cancer Hospital, Harbin Medical University, Harbin, China
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24
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Kim SG, Eom BW, Yoon H, Kim YW, Ryu KW. Prognostic Value of Preoperative Systemic Inflammatory Parameters in Advanced Gastric Cancer. J Clin Med 2022; 11:jcm11185318. [PMID: 36142965 PMCID: PMC9500881 DOI: 10.3390/jcm11185318] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 08/29/2022] [Accepted: 09/07/2022] [Indexed: 12/24/2022] Open
Abstract
Background: The predictive value of various systemic inflammatory parameters has been reported. However, it is still unclear which inflammatory parameters are the best predictors of prognosis in advanced gastric cancer and what are their mechanisms of action. The aim of this study was to evaluate the association between preoperative systemic inflammatory parameters and overall survival (OS) in patients with advanced gastric cancer. Methods: This retrospective study included 489 patients with stage II/III advanced gastric cancer treated at the National Cancer Center, Republic of Korea, between January 2012 and December 2015. We divided the patients into survivors and non-survivors and compared their clinicopathological characteristics. Univariate and multivariate analyses using the Cox proportional hazards model were performed to evaluate the prognostic value of inflammatory parameters. Results: The absolute lymphocyte count was significantly higher in survivors (2.07 ± 0.62 × 103/µL vs. 1.88 ± 0.63 × 103/µL, p = 0.001). The neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and platelet-to-lymphocyte ratio (PLR) were marginally lower in survivors. Survival analysis revealed that the NLR and PLR were independent prognostic factors for OS. Survival was significantly different depending on NLR and PLR in the same pathologic stages. Conclusions: NLR and PLR were independent prognostic factors for OS in patients with advanced gastric cancer. Regarding single inflammatory parameters, an elevated lymphocyte count was the only factor associated with a favorable prognosis. These results suggest that the enhanced immune function of patients affects their prognosis more than the increased systemic inflammatory response.
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Affiliation(s)
- Sung Gon Kim
- Center for Gastric Cancer, National Cancer Center, Goyang-si 10408, Korea
- Department of Surgery, Konyang University Hospital, Daejeon 35365, Korea
| | - Bang Wool Eom
- Center for Gastric Cancer, National Cancer Center, Goyang-si 10408, Korea
| | - Hongman Yoon
- Center for Gastric Cancer, National Cancer Center, Goyang-si 10408, Korea
| | - Young-Woo Kim
- Center for Gastric Cancer, National Cancer Center, Goyang-si 10408, Korea
| | - Keun Won Ryu
- Center for Gastric Cancer, National Cancer Center, Goyang-si 10408, Korea
- Correspondence:
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25
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Fu M, Yu L, Yang L, Chen Y, Chen X, Hu Q, Sun H. Predictive value of the preoperative prognostic nutritional index for postoperative progression in patients with pancreatic neuroendocrine neoplasms. Front Nutr 2022; 9:945833. [PMID: 36159473 PMCID: PMC9493178 DOI: 10.3389/fnut.2022.945833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 08/23/2022] [Indexed: 11/13/2022] Open
Abstract
Objective The preoperative nutritional status of cancer patients is closely related to prognosis. The prognostic nutritional index (PNI) has been shown to predict the prognosis of a variety of tumors, but its study in pancreatic neuroendocrine neoplasms (pNENs) is lacking. The aim of the present study is to investigate the predictive value of the preoperative PNI for postoperative progression in patients with pNENs. Methods The medical records of 181 patients with pNENs, who underwent surgery, were retrospectively analyzed. A time-dependent receiver operating characteristic (ROC) curve was plotted to determine the optimal cut-off value of the preoperative PNI. Correlations between the preoperative PNI and clinicopathological parameters were analyzed using multiple linear regression. A Kaplan-Meier curve was applied to assess the progression-free survival (PFS) rate, which was tested using a log rank. Univariate and multivariate Cox proportional risk regression models were used to analyze the predictive value of the preoperative PNI on prognosis. Results The optimal cut-off value of the preoperative PNI was 48.275. The patients were divided into a high PNI group (PNI > 48.275, n = 92) and a low PNI group (PNI ≤ 48.275, n = 89). The proportion of patients with tumor progression after surgery was significantly higher in the low PNI group compared with that in the high PNI group (P = 0.004). The Kaplan-Meier curve showed that the PFS rate after surgery was significantly lower in the low PNI group compared with that in the high PNI group (P = 0.026). The preoperative PNI was an independent predictor of PFS (HR: 2.727, 95% CI: 1.174∼6.333, P = 0.020). Conclusion The preoperative PNI has a predictive value for postoperative progression in patients with pNENs.
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Affiliation(s)
- Mengfei Fu
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Provincial Clinical Research Center for Diabetes and Metabolic Disorders, Wuhan, China
| | - Li Yu
- Department of Emergency Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Liu Yang
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Provincial Clinical Research Center for Diabetes and Metabolic Disorders, Wuhan, China
| | - Yang Chen
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Provincial Clinical Research Center for Diabetes and Metabolic Disorders, Wuhan, China
| | - Xiao Chen
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Provincial Clinical Research Center for Diabetes and Metabolic Disorders, Wuhan, China
| | - Qinyu Hu
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Provincial Clinical Research Center for Diabetes and Metabolic Disorders, Wuhan, China
| | - Hui Sun
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Provincial Clinical Research Center for Diabetes and Metabolic Disorders, Wuhan, China
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Wei ZJ, Qiao YT, Zhou BC, Rankine AN, Zhang LX, Su YZ, Xu AM, Han WX, Luo PQ. Model established based on blood markers predicts overall survival in patients after radical resection of types II and III adenocarcinoma of the esophagogastric junction. World J Gastrointest Surg 2022; 14:788-798. [PMID: 36157366 PMCID: PMC9453332 DOI: 10.4240/wjgs.v14.i8.788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 04/30/2022] [Accepted: 08/05/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND In recent years, the incidence of types II and III adenocarcinoma of the esophagogastric junction (AEG) has shown an obvious upward trend worldwide. The prognostic prediction after radical resection of AEG has not been well established.
AIM To establish a prognostic model for AEG (types II and III) based on routine markers.
METHODS A total of 355 patients who underwent curative AEG at The First Affiliated Hospital of Anhui Medical University from January 2014 to June 2015 were retrospectively included in this study. Univariate and multivariate analyses were performed to identify the independent risk factors. A nomogram was constructed based on Cox proportional hazards models. The new score models was analyzed by C index and calibration curves. The receiver operating characteristic (ROC) curve was used to compare the predictive accuracy of the scoring system and tumor-node-metastasis (TNM) stage. Overall survival was calculated using the Kaplan-Meier curve amongst different risk AEG patients.
RESULTS Multivariate analysis showed that TNM stage (hazard ratio [HR] = 2.286, P = 0.008), neutrophil-to-lymphocyte ratio (HR = 2.979, P = 0.001), and body mass index (HR = 0.626, P = 0.026) were independent prognostic factors. The new scoring system had a higher concordance index (0.697), and the calibration curves of the nomogram were reliable. The area under the ROC curve of the new score model (3-year: 0.725, 95% confidence interval [CI]: 0.676-0.777; 5-year: 0.758, 95%CI: 0.708-0.807) was larger than that of TNM staging (3-year: 0.630, 95%CI: 0.585-0.684; 5-year: 0.665, 95%CI: 0.616-0.715).
CONCLUSION Based on the serum markers and other clinical indicators, we have developed a precise model to predict the prognosis of patients with AEG (types II and III). The new prognostic nomogram could effectively enhance the predictive value of the TNM staging system. This scoring system can be advantageous and helpful for surgeons and patients.
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Affiliation(s)
- Zhi-Jian Wei
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
| | - Ya-Ting Qiao
- Department of Gastrointestinal Surgery, Affiliated Hospital of HeBei University, Baoding 071000, Hebei Province, China
| | - Bai-Chuan Zhou
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
| | - Abigail N Rankine
- Department of Clinical Medicine, Anhui Medical University, Hefei 230032, Anhui Province, China
| | - Li-Xiang Zhang
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
- Department of Gastroenterology, Anhui Provincial Key Laboratory of Digestive Disease, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
| | - Ye-Zhou Su
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
| | - A-Man Xu
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
| | - Wen-Xiu Han
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
| | - Pan-Quan Luo
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
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Ding P, Guo H, He X, Sun C, Lowe S, Bentley R, Zhou Q, Yang P, Tian Y, Liu Y, Yang L, Zhao Q. Effect of skeletal muscle loss during neoadjuvant imatinib therapy on clinical outcomes in patients with locally advanced GIST. BMC Gastroenterol 2022; 22:399. [PMID: 36028812 PMCID: PMC9413907 DOI: 10.1186/s12876-022-02479-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 08/19/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Currently, the effect of skeletal muscle loss during neoadjuvant imatinib therapy on clinical outcomes in patients with locally advanced gastrointestinal stromal tumors (LA-GIST) remains unclear. This study aims to investigate the relationship between changes in skeletal muscle and postoperative complications, survival and tumor response in patients with LA-GIST during neoadjuvant therapy with imatinib. METHODS We retrospectively analyzed pre- and post-treatment computed tomography images of 57 GIST patients who underwent radical surgery after neoadjuvant therapy with imatinib from January 2013 to March 2019. Skeletal muscle index (SMI) was measured at the L3 vertebral level in all patients. A cut-off value (SMI < 52.3 cm2/m2 and < 38.6 cm2/m2 for men and women, respectively) published in a previous study was used to define sarcopenia. Based on gender, we defined ΔSMI (%)/250 days above 9.69% for men and ΔSMI (%)/250 days above 7.63% for women as significant muscle loss (SML). Factors associated with postoperative complications and tumor response were analyzed using logistic regression, and predictors affecting patient prognosis were analyzed using Cox regression. RESULTS Of the 57 patients, sarcopenia was present before and after neoadjuvant therapy in 20 (35.09%) and 28 (49.12%) patients, respectively. It was not associated with immediate or long-term clinical outcomes. However, patients with SML during neoadjuvant therapy had a higher incidence of postoperative complications (60.00% vs. 25.00%, p = 0.008), worse pathological regression (44.00% vs. 75.00%, p = 0.017) and worse 3-year survival (Male, 68.75% vs. 95.45%, p = 0.027; Female, 66.67% vs. 100.00%, p = 0.046) than patients without SML. CONCLUSION The development of SML during neoadjuvant therapy in LA-GIST patients, rather than pre- and post-treatment sarcopenia, is a major prognostic factor for the long-term prognosis and is also associated with recent postoperative complication rates and pathological regression.
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Affiliation(s)
- Ping'an Ding
- The Third Department of Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, Hebei, China.,Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric Cancer, Shijiazhuang, 050011, China
| | - Honghai Guo
- The Third Department of Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, Hebei, China.,Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric Cancer, Shijiazhuang, 050011, China
| | - Xiaoxiao He
- The Third Department of CT/MRI, the Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, Hebei, China
| | - Chenyu Sun
- AMITA Health Saint Joseph Hospital Chicago, 2900 N. Lake Shore Drive, Chicago, IL, 60657, USA
| | - Scott Lowe
- College of Osteopathic Medicine, Kansas City University, 1750 Independence Ave, Kansas City, MO, 64106, USA
| | - Rachel Bentley
- College of Osteopathic Medicine, Kansas City University, 1750 Independence Ave, Kansas City, MO, 64106, USA
| | - Qin Zhou
- Radiation Oncology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Peigang Yang
- The Third Department of Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, Hebei, China.,Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric Cancer, Shijiazhuang, 050011, China
| | - Yuan Tian
- The Third Department of Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, Hebei, China.,Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric Cancer, Shijiazhuang, 050011, China
| | - Yang Liu
- The Third Department of Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, Hebei, China.,Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric Cancer, Shijiazhuang, 050011, China
| | - Li Yang
- The Third Department of CT/MRI, the Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, Hebei, China.
| | - Qun Zhao
- The Third Department of Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, Hebei, China. .,Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric Cancer, Shijiazhuang, 050011, China.
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Zhang X, Wang D, Sun T, Li W, Dang C. Advanced lung cancer inflammation index (ALI) predicts prognosis of patients with gastric cancer after surgical resection. BMC Cancer 2022; 22:684. [PMID: 35729545 PMCID: PMC9215041 DOI: 10.1186/s12885-022-09774-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 06/14/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction Advanced lung cancer inflammation index (ALI) has been implicated in the prognosis of many types of tumors. But few studies elucidate its role in gastric cancer (GC). Materials and methods We consecutively recruited 615 GC patients who underwent radical gastrectomy. Patients were grouped according to ALI status. Risk factors for overall survival (OS) and disease-free survival (DFS) in overall and sex-stratified cohorts were determined using multivariate cox regression analysis. We also compared survival differences between the two groups after one-to-one propensity score matching (PSM). Results Patients with low ALI showed larger tumor size, more advanced TNM staging, shorter OS (median: 37 vs 42 months) and DFS (median: 37 vs 42 months) (all P < 0.001). Multivariate analysis showed that elevated ALI was independently associated with longer OS and DFS. After stratification by sex, low ALI was an independent risk factor for OS and DFS in male patients but not in female patients. But our further PSM analysis showed prognostic value of ALI in both male and female subgroups. Conclusion Preoperative ALI is an independent prognostic factor for GC patients undergoing curative gastrectomy. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-022-09774-z.
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Affiliation(s)
- Xin Zhang
- Department of Oncology Surgery, First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, Shaanxi, 710061, P. R. China
| | - Danfang Wang
- Department of Xi'an Medical University, Xi'an, China
| | - Tuanhe Sun
- Department of Oncology Surgery, First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, Shaanxi, 710061, P. R. China
| | - Wenxing Li
- Department of Oncology Surgery, First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, Shaanxi, 710061, P. R. China
| | - Chengxue Dang
- Department of Oncology Surgery, First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, Shaanxi, 710061, P. R. China.
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Prognostic Nutritional Index Predicts Outcome of PD-L1 Negative and MSS Advanced Cancer Treated with PD-1 Inhibitors. BIOMED RESEARCH INTERNATIONAL 2022; 2022:6743126. [PMID: 35707390 PMCID: PMC9192216 DOI: 10.1155/2022/6743126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 05/24/2022] [Indexed: 11/18/2022]
Abstract
Purpose Tumor mutational burden (TMB), microsatellite instability-high (MSI-H), and expression of programmed death ligand-1 (PD-L1) have emerged as predictive biomarkers for responsiveness to immune checkpoint inhibitors (ICIs) in several cancer types. However, for patients with negative PD-L1 expression, or microsatellite stability (MSS), some cases may experience favorable response to immunotherapy, and there is currently a lack of good relevant predictors. We tried to introduce several peripheral blood markers for predicting treatment outcome and immune-related adverse events (irAEs) in PD-L1 negative and MSS patients. Methods A retrospective study of 142 PD-L1 negative and MSS patients was carried out. The association of peripheral blood markers including lactate dehydrogenase (LDH), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), albumin-to-globulin ratio (AGR), prognostic nutrition index (PNI), and other factors with clinicopathological characters and prognosis were assessed by Cox regression and Kaplan-Meier methods. Results Lower level of PNI and poor performance status (ECOG score of 2) was correlated with significantly shorter overall survival (OS) and worse outcome of ICIs. The multivariate analysis revealed that PNI (for OS HR = 0.465, 95% CI: 0.236-0.916, p = 0.027; for PFS HR = 0.493, 95% CI: 0.251-0.936, p = 0.031) and ECOG score (for OS HR = 4.601, 95% CI: 2.676-7.910, p < 0.001; for PFS HR = 2.830, 95% CI: 1.707-4.691, p < 0.001) were independent prognostic factors for OS and PFS. NLR was related to the onset of irAEs. Conclusions Pretreatment level of PNI and NLR, beyond PD-L1 expression and MSS, can improve the predictive accuracy for immunotherapy outcomes and has the potential to expand the candidate pool of patients for treatment with ICIs.
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Peng W, Dai J, Liu CC, Liu D, Xiao H. Body Mass Index and Prognosis of Patients With Stage II/III Gastric Cancer After Curative Gastrectomy: Completion of Perioperative Adjuvant Chemotherapy May Be a Confounding Factor. Front Oncol 2022; 12:899677. [PMID: 35769709 PMCID: PMC9234174 DOI: 10.3389/fonc.2022.899677] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 05/16/2022] [Indexed: 12/04/2022] Open
Abstract
Objective To investigate the association between body mass index (BMI) and overall survival (OS) of patients with stage II/III gastric cancer (GC) after radical gastrectomy, and evaluate the potential influence of perioperative adjuvant chemotherapy (PAC). Methods Medical records of 2,510 consecutive stage II/III GC patients who underwent curative resection between November 2010 and December 2020 were retrospectively reviewed. The optimal cutoff value of BMI for OS was determined by X-tile. The independent predictive factors for completeness of PAC were identified using univariate and multivariate logistic regression analyses. Cox regression analyses assessed the association among BMI, completeness of PAC, and OS. Results Of the 2,510 patients, 813 cases with BMI < 20.3 kg/m2 were classified as belonging in the low BMI group. Further analyses confirmed that low BMI was an independent predictor for incomplete PAC (< 6 cycles, n = 920) and poorer OS (hazard ratio: 1.317, 95% confidence interval: 1.162-1.494, P < 0.001), but neo-adjuvant chemotherapy (NAC) was a protective factor. An additive effect was found in those with both low BMI and incomplete PAC, as they had even worse OS. However, in patients with low BMI, completion of PAC (≥ 6 cycles) significantly improved OS, which became comparable to that in the high BMI group (P = 0.143). Conclusions Low preoperative BMI independently affects completion of PAC and prognosis of patients with stage II/III GC, but completing PAC can compensate for the adverse influence of low BMI on OS. Thus, strategies designed to ensure the completion of PAC, such as NAC and nutritional support, should be further investigated.
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Affiliation(s)
- Wei Peng
- Gastroenterology and Urology Department II, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Jing Dai
- Gastroenterology and Urology Department II, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Chao-chan Liu
- Gastroenterology and Urology Department II, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Dian Liu
- Department of Lamphoma and Abdominal Radiotherapy, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Hua Xiao
- Department of Hepatobiliary and Intestinal Surgery, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
- Department of Gastroduodenal and Pancreatic Surgery, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
- *Correspondence: Hua Xiao,
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Zhao X, Liu J, Wang Y, Yang Y, Pan Y, Ge S. Preoperative Nutritional Status and Risk Factors Associated with Delayed Discharge in Geriatric Patients Undergoing Gastrectomy: A Single-Center Retrospective Study. Appl Bionics Biomech 2022; 2022:8263986. [PMID: 35694276 PMCID: PMC9187457 DOI: 10.1155/2022/8263986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/08/2022] [Accepted: 05/12/2022] [Indexed: 11/18/2022] Open
Abstract
Objective Preoperative malnutrition is an independent risk factor for postoperative complications and survival for gastric cancer patients. The study is aimed at investigating the prevalence of malnutrition, perioperative nutritional support, and the risk factors associated with delayed discharge of geriatric patients undergoing gastrectomy. Methods A retrospective study of gastric cancer patients (age ≥ 65) who underwent gastrectomy at Zhongshan Hospital from January 2018 to May 2020 was conducted. Clinical data, including demographic information, medical history, surgery-related factors, and perioperative nutritional management, were collected and analyzed. Postoperative complications were assessed according to the Clavien-Dindo grading system, and the prognostic nutritional index (PNI) was calculated. The risk factors affecting the prolongation of postoperative hospital stay were analyzed. Results A total of 783 patients were reviewed. The overall frequency of malnutrition was 31.3% (249/783). The albumin, prealbumin, and hemoglobin levels were lower in the malnutrition group than in the well-nourished group. The proportion of patients who received preoperative total parenteral nutritional support in the malnutrition group was significantly higher than in the well-nourished group (12.4% vs. 3.7%, P < 0.001). All patients received postoperative parenteral nutrition (PN); the proportion of patients who received total nutrient admixture (TNA) in the malnutrition group was lower than in the well-nourished group (22.1% vs. 33.5%, P = 0.001). No significant difference was found in the duration of postoperative nutrition between groups (P > 0.05). The malnutrition group was associated with a higher rate of postoperative complications (P < 0.001). Univariate and multivariate regressions revealed that age > 70 years (OR = 1.216, 95% CI 1.048-1.411, P = 0.010), operation time > 180 min (OR = 1.431, 95% CI 1.237-1.656, P < 0.001), PNI < 44.5 (OR = 1.792, 95% CI 1.058-3.032, P = 0.030), and postoperative complications (OR = 2.191, 95% CI 1.604-2.991, P < 0.001) were significant risk factors associated with delayed discharge. Conclusion Malnutrition is relatively common in elderly patients undergoing gastrectomy. Advanced age, duration of surgery, lower levels of PNI, and postoperative complications were risk factors associated with delay discharge. Elderly gastric cancer patients with risk factors urgently require specific attention for reducing hospital stay.
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Affiliation(s)
- Xining Zhao
- Department of Anesthesiology, Zhongshan Hospital Fudan University, Shanghai 200032, China
| | - Jie Liu
- Department of Anesthesiology, Zhongshan Hospital Fudan University, Shanghai 200032, China
| | - Ying Wang
- Department of Anesthesiology, Zhongshan Hospital Fudan University, Shanghai 200032, China
| | - Yuying Yang
- Department of Anesthesiology, Zhongshan Hospital Fudan University, Shanghai 200032, China
| | - Yan Pan
- Department of Anesthesiology, Zhongshan Hospital Fudan University, Shanghai 200032, China
| | - Shengjin Ge
- Department of Anesthesiology, Zhongshan Hospital Fudan University, Shanghai 200032, China
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The Survival Relationship between Preoperative Inflammation Markers and Patients with Special Pathological Types of Gastric Cancer. Can J Gastroenterol Hepatol 2022; 2022:5715898. [PMID: 35340978 PMCID: PMC8956443 DOI: 10.1155/2022/5715898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 01/25/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The preoperative PLR is closely associated with prognosis of gastric cancer. This aims to research whether the PLR could predict overall survival (OS) of gastric cancer (GC) patients with SRC component. METHODS The data were collected from Harbin Medical University Cancer Hospital between January 2001 and December 2013 in China. The patients were diagnosed with GC by pathologic examination, which contained SRC component in pathological organization. PLR is obtained from peripheral blood markers (platelets/lymphocytes). RESULTS There is a difference in OS between high PLR group and low group, which is verified by Kaplan-Meier analysis and log-rank tests (P < 0.001). Moreover, multivariate analysis prove PLR was independent prognostic factor for GC (HR = 1.384, 95% (CI): 1.048-1.828; P = 0.022). The preoperative PLR in stage I + II (P = 0.033), stage III (P < 0.001), SRC component lower than 50% (P < 0.001), SRC component equal to or higher than 50% (P = 0.044), and R0 resection (P < 0.001) GC are still effective. CONCLUSION PLR is a simple, useful, and repeatable predictor of OS in gastric cancer of stages I-III with SRC component and may help clinicians identify patients with high risk and develop a more reasonable follow-up plan.
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Lu J, Xue Z, Xie JG, Xu BB, Yang HB, Wu D, Zheng HL, Xie JW, Wang JB, Lin JX, Chen QY, Li P, Huang CM, Zheng CH. Preoperative Muscle-Adipose Index: A New Prognostic Factor for Gastric Cancer. Ann Surg Oncol 2022; 29:10.1245/s10434-022-11509-0. [PMID: 35294649 DOI: 10.1245/s10434-022-11509-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 02/07/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Studies have shown that traditional nutrition indicators and body composition indicators are closely related to prognosis after radical gastric cancer (GC) surgery. However, the effect of the combined muscle and adipose composite on the prognosis of GC has not been reported. METHODS The clinicopathological data of 514 patients with GC were retrospectively analyzed. The skeletal muscle adipose tissue were measured by preoperative CT images to obtain the muscle index and adipose index. X-tile software was used to determine the diagnostic threshold of muscle-adipose imbalance. RESULTS The 5-year OS and RFS of the muscle-adipose imbalanced group were significantly worse than those of the balanced group. Multivariate analysis showed that muscle-adipose imbalance and the CONUT score were independent prognostic factors of OS and RFS (p < 0.05). The nuclear density curve showed that the recurrence risk of the muscle-adipose imbalanced group was higher than that of the balanced group, whereas the nuclear density curve of the CONUT score was confounded. Incorporating the muscle-adipose index into cTNM has the same prognostic performance as the pTNM staging system. Chemotherapy-benefit analysis showed that stage II/III patients in the muscle-adipose balanced group could benefit from adjuvant chemotherapy. CONCLUSIONS The preoperative muscle-adipose index discovered for the first time is a new independent prognostic factor that affects the prognosis with GC. In addition, the preoperative muscle-adipose index is better than traditional nutrition and body composition indicators in terms of the prognostic evaluation of GC patients and the predictive value of recurrence risk.
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Affiliation(s)
- Jun Lu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Zhen Xue
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Jian-Gao Xie
- Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, 350001, China
| | - Bin-Bin Xu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Hai-Bo Yang
- People's Hospital of Guyuan City of Ningxia, Ningxia, China
| | - Dong Wu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Hua-Long Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Jian-Wei Xie
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Jia-Bin Wang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Jian-Xian Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Qi-Yue Chen
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Ping Li
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Chang-Ming Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China.
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China.
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China.
| | - Chao-Hui Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China.
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China.
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China.
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Chen L, Sun H, Zhao R, Huang R, Pan H, Zuo Y, Zhang L, Xue Y, Song H, Li X. Controlling Nutritional Status (CONUT) Predicts Survival in Gastric Cancer Patients With Immune Checkpoint Inhibitor (PD-1/PD-L1) Outcomes. Front Pharmacol 2022; 13:836958. [PMID: 35308215 PMCID: PMC8931544 DOI: 10.3389/fphar.2022.836958] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 01/31/2022] [Indexed: 12/16/2022] Open
Abstract
Objective: The controlling nutritional status (CONUT), based on total lymphocyte count (TL), total cholesterol level (T-CHOL), and serum albumin (ALB), can provide a useful immunological prognostic biomarker for cancer patients. The present study aims to investigate the correlation between CONUT and prognosis in gastric cancer patients receiving immune checkpoint inhibitor (ICI) treatment. Methods: We retrospectively enrolled 146 patients with gastric cancer treated with ICIs (PD-1/PD-L1 inhibitors) from August 2016 to December 2020. The clinicopathologic characteristics were analyzed by Chi-square test or Fisher’s exact test. The Kaplan–Meier and log-rank test were used to calculate and compare progression-free survival (PFS) and overall survival (OS). The prognostic and predictive factors of PFS and OS were identified by univariate and multivariate analyses. A nomogram was developed to estimate 1-, 3-, and 5-year PFS and OS probability. Results: Through the CONUT score, there were 75 (51.37%) patients in the low CONUT group and 71 (48.63%) patients in the high CONUT group. There was a correlation between the CONUT score and age (p = 0.005), pathology (p = 0.043), ALB (p = 0.020), PALB (p = 0.032), and Hb (p = 0.001). The CA724, TNM stage, and treatment (ICIs vs. chemotherapy) were the independent prognostic factors for PFS and OS by multivariate analyses. Patients with high CONUT score had poorer PFS and OS (χ2 = 3.238, p = 0.072, and χ2 = 4.298, p = 0.038). In the subgroup analysis, the patients with high CONUT score were associated with shorter PFS and OS with ICIs or chemotherapy. With the PD-1/PD-L1 positive expression, the patients with high CONUT score had shorter PFS and OS than those with low CONUT score. Furthermore, the patients with high CA724 value were associated with shorter PFS and OS. The toxicity assessment in ICIs or chemotherapy was significantly associated with anemia. The nomograms were constructed to predict the probability of 1-, 3-, and 5-year PFS, and 1-, 3-, and 5-year OS with C-indices of 0.749 and 0.769, respectively. Conclusion: The CONUT, as a novel immuno-nutritional biomarker, may be useful in identifying gastric cancer patients who are unlikely to benefit from ICI treatment.
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Affiliation(s)
- Li Chen
- Department of Thyroid and Breast Surgery, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
- Department of Gastrointestinal Surgery, Harbin Medical University Cancer Hospital, Harbin Medical University, Harbin, China
| | - Hao Sun
- Department of Gastrointestinal Surgery, Harbin Medical University Cancer Hospital, Harbin Medical University, Harbin, China
| | - Ruihu Zhao
- Department of Gastrointestinal Surgery, Harbin Medical University Cancer Hospital, Harbin Medical University, Harbin, China
| | - Rong Huang
- Department of Gastrointestinal Surgery, Harbin Medical University Cancer Hospital, Harbin Medical University, Harbin, China
| | - Hongming Pan
- Department of Gastrointestinal Surgery, Harbin Medical University Cancer Hospital, Harbin Medical University, Harbin, China
| | - Yanjiao Zuo
- Department of Gastrointestinal Surgery, Harbin Medical University Cancer Hospital, Harbin Medical University, Harbin, China
| | - Lele Zhang
- Department of Gastrointestinal Surgery, Harbin Medical University Cancer Hospital, Harbin Medical University, Harbin, China
| | - Yingwei Xue
- Department of Gastrointestinal Surgery, Harbin Medical University Cancer Hospital, Harbin Medical University, Harbin, China
| | - Hongjiang Song
- Department of Gastrointestinal Surgery, Harbin Medical University Cancer Hospital, Harbin Medical University, Harbin, China
- *Correspondence: Hongjiang Song, ; Xingrui Li,
| | - Xingrui Li
- Department of Thyroid and Breast Surgery, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Hongjiang Song, ; Xingrui Li,
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Namikawa T, Shimizu S, Yokota K, Tanioka N, Munekage M, Uemura S, Maeda H, Kitagawa H, Kobayashi M, Hanazaki K. Neutrophil-to-lymphocyte ratio and C-reactive protein-to-albumin ratio as prognostic factors for unresectable advanced or recurrent gastric cancer. Langenbecks Arch Surg 2022; 407:609-621. [PMID: 34652563 DOI: 10.1007/s00423-021-02356-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 10/11/2021] [Indexed: 02/05/2023]
Abstract
PURPOSE This study evaluated the prognostic value of C-reactive protein-to-albumin (CAR) and neutrophil-to-lymphocyte ratios (NLR) in conjunction with host-related factors in patients with unresectable advanced or recurrent gastric cancer. METHODS A total of 411 patients with unresectable advanced gastric cancer were treated at Kochi Medical School between 2007 and 2019. Associations between clinicopathological parameters and systemic inflammatory and nutritional markers, including CAR and NLR, with overall survival were analyzed retrospectively. RESULTS The optimal cut-off values of predicted median survival time were 0.096 (sensitivity, 74.9%; specificity, 42.5%) for CAR and 3.47 (sensitivity, 64.1%; specificity, 57.5%) for NLR, based on the results of receiver operating characteristic analysis. A weak significant positive correlation was identified between CAR and NLR (r = 0.388, P < 0.001). The median survival time was significantly higher in patients with intestinal-type than those with diffuse-type histology (18.3 months vs. 9.5 months; P = 0.001), CAR < 0.096 than those with CAR ≥ 0.096 (14.8 months vs. 9.9 months; P < 0.029), and those with NLR < 3.47 than NLR ≥ 3.47 (14.7 months vs. 8.8 months; P < 0.001). Multivariate survival analysis revealed that diffuse-type histology (hazard ratio (HR) 1.865; 95% confidence interval (CI) 1.397-2.490; P < 0.001)), 1 or more performance status (HR 11.510; 95% CI 7.941-16.683; P < 0.001), and NLR ≥ 3.47 (HR 1.341; 95% CI 1.174-1.769; P = 0.023) were significantly associated with independent predictors of worse prognosis. CONCLUSIONS High CAR and NLR are associated with poor survival in patients with unresectable and recurrent gastric cancer.
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Affiliation(s)
- Tsutomu Namikawa
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan.
| | - Shigeto Shimizu
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Keiichiro Yokota
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Nobuhisa Tanioka
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Masaya Munekage
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Sunao Uemura
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Hiromichi Maeda
- Department of Human Health and Medical Sciences, Kochi Medical School, Kochi, Japan
| | - Hiroyuki Kitagawa
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Michiya Kobayashi
- Department of Human Health and Medical Sciences, Kochi Medical School, Kochi, Japan
| | - Kazuhiro Hanazaki
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
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He K, Si L, Pan X, Sun L, Wang Y, Lu J, Wang X. Preoperative Systemic Immune–Inflammation Index (SII) as a Superior Predictor of Long-Term Survival Outcome in Patients With Stage I–II Gastric Cancer After Radical Surgery. Front Oncol 2022; 12:829689. [PMID: 35296020 PMCID: PMC8918673 DOI: 10.3389/fonc.2022.829689] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 02/03/2022] [Indexed: 12/14/2022] Open
Abstract
Background Systemic immune–inflammation index (SII), calculated by immunoinflammatory cell counts of peripheral blood, is considered a predictor of survival outcome in several solid tumors, including gastric cancer (GC). However, there is no study focusing on the prognostic value of SII in the early stage of GC. This study aims to compare prognostic prediction capabilities of several inflammatory indices, nutritional indices, and tumor markers to further verify the superior prognostic value of SII in stage I–II GC patients after surgery. Methods In this study, 548 patients (358 in the training group and 190 in the validation group) with stage I–II GC after radical surgery were retrospectively analyzed. The peripheral blood indices of interest were SII, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), advanced lung cancer inflammation index (ALI), systemic inflammation score (SIS), prognostic nutritional index (PNI), body mass index (BMI), albumin, carcinoembryonic antigen (CEA), cancer antigen 125 (CA125), carbohydrate-associated antigen 19-9 (CA19-9), and alpha-fetoprotein (AFP). The time-dependent receiver operating characteristic (t-ROC) curves and the area under the curve (AUC) were used to determine the optimal cutoff value and prognostic ability of each parameter. Kaplan–Meier curves and multivariable Cox regression models were used to evaluate independent prognostic factors. The nomogram was constructed based on the result of bidirectional stepwise regression model. Results The optimal cutoff value of SII was 508.3. The 5-year overall survival rate of the low SII (SII-L) group was significantly higher than that of the high SII (SII-H) group (92% vs. 80%, P < 0.001), especially in the elderly and stage II patients (91% vs. 73%, P = 0.001; 86% vs. 67%, P = 0.003, respectively). The significant prognostic values of SII were consistent in most subgroups. In multivariate analysis, SII and CA19-9 were the only two independent prognostic hematology indices. The AUC value of SII (0.624) was greater than that of CA19-9 (0.528) and other prognostic parameters. Adding SII to the conventional model improved the predictive ability of 5-year overall survival as shown by the significantly increased net reclassification improvement (NRI) and integrated discrimination improvement (IDI) (P = 0.033, P = 0.053, respectively) and modestly improved consistency index (C-index) (increased by 1.6%). External validation of SII-based nomogram demonstrated favorable predictive performance and discrimination. In addition, interactive web dynamic nomogram was published to facilitate clinical use. Conclusion SII is a simple but powerful index with a high predictive value to predict survival outcome in patients with stage I–II GC after radical operation. The SII-based nomogram can provide intuitive and accurate prognosis prediction of individual patients.
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Affiliation(s)
| | | | | | | | | | - Jianwei Lu
- *Correspondence: Jianwei Lu, ; Xiaohua Wang,
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Hirahara N, Matsubara T, Kaji S, Uchida Y, Hyakudomi R, Yamamoto T, Takai K, Sasaki Y, Kawakami K, Tajima Y. Influence of nutrition on stage-stratified survival in gastric cancer patients with postoperative complications. Oncotarget 2022; 13:183-197. [PMID: 35079325 PMCID: PMC8782615 DOI: 10.18632/oncotarget.28179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 01/06/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND We assessed the relationship between preoperative prognostic nutritional index (PNI) and short- and long-term outcomes among gastric cancer patients because the clinical significance of PNI in these patients remains controversial. MATERIALS AND METHODS We retrospectively reviewed the medical records of 434 consecutive patients who underwent curative laparoscopic gastrectomy for gastric cancer. RESULTS Patients with postoperative complications had a significantly poorer overall survival (OS) than those without. On multivariate analyses, postoperative complications were independently associated with PNI value and operative procedure type. In the low PNI group (n = 118), those with postoperative complications experienced significantly poorer OS than those without complications. Among the low PNI group with pTNM stage I and II disease, those with postoperative complications experienced significantly worse OS than those without complications. However, among the high PNI group and patients with stage II and III disease in the low PNI group, OS was similar with respect to postoperative complications. CONCLUSIONS The present study confirmed that long-term prognosis was unaffected by postoperative complications in well-nourished gastric cancer patients. In addition, preoperative nutritional status and postoperative complications, may be crucial in determining the prognosis of gastric cancer, especially in early-stage cancer.
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Affiliation(s)
- Noriyuki Hirahara
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Takeshi Matsubara
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Shunsuke Kaji
- Department of Surgery, Matsue Red Cross Hospital, Shimane, Matsue, Horomachi, Japan
| | - Yuki Uchida
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Ryoji Hyakudomi
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Tetsu Yamamoto
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Kiyoe Takai
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Yohei Sasaki
- Department of Surgery, Masuda Red Cross Hospital, Shimane, Masuda, Otoyoshi-cho, Japan
| | - Koki Kawakami
- Department of Surgery, Matsue Red Cross Hospital, Shimane, Matsue, Horomachi, Japan
| | - Yoshitsugu Tajima
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
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Ma C, Yu R, Li J, Guo J, Xu J, Wang X, Liu P. Preoperative prognostic nutritional index and systemic immune-inflammation index predict survival outcomes in osteosarcoma: A comparison between young and elderly patients. J Surg Oncol 2021; 125:754-765. [PMID: 34811745 DOI: 10.1002/jso.26757] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 11/11/2021] [Indexed: 12/27/2022]
Abstract
OBJECTIVE This retrospective study of patients with osteosarcoma investigated the following biomarkers of inflammation and nutritional status: neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, prognostic nutritional index (PNI), and systemic immune-inflammation index (SII). The efficacies of these indicators to predict overall survival (OS) of young and elderly patients were compared. METHODS The data of 125 patients with osteosarcoma, comprising the young (≤20 years) and elderly (60-80 years), were reviewed. Receiver operating characteristic (ROC) curves were calculated to determine the optimal cut-off value and area under the ROC curve of each potential biomarker. Kaplan-Meier curves and a Cox proportional hazards model were used to perform survival analyses. RESULTS The cut-off values for low and high PNI ( ≤48.5, >48.5) and low and high SII (≤607.3, >607.3) were determined. Osteosarcoma patients in low PNI group or high SII group exhibited poorer OS relative to those in high PNI or low SII groups. The univariate and multivariate analyses indicated that preoperative PNI and SII were independent prognostic factors for OS in both the young and elderly subjects. CONCLUSION Preoperative PNI and SII can be viable biomarkers of prognosis for both young and elderly patients with osteosarcoma. Awareness of these valuable indexes will enable clinicians to evaluate the inflammatory and nutritional status of these patients and establish a framework for individualized therapy.
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Affiliation(s)
- Cong Ma
- Department of Orthopaedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.,Department of Orthopaedics, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Ronghui Yu
- Department of Orthopaedics, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Junhong Li
- Department of Orthopaedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jingjing Guo
- Department of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jianyun Xu
- Department of Orthopaedics, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Xiaoyan Wang
- Department of Orthopaedics, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Ping Liu
- Department of Orthopaedics, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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Nie RC, Chen GM, Wang Y, Yuan SQ, Zhou J, Duan JL, Liu WW, Chen S, Cai MY, Li YF. Association Between Body Mass Index and Survival Outcomes In Patients Treated With Immune Checkpoint Inhibitors: Meta-analyses of Individual Patient Data. J Immunother 2021; 44:371-375. [PMID: 34456293 PMCID: PMC8500279 DOI: 10.1097/cji.0000000000000389] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 07/21/2021] [Indexed: 01/02/2023]
Abstract
Despite that immune checkpoint inhibitors (ICIs) had tremendous improved the survival of multiple solid tumors, only a limited proportion of patients are responsive to ICIs. Therefore, effective variables are urgently needed to predict the probability of response to ICIs. Systematic searches were conducted from inception up to May, 2020. Prospective or retrospective studies of ICIs that investigated the association between body mass index (BMI) and survival outcomes, including overall survival (OS) and/or progression-free survival (PFS), were selected. The association between each BMI category and survival outcomes was calculated using Cox proportional hazard regression models and quantified as hazard ratio (HR) with corresponding 95% confidence interval. Seven clinical studies involving data from 3768 individual patients were included. The median OS was 15.5 months (95% confidence interval: 14.7-16.2 mo) and the median PFS was 5.7 months (5.2-6.3 mo). The median OS was significantly longer in overweight/obese patients than in nonoverweight patients (20.7 vs. 11.3 mo; P<0.001). The difference in OS between overweight and obese patients was not statistically significant (HR: 1.14, P=0.098). Similar results were observed for PFS outcomes. Subgroup analysis demonstrated improved OS in overweight/obese patients with nonsmall-cell lung cancer (HR: 0.81, P=0.002), melanoma (HR: 0.66, P<0.001), renal cell carcinoma (HR: 0.53, P<0.001), and multiple cancer type (HR: 0.34, P<0.001), with parallel results noted regarding PFS outcomes. Results of the present study suggested that BMI may be a satisfactory prognostic factor for patients treated with ICIs.
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Affiliation(s)
- Run-Cong Nie
- Departments of Gastric Surgery
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine
| | - Guo-Ming Chen
- Departments of Gastric Surgery
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine
| | - Yun Wang
- Hematologic Oncology
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine
| | - Shu-Qiang Yuan
- Departments of Gastric Surgery
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine
| | - Jie Zhou
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Jin-Ling Duan
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Wen-Wu Liu
- Departments of Gastric Surgery
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine
| | - Shi Chen
- Department of Gastrointestinal Surgery, the Sixth Affiliated Hospital, Sun Yat-sen University
| | - Mu-Yan Cai
- Pathology, Sun Yat-sen University Cancer Center
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine
| | - Yuan-Fang Li
- Departments of Gastric Surgery
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine
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Good performance of the Global Leadership Initiative on Malnutrition criteria for diagnosing and classifying malnutrition in people with esophageal cancer undergoing esophagectomy. Nutrition 2021; 91-92:111420. [PMID: 34399403 DOI: 10.1016/j.nut.2021.111420] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 07/09/2021] [Accepted: 07/13/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVES This study aimed to investigate the performance of the Global Leadership Initiative on Malnutrition (GLIM) criteria for malnutrition assessment in people with esophageal cancer undergoing esophagectomy. METHODS A prospective institutional database of 212 patients with esophageal cancer was reviewed for malnutrition assessment using the GLIM criteria. Perioperative metabolic characteristics, postoperative morbidities, and survival outcomes were investigated for GLIM-defined malnutrition. The performance of the two-step approach in implementing the GLIM criteria was evaluated. RESULTS One hundred eighty-nine patients were identified. The preoperative proportions of moderate and severe malnutrition diagnosed by the GLIM criteria were 45.0% and 30.7%, respectively. Patients with severe malnutrition showed lower levels of serum albumin, prealbumin, and total lymphocyte count on postoperative days 1, 3, and 5 (all Ps < 0.05). Severe malnutrition was not only predictive of overall complications (odds ratio, 8.75; P < 0.001), major complications (odds ratio, 15.6; P < 0.001), and delayed hospital discharge (odds ratio, 7.38; P = 0.001) but was also associated with poor overall and disease-free survival (respectively: hazard ratio, 3.75; P = 0.015; and hazard ratio, 4.18; P = 0.028). Notably, patients with severe malnutrition were more clinically impaired than those with moderate malnutrition. Regarding the two-step approaches, the Malnutrition Universal Screening Tool and Nutritional Risk Screening 2002 simplified malnutrition assessments using the GLIM criteria, and the prognostic nutritional index promoted the clinical significance of the GLIM criteria. CONCLUSIONS The GLIM criteria showed good performance in diagnosing and classifying malnutrition in people with esophageal cancer undergoing esophagectomy. The Malnutrition Universal Screening Tool, Nutritional Risk Screening 2002, and prognostic nutritional index could be appropriately used to implement the two-step approach to the GLIM criteria.
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Controlling Nutritional Status (CONUT) Score Is a Prognostic Factor for Patients with Gastric Cancer Treated by Perioperative FLOT. J Gastrointest Cancer 2021; 53:571-580. [PMID: 34263428 DOI: 10.1007/s12029-021-00664-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE The aim of this study was to show that the Controlling Nutritional Status (CONUT) score has predictive value in gastric cancer (GC) patients treated with perioperative fluorouracil, leucovorin, oxaliplatin, or docetaxel (FLOT). METHODS A total of 161 GC patients treated with perioperative FLOT in our center were included in the study. The ideal cutoff values for the CONUT score were obtained using the receiver operating characteristic (ROC) curve analysis, and the patients were divided into low (≤3) and high (> 3) CONUT groups. The associations of CONUT with clinicopathological factors and survival were evaluated retrospectively. RESULTS The median follow-up time was 11.2 months (2.3-32.3 months). The median overall survival (OS) for the entire population was 14.7 months (95% CI 13.5-15.9 months). Median OS was not reached in the low-CONUT group, but it was 14.2 months (95% CI 12.6-15.9) in the high-CONUT group and the difference was statistically significant (p = 0.002). The univariate Cox proportional hazards model revealed that OS was significantly associated with Eastern Cooperative Oncology Group (ECOG) status (p < 0.001), T4b stage (p 0.03), modified Glasgow Prognostic Scores (mGPS) (p 0.005), prognostic index (PI) (p 0.011), prognostic nutritional index (PNI) (p < 0.001), CONUT score (p 0.003), and mucinous histology (p 0.004). In multivariate analysis, ECOG performance status (p 0.029), PNI (p 0.001), CONUT score (p 0.040), and mucinous histology (p 0.001) were still identified as independent prognostic factors for OS. CONCLUSIONS Our study demonstrated the prognostic significance of the CONUT score in GC patients treated with perioperative FLOT.
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Sugawara K, Yamashita H, Urabe M, Okumura Y, Yagi K, Aikou S, Seto Y. The different survival impacts of body mass index in elderly and non-elderly patients with gastric carcinoma. Surg Oncol 2021; 37:101549. [PMID: 33819853 DOI: 10.1016/j.suronc.2021.101549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 02/10/2021] [Accepted: 03/26/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The age-dependent survival impact of body mass index (BMI) remains to be fully addressed in patients with gastric carcinoma (GC). We investigated the prognostic impacts of BMI in elderly (≥70 years) and non-elderly patients undergoing surgery for GC. METHODS In total, 1168 GC patients were retrospectively reviewed. Patients were stratified into 3 groups according to BMI; low (<20), medium (20-25) and high (>25). The effects of BMI on overall survival (OS) and cancer-specific survival (CSS) were assessed using univariate and multivariate Cox hazards models. RESULTS There were 242 (20.7%), 685 (58.7%) and 241 (20.6%) patients in the low-, medium- and high-BMI groups, respectively. The number of patients with high BMI but decreased muscle mass was extremely small (n = 13, 1.1%). Patients in the low-BMI group exhibited significantly poorer OS than those in the high- and medium-BMI group (P < 0.001). Notably, BMI classification significantly demarcated OS and CSS curves (both P < 0.001) in non-elderly patients, while did not in elderly patients (OS; P = 0.07, CSS; P = 0.54). Furthermore, the survival discriminability by BMI was greater in pStage II/III disease (P = 0.006) than in pStage I disease (P = 0.047). Multivariable analysis focusing on patients with pStage II/III disease showed low BMI to be independently associated with poor OS and CSS only in the non-elderly population. CONCLUSIONS BMI-based evaluation was useful for predicting survival and oncological outcomes in non-elderly but not in elderly GC patients, especially in those with advanced GC.
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Affiliation(s)
- Kotaro Sugawara
- Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
| | - Hiroharu Yamashita
- Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masayuki Urabe
- Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yasuhiro Okumura
- Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Koichi Yagi
- Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Susumu Aikou
- Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yasuyuki Seto
- Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Guner A, Cho M, Kim YM, Cheong JH, Hyung WJ, Kim HI. Prognostic Value of Postoperative Neutrophil and Albumin: Reassessment One Month After Gastric Cancer Surgery. Front Oncol 2021; 11:633924. [PMID: 33833991 PMCID: PMC8023044 DOI: 10.3389/fonc.2021.633924] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 03/01/2021] [Indexed: 12/13/2022] Open
Abstract
Objective The prognostic value of postoperative parameters reflecting the inflammatory and nutritional status of patients undergoing cancer surgery has been rarely studied. This study investigated the prognostic value of inflammatory and nutritional parameters measured preoperatively and 1 month after curative gastrectomy for gastric cancer. Methods Data from a prospectively maintained database of 1,194 patients with gastric cancer who underwent curative surgery in 2009–2018 were retrospectively reviewed. Demographics, clinicopathologic characteristics, operative data, survival data, and laboratory parameters were extracted. Neutrophil counts, lymphocyte counts, and albumin levels before surgery and 1 month postoperatively were analyzed. Results In multivariable analysis adjusted for age, sex, and pathologic stage, high neutrophil count (hazard ratio [HR] 1.09, 95% confidence interval [CI] 1.01–1.17, p = 0.022) and low albumin (HR 0.45, 95% CI 0.27–0.74, p = 0.002) 1 month postoperatively were independent prognostic factors for overall survival. High neutrophil count (HR 1.09, 95% CI 1.02–1.16, p = 0.015) 1 month postoperatively was also an independent prognostic factor for recurrence-free survival after adjusting for age, sex, body mass index, extent of gastrectomy, and pathologic stage. Patients were classified into risk groups based on thresholds of 4.2 × 103 cells/mm3 and 4.1 g/dl for 1-month neutrophil count and albumin. High-risk groups had a significantly worse prognosis than low-risk groups for overall survival (HR 5.87, 95% CI 3.28–10.51, p <0.001) and recurrence-free survival (HR 1.52, 95% CI 1.07–2.16, p = 0.021). Conclusions Neutrophil count and albumin level 1 month after curative surgery reflect long-term prognosis better than preoperative values. These parameters can be used to stratify patients with the same stage into different prognostic groups.
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Affiliation(s)
- Ali Guner
- Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea.,Faculty of Medicine, Department of General Surgery, Karadeniz Technical University, Trabzon, Turkey
| | - Minah Cho
- Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea.,Gastric Cancer Center, Yonsei Cancer Center, Seoul, South Korea.,Open NBI Convergence Technology Research Laboratory, Severance Hospital, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Yoo-Min Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea.,Gastric Cancer Center, Yonsei Cancer Center, Seoul, South Korea.,Open NBI Convergence Technology Research Laboratory, Severance Hospital, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Jae-Ho Cheong
- Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea.,Gastric Cancer Center, Yonsei Cancer Center, Seoul, South Korea.,Open NBI Convergence Technology Research Laboratory, Severance Hospital, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Woo Jin Hyung
- Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea.,Gastric Cancer Center, Yonsei Cancer Center, Seoul, South Korea.,Open NBI Convergence Technology Research Laboratory, Severance Hospital, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Hyoung-Il Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea.,Gastric Cancer Center, Yonsei Cancer Center, Seoul, South Korea.,Open NBI Convergence Technology Research Laboratory, Severance Hospital, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
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Body Composition Changes in Gastric Cancer Patients during Preoperative FLOT Therapy: Preliminary Results of an Italian Cohort Study. Nutrients 2021; 13:nu13030960. [PMID: 33809587 PMCID: PMC7999770 DOI: 10.3390/nu13030960] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 03/10/2021] [Accepted: 03/12/2021] [Indexed: 01/19/2023] Open
Abstract
Background: The impact of the new chemotherapy, fluorouracil plus leucovorin, oxaliplatin, and docetaxel (FLOT) on body composition in gastric cancer (GC) patients remains unknown. We assessed body composition changes of GC patients receiving the FLOT regimen and their impact on treatment outcomes. Methods: Preoperative pre- and post-FLOT computed tomography (CT) scans of advanced GC patients were studied. Lumbar skeletal muscle index (SMI) and adipose indices were calculated before and after FLOT. Results: A total of 26 patients were identified between April 2019 and January 2020. Nineteen patients were sarcopenic at diagnosis. The mean BMI decreased (from 24.4 ± 3.7 to 22.6 ± 3.1; p < 0.0001) as well as the SMI (from 48.74 ± 9.76 to 46.52 ± 9.98; p = 0.009) and visceral adipose index (VAI) (from 49.04 ± 31.06 to 41.99 ± 23.91; p = 0.004) during preoperative FLOT therapy. BMI, SMI, and VAI variations were not associated with toxicity, Response Evaluation Criteria in Solid Tumors (RECIST), response, delay and completion of perioperative FLOT chemotherapy, and the execution of gastrectomy; a decrease of SMI ≥ 5% was associated with a higher Mandard tumor regression grade (p = 0.01). Conclusions: Almost three-quarters (73.1%) of GC patients were sarcopenic at diagnosis. Preoperative FLOT was associated with a further reduction in SMI, BMI, and VAI. These changes were not associated with short-term outcomes.
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Qian Y, Liu H, Pan J, Yu W, Lv J, Yan J, Gao J, Wang X, Ge X, Zhou W. Preoperative Controlling Nutritional Status (CONUT) score predicts short-term outcomes of patients with gastric cancer after laparoscopy-assisted radical gastrectomy. World J Surg Oncol 2021; 19:25. [PMID: 33485347 PMCID: PMC7827975 DOI: 10.1186/s12957-021-02132-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 01/13/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND An emerging prediction tool, the Controlling Nutritional Status (CONUT) score, has shown good assessment ability of postoperative outcomes in cancer patients. This study evaluated the role of the preoperative CONUT score regarding the short-term outcomes of gastric cancer (GC) after laparoscopic gastrectomy. METHODS Three hundred and nine GC patients undergoing laparoscopic gastrectomy from January 2016 to June 2019 were analysed, retrospectively. The patients were divided into two groups according to the CONUT optimal cut-off value. Clinical characteristics and postoperative complications in the two groups were analysed and evaluated. Risk factors for complications were identified by univariate and multivariate analyses. RESULTS A total of 309 patients underwent laparoscopic gastrectomy; 91 (29.4%) patients experienced postoperative complications. The preoperative CONUT score showed a good predictive ability for postoperative complications (area under the curve (AUC) = 0.718, Youden index = 0.343) compared with other indices, with an optimal cut-off value of 2.5. Patients with high CONUT score had a significantly higher incidence of overall complications (P < 0.001). Age, haemoglobin, C-reactive protein, red blood cell levels, CONUT scores, surgical procedure type, T1, T4, N0 and N3 pathological TNM classification, and pathological stages of I and III were associated with postoperative complications (P < 0.05). Furthermore, the preoperative CONUT score was identified as an independent risk predictor of postoperative complications (P = 0.012; OR = 2.433; 95% CI, 1.218-4.862) after multivariate analysis. CONCLUSIONS The preoperative CONUT score is a practical nutritional assessment for predicting short-term outcomes in GC patients after laparoscopy-assisted gastrectomy.
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Affiliation(s)
- Yun Qian
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, China
| | - Huaying Liu
- Department of Medicine, GuangXi Medical College, Nanning, China
| | - Junhai Pan
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, China
| | - Weihua Yu
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, China
| | - Jiemin Lv
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, China
| | - Jiafei Yan
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, China
| | - Jiaqi Gao
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, China
| | - Xianfa Wang
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, China.
| | - Xiaolong Ge
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, China.
| | - Wei Zhou
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, China
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Gu L, Wang M, Cui X, Mo J, Yuan L, Mao F, Zhang K, Ng DM, Chen P, Wang D. Clinical significance of peripheral blood-derived inflammation markers in advanced gastric cancer after radical resection. BMC Surg 2020; 20:219. [PMID: 33008382 PMCID: PMC7532590 DOI: 10.1186/s12893-020-00884-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 09/24/2020] [Indexed: 01/19/2023] Open
Abstract
Background The prognostic significance of peripheral blood-derived inflammation markers in patients with gastric cancer (GC) has not been elucidated. This study aimed to investigate the relationship between systemic inflammatory markers and GC prognosis. Methods A prospective observational cohort study involving 598 patients was conducted to analyze the prognosis of GC based on systemic inflammatory markers. The following peripheral blood-derived inflammation markers were evaluated: the neutrophil-lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), systemic immune-inflammation index (SII), C-reactive protein/albumin (CRP/Alb) ratio, Glasgow Prognostic Score (GPS), modified Glasgow Prognostic Score (mGPS), prognostic nutrition index (PNI), and prognostic index (PI). The receiver operating characteristics (ROC) curve and the Youden index were used to determine the optimal cutoff values. Univariate and multivariate analysis of prognostic factors was conducted accordingly. Results The optimal cutoff values of the PNI, fibrinogen, NLR, PLR, SII, and CRP/Alb were 49.5, 397 ng/dl, 2.5, 154, 556, and 0.05, respectively. Multivariate analysis showed that age, PLR, TNM stage, and chemotherapy were the independent prognostic factors for advanced gastric cancer (AGC). Adjuvant chemotherapy improved the long-term prognosis of patients with PLR ≥154, but chemotherapy had no significant effect on the survival of patients with PLR < 154. Conclusions Our findings show that higher PLR (≥154) is an independent risk factor for poor prognosis in GC patients. Besides, PLR can predict adjuvant chemotherapy (oxaliplatin/5-fluorouracil combination) response in patients with GC after surgery.
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Affiliation(s)
- Lihu Gu
- Department of General Surgery, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, Zhejiang, China.,Key Laboratory of Diagnosis and Treatment of Digestive System Tumors of Zhejiang Province, Ningbo, Zhejiang, China.,Ningbo Clinical Research Center for Digestive System Tumors, Ningbo, Zhejiang, China
| | - Mian Wang
- Infection Department, Ningbo Yinzhou No. 2 Hospital, Ningbo, Zhejiang, China
| | - Xuena Cui
- Intensive Care Unit, Ningbo Yinzhou No. 2 Hospital, Ningbo, Zhejiang, China
| | - Jiahang Mo
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Lingling Yuan
- Department of General Surgery, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, Zhejiang, China
| | - Feiyan Mao
- Department of General Surgery, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, Zhejiang, China
| | - Kang Zhang
- Medical College of Ningbo University, Ningbo, Zhejiang, China
| | - Derry Minyao Ng
- Medical College of Ningbo University, Ningbo, Zhejiang, China
| | - Ping Chen
- Department of General Surgery, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, Zhejiang, China
| | - Dongjie Wang
- Department of Clinical Laboratory, HwaMei Hospital, University of Chinese Academy of Sciences, Northwest Street 41, Haishu District, Ningbo, 315010, Zhejiang, China.
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Xiao AT, Tong YX, Xu XS, Zhou Y, Zhang S. Preoperative Nutritional Status Contributes to the Development of Neutropenia Event in Patients With Gastric Cancer Receiving CAPEOX Adjuvant Chemotherapy. Front Oncol 2020; 10:692. [PMID: 32426291 PMCID: PMC7204396 DOI: 10.3389/fonc.2020.00692] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 04/14/2020] [Indexed: 11/17/2022] Open
Abstract
Purpose: The aim of this study is to evaluate the risk factors for ≥ grade 3 neutropenia in gastric cancer patients receiving postoperative adjuvant chemotherapy. Methods: This is a retrospective study from a single tertiary referral hospital. Patients diagnosed with gastric cancer who met the inclusion criteria were included in this study. Baseline and clinicopathological characteristics of the patients were collected. Patients were followed-up for 12 months and the incidence of neutropenia were recorded. Factors associated with neutropenia of chemotherapy in cycle 1 were investigated. Results: A total of 202 patients with gastric cancer were included. All patients received oxaliplatin plus oral capecitabine (CAPEOX) as the adjuvant chemotherapy. The incidence of ≥ grade 3 neutropenia is 11.9% (24/202) in cycle 1 among all patients. In multivariate analysis, independent risk factors for ≥ grade 3 neutropenia were serum prealbumin level (p = 0.041), prognostic nutritional index (PNI) (p = 0.049) and pre-cycle neutrophil count (p = 0.007). Conclusions: Our findings for the first time showed that nutritional parameter as prealbumin level and PNI are independent risk factors for neutropenia in gastric cancer patients receiving adjuvant chemotherapy. This may provide evidence for further investigation on prophylaxis use of granulocyte colony-stimulating factor in selected high-risk patients to prevent sever neutropenia in cycle 1 of adjuvant chemotherapy.
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Affiliation(s)
| | | | | | | | - Sheng Zhang
- Department of Gastrointestinal Surgery, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
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