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Huang J, Dong Z, Chen F, Xiang H, Chen T, Sun T, Chen S, Cai X, Liang C, Yu W. Risk analysis of jejunal orientation on the incidence of dysphagia after total gastrectomy: a retrospective cohort study. Surg Endosc 2025; 39:2973-2981. [PMID: 40116901 PMCID: PMC12041171 DOI: 10.1007/s00464-025-11660-1] [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: 11/21/2024] [Accepted: 03/09/2025] [Indexed: 03/23/2025]
Abstract
BACKGROUND Dysphagia is a common complication after total gastrectomy and esophagojejunostomy for gastric cancer. Dysphagia leads to impaired quality of life in the short- and long-term postoperative period and affects patient prognosis. The reasons for the occurrence of dysphagia have been controversial, for which we provide new insights. We compared the effects of different jejunal positions on the incidence of postoperative dysphagia in patients with gastric cancer. METHODS A total of 116 patients who underwent radical total gastrectomy and esophagojejunostomy for gastric cancer were included. The patients were divided into 2 groups: right esophagojejunostomy (REJ) and left esophagojejunostomy (LEJ). Clinical and pathologic characteristics, incidence of postoperative dysphagia and other surgical complications were compared between the two groups. RESULTS After grouping the patients, there were 60 patients in the REJ group and 56 patients in the LEJ group. The incidence of postoperative dysphagia was higher in the REJ group than in the LEJ group (p = 0.035) 17 (28.3%) and 7 (12.5%) respectively. Anastomotic stenosis occurred in one patient in the REJ group, and displacement of the jejunum occurred in six patients after imaging, and two of them underwent secondary surgical treatment to severe dysphagia, which was not found in the LEJ group. Multivariate logistic regression analysis showed that LEJ was an independent protective factor for dysphagia and anastomotic fistula was an independent risk factor for dysphagia (P < 0.05). The jejunal position had the greatest impact on dysphagia. CONCLUSIONS LEJ can effectively reduce the incidence of dysphagia in gastric cancer patients after esophagojejunostomy. Clinical and follow-up outcomes demonstrate the superiority of the LEJ reconstruction method in the treatment of TG and EJ.
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Affiliation(s)
- Jiarong Huang
- Department of General Surgery, The Affiliated LiHuiLi Hospital of NingBo University, Ningbo, 315000, Zhejiang, China
| | - Zhebin Dong
- Department of General Surgery, The Affiliated LiHuiLi Hospital of NingBo University, Ningbo, 315000, Zhejiang, China
| | - Fangqian Chen
- Department of General Surgery, The Affiliated LiHuiLi Hospital of NingBo University, Ningbo, 315000, Zhejiang, China
| | - Hanting Xiang
- Department of General Surgery, The Affiliated LiHuiLi Hospital of NingBo University, Ningbo, 315000, Zhejiang, China
| | - Tianci Chen
- Department of General Surgery, The Affiliated LiHuiLi Hospital of NingBo University, Ningbo, 315000, Zhejiang, China
| | - Tianyuan Sun
- Department of General Surgery, The Affiliated LiHuiLi Hospital of NingBo University, Ningbo, 315000, Zhejiang, China
| | - Sangsang Chen
- Department of General Surgery, The Affiliated LiHuiLi Hospital of NingBo University, Ningbo, 315000, Zhejiang, China
| | - Xianlei Cai
- Department of General Surgery, The Affiliated LiHuiLi Hospital of NingBo University, Ningbo, 315000, Zhejiang, China
| | - Chao Liang
- Department of General Surgery, The Affiliated LiHuiLi Hospital of NingBo University, Ningbo, 315000, Zhejiang, China.
| | - Weiming Yu
- Department of General Surgery, The Affiliated LiHuiLi Hospital of NingBo University, Ningbo, 315000, Zhejiang, China.
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Zhou B, Song Y, Chen C, Chen X, Tao T. Preoperative Prediction of Sarcopenia in Patients Scheduled for Gastric and Colorectal Cancer Surgery. J Gastrointest Cancer 2025; 56:82. [PMID: 40116976 DOI: 10.1007/s12029-025-01206-y] [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] [Accepted: 03/14/2025] [Indexed: 03/23/2025]
Abstract
INTRODUCTION Sarcopenia negatively impacts surgical outcomes in gastrointestinal cancer patients, yet practical preoperative screening tools are lacking. The CRP/ALB ratio, a novel biomarker of systemic inflammation and nutritional status, may enhance sarcopenia prediction but remains underexplored in surgical oncology. This study aims to identify the predictors for preoperative sarcopenia prediction in gastric and colorectal cancer patients. METHODS This retrospective study analyzed 145 patients undergoing curative surgery (2019-2021). Sarcopenia was defined by sex-specific CT-measured L3 skeletal muscle index (cutoffs, male ≤ 40.8 cm2/m2; female ≤ 34.9 cm2/m2). Multivariable logistic regression identified predictors, with model performance assessed via ROC analysis and Cohen's Kappa. RESULTS The cohort (median age 64 years; 73.8% male) comprised 66 gastric (45.5%) and 79 colorectal (54.5%) cancer patients, with 29 (20%) diagnosed with sarcopenia. Sarcopenic patients exhibited a higher NRS 2002 score (P < 0.001), lower PNI score (P < 0.05), and higher CRP/ALB ratio (P < 0.05). Multivariate logistic regression analysis results showed that CRP/ALB ratio (OR = 3.084, 95% CI 1.071-8.882, P = 0.037), age (OR = 1.074, 95% CI 1.021-1.130, P = 0.006), and BMI (OR = 0.667, 95% CI 0.542-0.820, P = 0.000) were associated with the increased risk of sarcopenia. The combined model achieved superior discrimination (AUC = 0.854, 95% CI 0.770-0.937), yielding 75.86% sensitivity and 84.82% specificity at optimal cutoff value - 1.0340, and a Cohen's Kappa coefficient of 0.542 when compared to CT results. CONCLUSION The CRP/ALB ratio combined with BMI and age is utilized as a convenient and effective tool for preoperative sarcopenia screening. This model-driven approach provides robust strategies to facilitate preoperative interventions, optimize perioperative care, and enhance long-term oncological outcomes for patients undergoing gastric and colorectal cancer surgery.
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Affiliation(s)
- Beijia Zhou
- Department of Clinical Nutrition, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Yanjun Song
- Department of General Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Chen Chen
- Department of Clinical Nutrition, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Xiaotian Chen
- Department of Clinical Nutrition, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Tingting Tao
- Department of General Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China.
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Zeng D, Wen NY, Wang YQ, Cheng NS, Li B. Prognostic roles nutritional index in patients with resectable and advanced biliary tract cancers. World J Gastroenterol 2025; 31:97697. [PMID: 39958446 PMCID: PMC11752707 DOI: 10.3748/wjg.v31.i6.97697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Revised: 10/24/2024] [Accepted: 12/16/2024] [Indexed: 01/10/2025] Open
Abstract
BACKGROUND Biliary tract cancer (BTC) is a rare, aggressive malignancy with increasing incidence and poor prognosis. Identifying preoperative prognostic factors is crucial for effective risk-benefit assessments and patient stratification. The prognostic nutritional index (PNI), which reflects immune-inflammatory and nutritional status, has shown prognostic value in various cancers, but its significance in BTC remains unclear. AIM To assess the prognostic value of the preoperative PNI in BTC patients, with a focus on overall survival (OS) and disease-free survival (DFS). METHODS Comprehensive searches were conducted in the PubMed, EMBASE, and Web of Science databases from inception to April 2024. The primary outcomes of interest focused on the associations between the preoperative PNI and the prognosis of BTC patients, specifically OS and disease-free survival (DFS). Statistical analyses were conducted via STATA 17.0 software. RESULTS Seventeen studies encompassing 4645 patients met the inclusion criteria. Meta-analysis revealed that a low PNI was significantly associated with poorer OS [hazard ratio (HR) 1.91, 95%CI: 1.59-2.29; P < 0.001] and DFS (HR 1.93, 95%CI: 1.39-2.67; P < 0.001). Subgroup analyses revealed consistent results across BTC subtypes (cholangiocarcinoma and gallbladder cancer) and stages (resectable and advanced). Sensitivity analyses confirmed the robustness of these findings, and no significant publication bias was detected. CONCLUSION This study demonstrated that a low preoperative PNI predicts poor OS and DFS in BTC patients, highlighting its potential as a valuable prognostic tool. Further prospective studies are needed to validate these findings and enhance BTC patient management.
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Affiliation(s)
- Di Zeng
- Division of Biliary Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
- Research Center for Biliary Diseases, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Ning-Yuan Wen
- Division of Biliary Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
- Research Center for Biliary Diseases, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Yao-Qun Wang
- Division of Biliary Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
- Research Center for Biliary Diseases, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Nan-Sheng Cheng
- Division of Biliary Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
- Research Center for Biliary Diseases, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Bei Li
- Division of Biliary Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
- Research Center for Biliary Diseases, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
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Teja M, Garrido MI, Ocanto A, Couñago F. Prognostic impact of inflammatory and nutritional biomarkers in pancreatic cancer. World J Clin Oncol 2025; 16:101191. [PMID: 39867733 PMCID: PMC11528899 DOI: 10.5306/wjco.v16.i1.101191] [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: 09/06/2024] [Revised: 09/28/2024] [Accepted: 10/10/2024] [Indexed: 10/30/2024] Open
Abstract
Pancreatic cancer is usually associated with a poor prognosis. Surgery is the main curative treatment but pancreatic operations are aggressive and new tools that help clinicians to predict surgical and prognostic outcomes are necessary. Lu et al recently published a retrospective, single centre cohort study evaluating the impact of seven nutritional and inflammatory markers in pancreatic cancer surgical patients: The albumin-to-globulin ratio, prognostic nutritional index (PNI), systemic immune-inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), nutritional risk index, and the geriatric nutritional risk index. A significant correlation was found between the PNI, SII, NLR, and PLR and a hospital discharge of less than 15 days. In a univariable analysis, PNI, SII, NLR and PLR were significantly related to recurrence-free survival and, in a multivariable analysis PNI was associated with overall survival. Various meta-analyses corroborate the results in terms of prognosis but individual studies are discordant on their usefulness. Besides, the cut-off values for these markers vary significantly between studies and there are no clinical trials comparing them to identify the most relevant ones. These are limitations when implementing nutritional and inflammatory biomarkers into clinical practice and further studies are needed in order to answer these questions.
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Affiliation(s)
- Macarena Teja
- Department of Radiation Oncology, GenesisCare-San Francisco de Asís University Hospital, Madrid 28002, Spain
- Department of Radiation Oncology, GenesisCare-Vithas La Milagrosa University Hospital, Madrid 28010, Spain
| | - María I Garrido
- Department of Radiation Oncology, GenesisCare-San Francisco de Asís University Hospital, Madrid 28002, Spain
- Department of Radiation Oncology, GenesisCare-Vithas La Milagrosa University Hospital, Madrid 28010, Spain
| | - Abrahams Ocanto
- Department of Radiation Oncology, GenesisCare-San Francisco de Asís University Hospital, Madrid 28002, Spain
- Department of Radiation Oncology, GenesisCare-Vithas La Milagrosa University Hospital, Madrid 28010, Spain
| | - Felipe Couñago
- Department of Radiation Oncology, GenesisCare-San Francisco de Asís University Hospital, Madrid 28002, Spain
- Department of Radiation Oncology, GenesisCare-Vithas La Milagrosa University Hospital, Madrid 28010, Spain
- National Director, GenesisCare Spain, Madrid 28043, Spain
- Department of Medicine, School of Medicine, Health and Sport, European University of Madrid, Madrid 28670, Spain
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Demircioğlu MK, Sari S, Korkmaz MS, Yildiz G, Akbulut S, Matlim Ozel T, Soytas Y. HALP (Hemoglobin, Albumin, Lymphocyte, and Platelet) Score and Its Companions in Papillary Thyroid Cancer: Can They Predict Central Lymph Node Metastasis? Cureus 2025; 17:e76801. [PMID: 39897301 PMCID: PMC11786808 DOI: 10.7759/cureus.76801] [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] [Accepted: 01/02/2025] [Indexed: 02/04/2025] Open
Abstract
Background Papillary thyroid cancer (PTC) is one of the most common cancers with a favorable prognosis. The prognosis is most commonly associated with lymph node metastasis. We investigated whether there is a relationship between the hemoglobin, albumin, lymphocyte, and platelet (HALP) score and PTC central region lymph node metastasis in the preoperative period. NLR (neutrophil/lymphocyte ratio), PLR (platelet/lymphocyte ratio), MLR (monocyte/lymphocyte ratio), PIV (pan-immune-inflammation value), PNI (prognostic nutritional index), SII (systemic immune-inflammation index) were analyzed as other predictive factors for PTC central region lymph node metastasis. Methods The data of 235 patients who were operated on for PTC and underwent additional central neck dissection in our clinic were analyzed retrospectively. The effect of the HALP score, NLR, PLR, MLR, PIV, PNI, and SII values on PTC central region lymph node metastasis was analyzed with univariate and multiple logistic regression analyses. Results The HALP score, NLR, PLR, MLR, PIV, PNI, and SII had no statistically significant effect on the number of positive lymph nodes in the central region, lymphatic invasion, vascular invasion, extra-thyroidal invasion in PTC (p>0.050 for each). For PTC, stage progression was associated with a decrease in preoperative PNI (OR=0.871; p=0.019). Conclusion There was a significant negative correlation between PNI and the stage of the PTC. No significant correlation was found between the HALP score and prognostic predictors of papillary PTC central lymph node metastasis. This may be related to the fact that PTC is a type of cancer that does not affect biochemical parameters much.
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Affiliation(s)
| | - Serkan Sari
- General Surgery, Basaksehir Cam and Sakura City Hospital, Istanbul, TUR
| | | | - Gorkem Yildiz
- General Surgery, Basaksehir Cam and Sakura City Hospital, Istanbul, TUR
| | - Sezer Akbulut
- General Surgery, Basaksehir Cam and Sakura City Hospital, Istanbul, TUR
| | - Tugba Matlim Ozel
- General Surgery, Basaksehir Cam and Sakura City Hospital, Istanbul, TUR
| | - Yigit Soytas
- General Surgery, Basaksehir Cam and Sakura City Hospital, Istanbul, TUR
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Zębalski MA, Krzywon A, Nowosielski K. Prehabilitation-A Simple Approach for Complex Patients: The Results of a Single-Center Study on Prehabilitation in Patients with Ovarian Cancer Before Cytoreductive Surgery. Cancers (Basel) 2024; 16:4032. [PMID: 39682218 DOI: 10.3390/cancers16234032] [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: 10/31/2024] [Revised: 11/27/2024] [Accepted: 11/28/2024] [Indexed: 12/18/2024] Open
Abstract
Background/Objectives: Prehabilitation is a low-cost, safe procedure with no side effects, and it may have a positive impact on postoperative outcomes. However, it is not widely implemented. Our study aimed to assess the impact of prehabilitation on postoperative outcomes in patients with ovarian cancer within the field of gynecological oncology. Methods: We analyzed 110 patients with ovarian cancer who participated in a prehabilitation program before cytoreductive surgery. Based on the results of a 6-min walk test (6MWT), patients were divided into two groups: Group A (patients who improved their 6MWT results) and Group B (patients who did not improve their 6MWT results). Results: Patients in Group A demonstrated better postoperative outcomes. The length of hospital stay was significantly shorter in Group A compared to Group B (median 7 [5, 9] vs. 9 [6, 17], p = 0.032). Group A also had a lower overall number of complications and also fewer complications, as summarized by the Clavien-Dindo classification, compared to Group B. Conclusions: Patient adherence to prehabilitation recommendations was adequate. Prehabilitation was associated with improved postoperative outcomes, including shorter hospital stays and fewer complications. These benefits were more pronounced with higher patient compliance with the prehabilitation program and improvements were recorded in preoperative physical capacity.
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Affiliation(s)
- Marcin Adam Zębalski
- Department of Gynecology, Obstetrics and Gynecological Oncology, University Clinical Center of the Medical University of Silesia, 40-752 Katowice, Poland
| | - Aleksandra Krzywon
- Department of Biostatistics and Bioinformatics, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, 44-102 Gliwice, Poland
| | - Krzysztof Nowosielski
- Department of Gynecology, Obstetrics and Gynecological Oncology, University Clinical Center of the Medical University of Silesia, 40-752 Katowice, Poland
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Prueksaritanond N, Petchsila K, Insin P. The Association of Preoperative Prognostic Nutritional Index With Survival Outcome in Ovarian Clear Cell Cancer. World J Oncol 2024; 15:950-959. [PMID: 39697428 PMCID: PMC11650612 DOI: 10.14740/wjon1963] [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: 08/30/2024] [Accepted: 10/08/2024] [Indexed: 12/20/2024] Open
Abstract
Background The preoperative prognostic nutritional index (PPNI) has been investigated as a prognostic indicator in various cancers including epithelial ovarian cancer (EOC). However, its prognostic relevance in epithelial ovarian clear cell cancer (EOC-CC) remains uncertain. The objective of the study was to clarify the prognostic values of PPNI in EOC-CC patients. Methods We retrospectively reviewed 290 EOC-CC patients who underwent staging surgery at Rajavithi Hospital between January 2008 and December 2019. The PPNI was calculated using serum albumin × 10 (g/L) + 0.005 × peripheral blood lymphocyte count (per mm3). The association between PPNI and survival outcome was analyzed using the Kaplan-Meier method and the Cox proportional hazard model. Results The optimal cut-off value of PPNI, set at a mean of PPNI as 50, divided the EOC-CC patients into two groups: the low (n = 115) and the high (n = 175) PPNI group. With a median follow-up time of 63 months, patients with high PPNI exhibited significantly superior 5-year overall survival (OS) rates (76.4% vs. 56.8%, P = 0.004) and 5-year progression-free survival (PFS) rates (71.0% vs. 58.7%, P = 0.017) compared to patients with low PPNI. Univariate analysis revealed high PPNI correlated with increased OS (hazard ratio (HR): 0.51; 95% confidence interval (CI): 0.35 - 0.75) and PFS (HR: 0.63; 95% CI: 0.43 - 0.92). Nevertheless, in a multivariate analysis, high PPNI did not retain its status as an independent prognostic factor for a favorable prognosis in EOC-CC patients. Conclusion The present study did not confirm the prognostic significance of PPNI on survival outcomes in EOC-CC patients. Therefore, conducting prospective clinical research with large samples is necessary to illustrate the predictive values of PPNI in this rare disease.
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Affiliation(s)
- Nisa Prueksaritanond
- Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, Rajavithi Hospital, Bangkok, Thailand
- College of Medicine, Rangsit University, Bangkok, Thailand
| | - Kittisak Petchsila
- Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, Rajavithi Hospital, Bangkok, Thailand
| | - Putsarat Insin
- Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, Rajavithi Hospital, Bangkok, Thailand
- College of Medicine, Rangsit University, Bangkok, Thailand
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Park IH, Ko NG, Jin M, Lee YJ. Lower prognostic nutritional index is associated with a greater decline in long-term kidney function in general population. Nutr J 2024; 23:146. [PMID: 39567944 PMCID: PMC11580526 DOI: 10.1186/s12937-024-01047-8] [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: 08/23/2024] [Accepted: 11/13/2024] [Indexed: 11/22/2024] Open
Abstract
BACKGROUND The prognostic nutritional index (PNI) is an integrated index of serum albumin and peripheral lymphocyte count, where low values may reflect poor nutritional status or inflammation. The long-term effect of PNI on renal function is not well known in the general population. Therefore, we investigated whether the PNI is related to renal function changes in the general population. METHODS Data from participants who underwent a health check-up between 2002 and 2018 were retrospectively examined. PNI was computed by 10×serum albumin (g/dL) + 0.005×total lymphocyte count (per mm3). The primary exposure was PNI, divided into quintiles. The primary outcome was a 25% decline in eGFR from baseline over a 5-year follow-up period. RESULTS This study included 15,437 participants (mean [standard deviation, SD] age, 43.7 [7.9] years; 46% male). The median (interquartile ranges) 5-year change of eGFR was - 5.2 (- 18.8, - 3.3) mL/min/1.73m2. A total of 2,272 participants (14.7%) experienced a 25% decline in eGFR at 5 years. Compared to the highest PNI group, lower PNI groups were at greater risk for a 25% decline in eGFR; odds ratios and 95% confidence intervals were 1.42 (1.20, 1.68), 1.23 (1.04, 1.45), 1.21 (1.03, 1.43), and 1.19 (1.01, 1.40) for the first to fourth quintiles of PNI, respectively. In linear regression analyses, lower PNI groups also showed a larger decline in eGFR over 5 years compared to the highest PNI group. CONCLUSIONS Lower PNI was associated with a larger decline in renal function in the general population.
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Affiliation(s)
- In Ho Park
- Division of Nephrology, Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, 158, Paryong-ro, Masanhoewon-gu 51353, Changwon, Republic of Korea
| | - Nak Gyeong Ko
- Department of Research & Support, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Mihyeon Jin
- Department of Research & Support, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Yu-Ji Lee
- Division of Nephrology, Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, 158, Paryong-ro, Masanhoewon-gu 51353, Changwon, Republic of Korea.
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Özcan P, Çarkman MS. The relationship between the Prognostic Nutritional Index and lymphovascular and perineural invasion of the tumor in patients diagnosed with gastric cancer, and its effect on overall survival. Medicine (Baltimore) 2024; 103:e40087. [PMID: 39432609 PMCID: PMC11495739 DOI: 10.1097/md.0000000000040087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2024] [Accepted: 09/26/2024] [Indexed: 10/23/2024] Open
Abstract
A low Prognostic Nutritional Index (PNI) value, lymphovascular invasion (LVI), and perineural invasion (PeNI) have been identified as indicators of poor prognosis for many malignancies. We aimed to evaluate the relationship between PNI and LVI/PeNI, their prognostic significance, and their effect on overall survival in gastric cancer patients who underwent curative gastrectomy. A cutoff value of 39.8 was taken for the PNI, and PNI < 39.8 was defined as moderate to severe malnutrition. Patients were grouped as PNI-low (PNI < 39.8) and PNI-high (PNI ≥ 39.8). Paraffin-embedded tissue sections of surgical specimens were used to evaluate PeNI as defined by previously reported criteria. The study included 270 patients with ages ranging from 23 to 90 years. The mean PNI was calculated as 39.8 ± 6.35. PeNI was detected in 232 patients (85.93%), and LVI was identified in 248 patients (91.85%). It was observed that the PNI value of patients with an expired status in the PNI < 39.8 group was lower compared to those who survived, and in patients with PNI > 39.8, those without PeNI had better survival. The presence of PeNI in patients with PNI > 39.8 increased the mortality risk by 2.088 units, while in patients with PNI > 39.8, it was found that those without LVI had better survival, and the presence of LVI increased the mortality risk by 3.171 units. Mortality developed in 166 patients (61.48%) during the five-year follow-up period. The five-year overall survival was found to be 31.02 ± 21.73 months. In patients with gastric cancer, the PNI, LVI, and PeNI are independent prognostic factors for overall survival in postoperative patients. A low PNI score is an inherently poor prognostic factor. In patients with a high PNI score, the presence of positive LVI and PeNI negatively impacts survival. We found that in patients with a low PNI, the rates of PeNI and LVI are higher compared to those with a high PNI, and this significantly affects mortality.
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Affiliation(s)
- Pırıltı Özcan
- Department of General Surgery, Istanbul University, Cerrahpaşa Faculty of Medicine, Istanbul, Turkey
| | - Mehmet Sinan Çarkman
- Department of General Surgery, Istanbul University, Cerrahpaşa Faculty of Medicine, Istanbul, Turkey
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Deng H, He Y, Huang G, Huang Y, Wu J, Qin X. Predictive value of prognostic nutritional index in patients undergoing gastrectomy for gastric cancer: A systematic review and meta-analysis. Medicine (Baltimore) 2024; 103:e39917. [PMID: 39465872 PMCID: PMC11479530 DOI: 10.1097/md.0000000000039917] [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: 02/19/2024] [Accepted: 09/13/2024] [Indexed: 10/29/2024] Open
Abstract
BACKGROUND The value of prognostic nutritional index (PNI) in gastrectomy remains controversial. This meta-analysis aimed to evaluate the predictive value of PNI in patients undergoing gastrectomy for malignancy. METHODS We retrieved studies from medical literature databases to analyze the endpoints of overall survival, cancer-specific survival, recurrence-free survival, and clinicopathologic features. The hazard ratio (HR) and 95% confidence interval (CI) were used to access the survival prognostic value of PNI in patients after gastrectomy. Odds ratio and mean difference were used to evaluate the relationship between the low PNI and clinicopathologic features. RESULTS In total, we included 38 articles (39 trial comparisons) which contained 23,756 gastrectomy patients. The results showed that low PNI was associated with shorter overall survival (HR: 1.82, 95% CI 1.62-2.03), shorter cancer-specific survival (HR: 1.44, 95% CI 1.24-1.67), and shorter recurrence-free survival (HR: 2.52, 95% CI 1.41-4.47). Besides, patients with low PNI had a higher risk of postoperative complications compared with high PNI (HR: 1.65, 95% CI 1.30-2.09). And low PNI group was found to be related to older, lower BMI, larger tumor size, deeper tumor invasion, poorer differentiation, more advanced tumor stage, total gastrectomy, and the presence of lymph node metastasis, lymphatic invasion, and vessel invasion. CONCLUSION PNI was significantly associated with survival and postoperative complications of gastric cancer patients undergoing gastrectomy. Therefore PNI has the potential to be a prognostic predictor for gastrectomy.
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Affiliation(s)
- Huachu Deng
- Department of Gastrointestinal and Gland Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Yiqiang He
- Department of Hepatobiliary and Gastrointestinal Surgery, Affiliated Nationalities Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Gaofei Huang
- Department of Emergency Medicine, Liuzhou People’s Hospital, Liuzhou, Guangxi, China
| | - Yuetong Huang
- Department of Gastrointestinal and Gland Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Jiaheng Wu
- Department of Gastrointestinal and Gland Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Xingan Qin
- Department of Gastrointestinal and Gland Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
- Guangxi Key Laboratory of Enhanced Recovery After Surgery for Gastrointestinal Cancer, Guangxi, China
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Li CJ, Lee PC, Huang KW, Huang KJ, Chang TE, Chang CC, Wang SE, Shyr YM, Li CP, Luo JC, Hou MC. Postoperative prognostic nutrition index predicts survival in patients with small bowel adenocarcinoma after surgical resection. J Chin Med Assoc 2024; 87:819-827. [PMID: 39017659 DOI: 10.1097/jcma.0000000000001134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/18/2024] Open
Abstract
BACKGROUND Surgical resection (SR) is the main treatment for small bowel adenocarcinoma (SBA), but it increases metabolic demand, systemic inflammation, and digestive dysfunction, resulting in major impacts on the postoperative outcomes of patients. In this study, we aimed to investigate the role of the postoperative prognostic nutritional index (PNI), a surrogate marker of inflammation and nutrition, in patients with SBA after resection. METHODS From June 2014 to March 2022, 44 consecutive patients who underwent SR for SBA in Taipei Veterans General Hospital were retrospectively reviewed. Factors associated with survival including PNI were analyzed. RESULTS PNI decreased in patients after SR for SBA (median change: -1.82), particularly in those who underwent Whipple operation or developed postoperative pancreatic fistula. Postoperative PNI <45.2 best predicted overall survival (OS) (area under the receiver operating characteristic curve [AUROC]: 0.826, p = 0.001). Patients with lower postoperative PNI had significantly worse OS compared to those with higher postoperative values (median OS: 19.3 months vs not reached, p < 0.001). Low postoperative PNI (hazard ratio [HR]: 11.404, p = 0.002), tumoral lymphovascular invasion (HR: 8.023, p = 0.012), and adjuvant chemotherapy (HR: 0.055, p = 0.002) were independent risk factors for OS. Postoperative PNI also significantly predicted recurrence-free survival independent of lymphovascular invasion and adjuvant chemotherapy (HR: 6.705, p = 0.001). CONCLUSION PNI commonly decreases in patients with SBA who undergo Whipple surgery or develop postoperative pancreatic fistula. Postoperative PNI independently predicts survival and may serve as a clinical marker to optimize patient outcomes.
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Affiliation(s)
- Chia-Ju Li
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Division of Holistic and Multidisciplinary Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Pei-Chang Lee
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Kuo-Wei Huang
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Gastroenterology, Department of Medicine, Taipei City Hospital, Yangming Branch, Taipei, Taiwan, ROC
| | - Kuan-Jung Huang
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Tien-En Chang
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Endoscopy Center for Diagnosis and Treatment, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Ching-Chih Chang
- Division of Holistic and Multidisciplinary Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Shin-E Wang
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Yi-Ming Shyr
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Chung-Pin Li
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Clinical Skills Training, Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Jiing-Chyuang Luo
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Ming-Chih Hou
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
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12
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Jaquet R, Rivkine E, De Souza N, Roudié J. Benefits of jejunostomy feeding in patients who underwent gastrectomy for cancer treatment. World J Gastrointest Surg 2024; 16:2461-2473. [PMID: 39220058 PMCID: PMC11362917 DOI: 10.4240/wjgs.v16.i8.2461] [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: 02/18/2024] [Revised: 06/17/2024] [Accepted: 07/08/2024] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND Gastric cancer is associated with significant undernutrition responsible for an increase in morbidity and mortality after gastrectomy. AIM To evaluate the impact of enteral nutrition by jejunostomy feeding in patients undergoing gastrectomy for cancer. METHODS Between 2003 and 2017, all patients undergoing gastrectomy for cancer treatment were included retrospectively. A group with jejunostomy (J + group) and a group without jejunostomy (J - group) were compared. RESULTS Of the 172 patients included, 60 received jejunostomy. Preoperatively, the two groups were comparable with respect to the nutritional parameters studied (body mass index, albumin, etc.). In the postoperative period, the J + group lost less weight and albumin: 5.74 ± 8.4 vs 9.86 ± 7.5 kg (P = 0.07) and 7.2 ± 5.6 vs 14.7 ± 12.7 g/L (P = 0.16), respectively. Overall morbidity was 25% in the J + group and 36.6% in the J - group (P = 0.12). The J + group had fewer respiratory, infectious, and grade 3 complications: 0% vs 5.4% (P = 0.09), 1.2% vs 9.3% (P = 0.03), and 0% vs 4.7% (P = 0.05), respectively. The 30-day mortality was 6.7% in the J + group and 6.3% in the J - group (P = 0.91). CONCLUSION Jejunostomy feeding after gastrectomy improves nutritional characteristics and decreases postoperative morbidity. A prospective study could confirm our results.
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Affiliation(s)
- Romain Jaquet
- Department of Digestive and Visceral Surgery, Nord Essonne Hospital Group - Longjumeau Site, Longjumeau 91160, France
| | - Emmanuel Rivkine
- Department of General and Digestive Surgery, Pierre Zobda-Quitman Hospital, University Hospital Center, Martinique, France, Fort de France 97261, Martinique
| | - Nicole De Souza
- Department of General and Digestive Surgery, Pierre Zobda-Quitman Hospital, University Hospital Center, Martinique, France, Fort de France 97261, Martinique
| | - Jean Roudié
- Department of General and Digestive Surgery, Pierre Zobda-Quitman Hospital, University Hospital Center, Martinique, France, Fort de France 97261, Martinique
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Ren LF, Xu YH, Long JG. Prognostic Value of Postoperative Complication for Gastric Cancer. J Laparoendosc Adv Surg Tech A 2024; 34:339-353. [PMID: 38573161 DOI: 10.1089/lap.2023.0456] [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] [Indexed: 04/05/2024] Open
Abstract
Background: The incidence of complications in gastric cancer (GC) patients after surgery was increasing, and it was not clear whether postoperative complications would have an impact on prognosis. The current study attempted to investigate the role of postoperative complication for prognosis on GC patients undergoing radical resection. Materials and Methods: Eligible studies were searched in three databases, including PubMed, Embase, and the Cochrane Library, in accordance with the searching strategy on September 4th, 2022. The survival values were most concerned; then, hazard ratios (HRs) and 95% confidence intervals (CIs) were pooled up. All prognostic values, including overall survival (OS), disease-free survival (DFS), disease-specific survival (DSS), and recurrence-free survival (RFS), were allowed. Subgroup analysis based on complication types was used for further in-depth research. Results: A total of 29 studies involving 33,858 patients were included in this study. Intra-abdominal abscess (19.4%) was the most common complications in the included studies, followed by anastomotic leakage (17.0%) and pneumonia (16.4%). There were 23, 4, 6, and 10 studies that reported OS, DFS, DSS, and RFS, respectively. After analysis, postoperative complication was found to be an independent prognostic factor for OS (HR = 1.52, I2 = 1.14%, 95% CI = 1.42-1.61, P = .00), DFS (HR = 1.71, I2 = 0.00%,95% CI = 1.44-1.98, P < .05), DSS (HR = 1.60, I2 = 54.58%, 95% CI = 1.26-1.93, P < .1), and RFS (HR = 1.26, I2 = 0.00%, 95% CI = 1.11-1.41, P < .05). Subgroup analysis found that noninfectious complication was not significantly associated with OS (HR = 1.39, I2 = 0.00%, 95% CI = 0.96-1.82, P > .05). Conclusion: Surgeons needed to pay more attention to GC patients who developed postoperative complications, especially infectious complications, and take proactive management to improve the prognosis.
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Affiliation(s)
- Lin-Fei Ren
- Department of General Surgery, Affiliated Banan Hospital of Chongqing Medical University, Chongqing, China
| | - Yong-Hong Xu
- Department of General Surgery, Affiliated Banan Hospital of Chongqing Medical University, Chongqing, China
| | - Jie-Gen Long
- Department of General Surgery, Affiliated Banan Hospital of Chongqing Medical University, Chongqing, China
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Qian D, Shen P, Zhu J, Ji S, Kong Y. Association of preoperative muscle-adipose index measured by computed tomography with survival in patients with esophageal squamous cell carcinoma. World J Surg Oncol 2024; 22:61. [PMID: 38383431 PMCID: PMC10882774 DOI: 10.1186/s12957-024-03338-0] [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: 11/21/2023] [Accepted: 02/14/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Conventional nutritional metrics are closely associated with the prognosis of patients with radically resected esophageal squamous cell carcinoma (ESCC). Nevertheless, the prognostic implications of muscle and adipose tissue composite indexes in ESCC remain unknown. METHODS We retrospectively analyzed clinicopathological data of 304 patients who underwent resected ESCC. To obtain measurements of the muscle and adipose indexes, preoperative computed tomography (CT) images were used to quantify skeletal-muscle adipose tissue. The diagnostic threshold for muscle-adipose imbalance was determined using X-tile software and used to analyze the association between the muscle-adipose index (MAI) and survival. Instantaneous risk of recurrence was assessed using a hazard function. We constructed a nomogram based on the MAI and other clinical characteristics and established a novel predictive model with independent prognostic factors. The prognostic capabilities of these nomograms were evaluated using calibration curves, receiver operating characteristic (ROC) curves, and decision-curve analysis (DCA). RESULTS The overall survival (OS) and disease-free survival (DFS) rates in the muscle-adipose-balanced group were significantly better than those in the muscle-adipose-imbalanced group. Multivariate analyses revealed that the MAI, prognostic nutritional index (PNI), tumor stage, and tumor differentiation were independent prognostic factors for OS and DFS in patients with resected ESCC (P < 0.05). The nuclear density curve indicated a lower risk of recurrence for patients in the muscle-adipose-balanced group than that for their imbalanced counterparts. Conversely, the nuclear density curve for PNI was confounded. Postoperative radiotherapy- (RT) benefit analysis demonstrated that patients with ESCC in the muscle-adipose-balanced group could benefit from adjuvant RT. CONCLUSION This study confirmed that preoperative MAI could serve as a useful independent prognostic factor in patients with resected ESCC. A nomogram based on the MAI and other clinical characteristics could provide individualized survival prediction for patients receiving radical resection. Timely and appropriate nutritional supplements may improve treatment efficacy.
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Affiliation(s)
- Danqi Qian
- Department of Radiotherapy and Oncology, The Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, 214000, People's Republic of China
| | - Peipei Shen
- Department of Radiotherapy and Oncology, The Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, 214000, People's Republic of China
| | - Jiahao Zhu
- Department of Radiotherapy and Oncology, The Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, 214000, People's Republic of China
| | - Shengjun Ji
- Department of Radiotherapy and Oncology, The Affiliated Suzhou Hospital of Nanjing Medical University, Gusu School, Nanjing Medical University, Suzhou, Jiangsu, 215000, People's Republic of China.
| | - Yan Kong
- Department of Radiotherapy and Oncology, The Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, 214000, People's Republic of China.
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15
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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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16
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Cui X, Shen P, Jin L, Sun Y, Pan Y, Lv M, Shan L, Dai H, Sun L, Wang Z, Li W, Yu K, Zhang Y. Preoperative prognostic nutritional index is an independent indicator for perioperative prognosis in coronary artery bypass grafting patients. Nutrition 2023; 116:112215. [PMID: 37820569 DOI: 10.1016/j.nut.2023.112215] [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: 05/11/2023] [Revised: 08/13/2023] [Accepted: 09/01/2023] [Indexed: 10/13/2023]
Abstract
OBJECTIVES The prognostic nutritional index is widely used for surgery prognosis, but the association between preoperative prognostic nutritional index and short-term prognosis for coronary artery bypass grafting surgery and the profiles of perioperative prognostic nutritional index remain unclear. METHODS This study retrospectively enrolled a total of 879 adult patients undergoing coronary artery bypass grafting surgery in the Shanghai Chest Hospital from 2006 to 2022. The prognostic nutritional index was calculated based on serum albumin and peripheral lymphocyte count. In-hospital mortality, demographic characteristics, blood biochemistry parameters, cardiovascular medical history, and physical examination results were collected from the hospital information system. The propensity score matching method and multivariate logistic regression were used to detect the association between preoperative prognostic nutritional index and in-hospital mortality. RESULTS Patients were divided into a high-prognostic nutritional index group (n = 500) and a low-prognostic nutritional index group (n = 379), using a cutoff value of 48.1 according to receiver operating characteristic curve analysis. The propensity score matching-adjusted mean prognostic nutritional index levels decreased from 48.35 before the operation to 34.04 an in ≤24 h after the operation and rebounded to 43.36 before discharge. High preoperative prognostic nutritional index was inversely associated with in-hospital mortality for coronary artery bypass grafting surgery (odds ratio = 0.86; 95% CI, 0.77-0.97) in propensity score matching-adjusted multivariate logistic regression. CONCLUSIONS Preoperative prognostic nutritional index is an independent indicator for in-hospital mortality of for coronary artery bypass grafting surgery, and the variation trend of prognostic nutritional index during perioperation tends to be U-shaped.
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Affiliation(s)
- Xueying Cui
- Department of Nutrition, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Peiming Shen
- Department of Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lei Jin
- Department of Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yangyang Sun
- First School of Clinical Medicine, Nanjing Medical University, Nanjing, China
| | - Yilin Pan
- First School of Clinical Medicine, Nanjing Medical University, Nanjing, China
| | - Mengwei Lv
- Department of Cardiothoracic Surgery, The Affiliated BenQ Hospital of Nanjing Medical University, Suzhou, China
| | - Lingtong Shan
- Department of Thoracic Surgery, Sheyang County People's Hospital, Yancheng, China
| | - Huangdong Dai
- Department of Cardiovascular Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lin Sun
- Department of Cardiovascular Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zikun Wang
- Department of Cardiovascular Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei Li
- Department of Cardiovascular Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Kaiyan Yu
- Department of Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yangyang Zhang
- Department of Cardiovascular Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Guo L, Zhao Q, Zheng LW, Wang M. Multifunctional Nanofibrous Scaffolds Capable of Localized Delivery of Theranostic Nanoparticles for Postoperative Cancer Management. Adv Healthc Mater 2023; 12:e2302484. [PMID: 37702133 DOI: 10.1002/adhm.202302484] [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: 08/01/2023] [Indexed: 09/14/2023]
Abstract
Postoperative recovery of cancer patients can be affected by complications, such as tissue dysfunction or disability caused by tissue resection, and also cancer recurrence resulting from residual cancer cells. Despite impressive progress made for tissue engineering scaffolds that assist tissue regeneration for postoperative cancer patients, the majority of existing tissue engineering scaffolds still lack functions for monitoring and killing residual cancer cells, if there are any, upon their detection. In this study, multifunctional scaffolds that comprise biodegradable nanofibers and core-shell structured microspheres encapsulated with theranostic nanoparticles (NPs) are developed. The multifunctional scaffolds possess an extracellular matrix-like nanofibrous architecture and soft tissue-like mechanical properties, making them excellent tissue engineering patch candidates for assisting in the repair and regeneration of tissues at the cancerous sites after surgery. Furthermore, they are capable of localized delivery of theranostic NPs upon quick degradation of core-shell structured microspheres that contain theranostic NPs. Leveraging on folic acid-mediated ligand-receptor binding, surface-enhanced Raman scattering activity, and near-infrared-responsive photothermal effect of the theranostic gold NPs (AuNPs) delivered locally, the multifunctional scaffolds display excellent active targeting, diagnosis, and photothermal therapy functions for cancer cells, showing great promise for adaptive postoperative cancer management.
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Affiliation(s)
- Lin Guo
- Department of Mechanical Engineering, The University of Hong Kong, Pokfulam Road, Hong Kong
| | - Qilong Zhao
- Department of Mechanical Engineering, The University of Hong Kong, Pokfulam Road, Hong Kong
- Institute of Biomedical & Health Engineering, Shenzhen Institute of Advanced Technology (SIAT), Chinese Academy of Sciences (CAS), Shenzhen, 518055, China
| | - Li-Wu Zheng
- Faculty of Dentistry, The University of Hong Kong, 34 Hospital Road, Sai Ying Pun, Hong Kong
| | - Min Wang
- Department of Mechanical Engineering, The University of Hong Kong, Pokfulam Road, Hong Kong
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Bao Q, Song L, Ma L, Wang M, Hou Z, Lin J, Li C. Prediction of postoperative hypokalemia in patients with oral cancer undergoing en bloc cancer resection: a retrospective cohort study. BMC Oral Health 2023; 23:663. [PMID: 37710182 PMCID: PMC10500799 DOI: 10.1186/s12903-023-03371-7] [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: 10/16/2022] [Accepted: 08/30/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND The factors associated with postoperative hypokalemia in patients with oral cancer remain unclear. We determined the preoperative factors associated with postoperative hypokalemia in patients with oral cancer following en bloc cancer resection and established a nomogram for postoperative hypokalemia prediction. METHODS Data from 381 patients with oral cancer who underwent en bloc cancer resection were retrospectively analyzed. Univariate and multivariate analyses were performed to identify the risk factors for postoperative hypokalemia. We used receiver operating characteristic (ROC) curves to quantify the factors' effectiveness. A nomogram was created to show each predictor's relative weight and the likelihood of postoperative hypokalemia development. The multinomial regression model's effectiveness was also evaluated. RESULTS Preoperative factors, including sex, preoperative serum potassium level, and preoperative platelet-to-lymphocyte ratio (PLR), were significantly associated with postoperative hypokalemia. Based on the ROC curve, the preoperative serum potassium and PLR cut-off levels were 3.98 mmol/L and 117, respectively. Further multivariate analysis indicated that female sex, preoperative serum potassium level < 3.98 mmol/L, and preoperative PLR ≥ 117 were independently associated with postoperative hypokalemia. We constructed a predictive nomogram with all these factors for the risk of postoperative hypokalemia with good discrimination and internal validation. CONCLUSIONS The predictive nomogram for postoperative hypokalemia risk constructed with these factors had good discrimination and internal validation. The developed nomogram will add value to these independent risk factors that can be identified at admission in order to predict postoperative hypokalemia.
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Affiliation(s)
- Qilin Bao
- Nutrition Department, West China Hospital of Stomatology, Sichuan University, State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, No. 14, Section Three, Ren Min Nan Road, Chengdu, Sichuan, China
| | - Lei Song
- Nutrition Department, West China Hospital of Stomatology, Sichuan University, State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, No. 14, Section Three, Ren Min Nan Road, Chengdu, Sichuan, China
| | - Liyuan Ma
- Medical Record Room, West China Hospital of Stomatology, Sichuan University, State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, No. 14, Section Three, Ren Min Nan Road, Chengdu, Sichuan, China
| | - Meng Wang
- Medical Record Room, West China Hospital of Stomatology, Sichuan University, State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, No. 14, Section Three, Ren Min Nan Road, Chengdu, Sichuan, China
| | - Zhaohuan Hou
- Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, No. 14, Section Three, Ren Min Nan Road, Chengdu, Sichuan, China
| | - Jie Lin
- Department of Oral Anesthesia, West China Hospital of Stomatology, Sichuan University, State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, No. 14, Section Three, Ren Min Nan Road, Chengdu, Sichuan, China
| | - Chunjie Li
- Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, No. 14, Section Three, Ren Min Nan Road, Chengdu, Sichuan, China.
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Han Y, Wu J, Ji R, Tan H, Tian S, Yin J, Xu J, Chen X, Liu W, Cui H. Preoperative sarcopenia combined with prognostic nutritional index predicts long-term prognosis of radical gastrectomy with advanced gastric cancer: a comprehensive analysis of two-center study. BMC Cancer 2023; 23:751. [PMID: 37580693 PMCID: PMC10424379 DOI: 10.1186/s12885-023-11251-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 08/03/2023] [Indexed: 08/16/2023] Open
Abstract
PURPOSE This study aims to investigate the predictive value of the combined index smni(skeletal muscle index (SMI)-prognostic nutrition index(PNI)) for the postoperative survival of patients with advanced gastric cancer(AGC). METHODS 650 patients with AGC from two centers (290 cases from the First Affiliated Hospital of Dalian University and 360 points from the Fujian Medical University Union Hospital) were selected as the study subjects based on unified screening criteria. Clinical data, preoperative abdominal CT images, results of hematology-related examinations, tumor-related characteristics, and surgical and follow-up data of the patients were collected and organized. The L3 vertebral level muscle area was measured using computer-assisted measurement techniques, and the skeletal muscle index(SMI) was calculated based on this measurement. The prognostic nutrition index (PNI) was calculated based on serum albumin and lymphocyte count indicators. The Kaplan-Meier survival analysis of data from the First Affiliated Hospital was used to determine that SMI and PNI are significantly correlated with the postoperative survival rate of patients with advanced gastric cancer. Based on this, a novel combined index smni was fitted and stratified for risk. Cox proportional hazards regression analysis was used to determine that the index smni is an independent prognostic risk factor for patients with AGC after surgery. The ROC curve was used to describe the predictive ability of the new combined index and its importance and predictive power in predicting postoperative survival of patients with AGC, which was verified in the data of Fujian Medical University Union Hospital. RESULT The Kaplan-Meier curve analysis of the combined indicator smni Is clearly associated with long-term survival(3-year OS (P < 0.001) and DSS (P < 0.001)), univariate analysis and multivariate analysis showed that smni was an independent prognostic risk factor, The ROC curve for the first center 3-year OS(AUC = 0.678), DSS(AUC = 0.662) show good predictive ability and were validated in the second center. CONCLUSION The combined index smni has a good predictive ability for the postoperative survival rate of patients with AGC and is expected to provide a new reference basis and more accurate and scientific guidance for the postoperative management and treatment of patients with AGC.
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Affiliation(s)
- Yubo Han
- Department of General Surgery, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Ju Wu
- Fujian Medical University Union Hospital, Department of Gastric Surgery, Fuzhou, China
| | - Rui Ji
- Department of General Surgery, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Hao Tan
- Department of General Surgery, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Simiao Tian
- Department of Medical Record and Statistics, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Jiajun Yin
- Department of General Surgery, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Jian Xu
- Department of General Surgery, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Xi Chen
- Department of General Surgery, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Wenfei Liu
- Department of Radiology, Affiliated Zhongshan Hospital of Dalian University, Dalian, China.
| | - Hongzhang Cui
- Department of General Surgery, Affiliated Zhongshan Hospital of Dalian University, Dalian, China.
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Almohammadi AA, Alqarni MA, Alqaidy MY, Ismail SA, Almabadi RM. Impact of the Prognostic Nutritional Index on Postoperative Outcomes in Patients Undergoing Heart Surgery. Cureus 2023; 15:e43745. [PMID: 37727198 PMCID: PMC10506361 DOI: 10.7759/cureus.43745] [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] [Accepted: 08/18/2023] [Indexed: 09/21/2023] Open
Abstract
Background Malnutrition is associated with adverse outcomes in patients undergoing cardiac surgery. The prognostic nutritional index (PNI) is a validated tool for assessing nutritional status in cardiovascular diseases. This study aims to evaluate the prognostic value of PNI in heart surgery patients, including mortality rate, length of hospital and ICU stays, and infection rate, while investigating correlations with demographic and clinical characteristics. Methods A retrospective cross-sectional study was conducted in King Fahad Armed Forces Hospital in Jeddah, Saudi Arabia. Data from electronic medical records of patients undergoing heart surgery between 2019 and 2021 were retrospectively reviewed. The study involved patients with valvular heart disease, including those requiring concomitant procedures. Statistical analysis was conducted using t-tests, logistic regression, and Kaplan-Meier survival curve analysis. Results This study included 264 individuals with a mean age of 56.48±12.11 years. The prevalence of low PNI was 50.80% and high PNI was 49.20%. No significant differences in PNI levels were found between individuals with various clinical conditions, except for target vessel revascularization. The mortality rate was slightly higher in the low PNI group, but not statistically significant. Significant differences in laboratory findings were observed between high and low PNI groups. Individuals with low PNI had longer hospital stays. Conclusion Lower PNI levels consistently correlate with longer hospital stays and higher morbidity and mortality rates, suggesting the potential importance of PNI and other nutritional markers in assessing risk and predicting outcomes in cardiac surgery patients.
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Affiliation(s)
| | - Maha A Alqarni
- Nutrition and Dietetics, King Fahad Armed Forces Hospital, Jeddah, SAU
| | - Marwah Y Alqaidy
- Nutrition and Dietetics, King Fahad Armed Forces Hospital, Jeddah, SAU
| | - Sarah A Ismail
- Nutrition and Dietetics, King Fahad Armed Forces Hospital, Jeddah, SAU
| | - Reem M Almabadi
- Nutrition and Dietetics, King Fahad Armed Forces Hospital, Jeddah, SAU
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Wei J, Lu J, Jia H, Yang X, Guo X, Liu J, Li X. Value of a preoperative prognostic nutritional index for the prognostic evaluation of gastric neuroendocrine carcinoma patients. Front Nutr 2023; 10:1043550. [PMID: 37554699 PMCID: PMC10406506 DOI: 10.3389/fnut.2023.1043550] [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: 09/13/2022] [Accepted: 06/23/2023] [Indexed: 08/10/2023] Open
Abstract
OBJECTIVE To study the value of Onodera's prognostic nutrition index (PNI) in patients with gastric neuroendocrine cancer (G-NEC). METHODS The clinical data on 148 cases of G-NEC presented between March 2010 and April 2022 were retrospectively analyzed. The relationship between the clinical characteristics of the patients and PNI was analyzed. Optimal PNI cutoff values for G-NEC prognosis prediction were calculated using the X-tile software. The survival curves were created using the Kaplan-Meier method. A Cox proportional hazards model was also established to identify independent prognostic factors that impact the prognosis of patients with G-NEC. RESULTS The median overall survival (OS) rate was 30 months (range 6-127 months), and the OS rates at 1, 3 and 5 years were 89.2, 71.6 and 68.2%, respectively. The mean PNI of the 148 patients before the operation was 49.5 ± 8.0. The mean PNI of patients with anemia (p < 0.001) and abnormal carcinoembryonic antigen (p = 0.039) was significantly lower than that of patients without such comorbidities. The mean PNI of patients with Stage III tumors (p < 0.001) and postoperative complications was significantly lower (p = 0.005). PNI optimal cutoff values were 50 (p < 0.001). Based on the cut-off value of the PNI, these patients were divided into a PNI-high group (PNI ≥ 50.0, n = 77) and a PNI-low group (PNI < 50.0, n = 71). The PNI-high group had a significantly better 5-years OS rate compared with the PNI-low group (76.6% vs. 59.2%, χ2 = 14.7, p < 0. 001). Multivariate analysis demonstrated that PNI and pathological stage were independent prognostic factors for patients with G-NEC. In the subgroup analysis, OS rates were significantly lower in the PNI-low group than in the PNI-high group among patients with stage I and stage III of the disease. CONCLUSION The PNI is a simple and useful marker for predicting long-term outcomes in G-NEC patients regardless of tumor stage. Based on our results, we suggest that PNI should be included in routine assessments of patients with G-NEC.
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Affiliation(s)
| | | | | | | | | | | | - Xiaohua Li
- Department of Gastrointestinal Surgery, Xijing Hospital, Air Force Military Medical University, Xi'an, Shaanxi, China
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22
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Abe A, Nakayama A, Otsuka Y, Shibata K, Matsui Y, Ito Y, Hayashi H, Momokita M, Taniguchi S. Relationship of preoperative oral hypofunction with prognostic nutritional index in gastric cancer: A case-control retrospective study. PLoS One 2023; 18:e0283911. [PMID: 37262024 DOI: 10.1371/journal.pone.0283911] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 05/17/2023] [Indexed: 06/03/2023] Open
Abstract
Preoperative nutritional status is an important prognostic factor in gastric cancer patients. This study will evaluate whether preoperative oral dysfunction is associated with prognostic nutrition index (PNI). This case-control study analyzed 95 patients who underwent oral function management. We assessed the following parameters: body mass index, stage of gastric cancer, C-reactive protein, total lymphocyte count, albumin, and prognostic nutritional index. The patients were divided into groups with prognostic nutritional indexes <45 and >45. Logistic regression analysis was used to assess the association between the measurements of oral function and the prognostic nutritional index. Univariate analysis of factors associated with decreased oral function and prognostic nutritional index showed significant differences between the two groups in C-reactive protein, neutrophils, and tongue pressure (p<0.01). However, oral hygiene, oral dryness, occlusal force, tongue-lip motor function, masticatory function, and swallowing function were not significantly different. Multivariate analysis showed that C-reactive protein (odds ratio: 0.12, 95% confidence interval: 0.30-0.45, p<0.01) and tongue pressure (odds ratio: 3.62, 95% confidence interval: 1.04-12.60, p<0.05) were independent risk factors for oral hypofunction. Oral function decreased in perioperative patients with gastric cancer, and decreased tongue pressure is associated with a decreased prognostic nutritional index.
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Affiliation(s)
- Atsushi Abe
- Department of Oral and Maxillofacial Surgery, Nagoya Ekisaikai Hospital, Nagoya, Aichi Prefecture, Japan
| | - Atsushi Nakayama
- The First Department of Oral and Maxillofacial Surgery, School of Dentistry, Aichi-Gakuin University, Nagoya, Aichi Prefecture, Japan
| | - Yuya Otsuka
- Department of Oral and Maxillofacial Surgery, Nagoya Ekisaikai Hospital, Nagoya, Aichi Prefecture, Japan
| | - Kanae Shibata
- Department of Oral and Maxillofacial Surgery, Nagoya Ekisaikai Hospital, Nagoya, Aichi Prefecture, Japan
| | - Yoshihito Matsui
- Department of Oral and Maxillofacial Surgery, Nagoya Ekisaikai Hospital, Nagoya, Aichi Prefecture, Japan
| | - Yu Ito
- Department of Oral and Maxillofacial Surgery, Nagoya Ekisaikai Hospital, Nagoya, Aichi Prefecture, Japan
| | - Hiroki Hayashi
- Department of Oral and Maxillofacial Surgery, Nagoya Ekisaikai Hospital, Nagoya, Aichi Prefecture, Japan
| | - Moeko Momokita
- Department of Oral and Maxillofacial Surgery, Nagoya Ekisaikai Hospital, Nagoya, Aichi Prefecture, Japan
| | - Shinichi Taniguchi
- Department of Oral and Maxillofacial Surgery, Nagoya Ekisaikai Hospital, Nagoya, Aichi Prefecture, Japan
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Williams DGA, Miller TE. Nutrition screening and therapy in the older surgical patient: an area that is ignored. Int Anesthesiol Clin 2023; 61:29-33. [PMID: 36815485 DOI: 10.1097/aia.0000000000000397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Affiliation(s)
- David G A Williams
- Duke University School of Medicine, Duke University Health System, Durham, North Carolina
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Cheng X, Wang C, Liu Y, Zhang X, Zhou L, Lin Z, Zeng W, Liu L, Yang C, Li W. Effects of different radical distal gastrectomy on postoperative inflammatory response and nutritional status in patients with gastric cancer. Front Surg 2023; 10:1112473. [PMID: 37009613 PMCID: PMC10050336 DOI: 10.3389/fsurg.2023.1112473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 02/27/2023] [Indexed: 03/17/2023] Open
Abstract
ObjectivesThe inflammatory response caused by gastric cancer surgery and the low nutritional status of patients with gastric cancer can cause growth of tumour cells, reduce immunity, and increase tumour burden. We investigated the effects of different surgical methods on postoperative inflammatory response and nutritional status in patients with distal gastric cancer.MethodsClinical data of 249 patients who underwent radical distal gastrectomy for distal gastric cancer from February 2014 to April 2017 were retrospectively analysed. Patients were divided according to the surgical method (open distal gastrectomy [ODG], laparoscopic-assisted distal gastrectomy [LADG] and total laparoscopic distal gastrectomy [TLDG]). Characteristics of different surgical procedures, including inflammation parameters and nutritional indicators, and different time points (preoperatively, 1 day postoperatively, and 1 week postoperatively) were compared using non-parametric test analysis.ResultsAt postoperative day 1, white blood cell count [WBC], neutrophil count [N], neutrophil/lymphocyte ratio [NLR], and platelet/lymphocyte ratio [PLR] increased in the three groups, and ΔN and ΔNLR were significant; the smallest change was observed in TLDG (P < 0.05). Albumin [A]and prognostic nutrition index [PNI] significantly decreased; the smallest ΔA and ΔPNI, which were statistically significant, were noted in TLDG. One week postoperatively, WBC, N, NLR, and PLR decreased, and WBC, N, and NLR showed significant difference. A and PNI of the three groups increased after 1 week, and A and PNI showed significant differences.ConclusionPostoperative inflammatory response and nutritional status of patients with distal gastric cancer are associated with the surgical technique. TLDG has little influence on the inflammatory response and nutritional level compared with LADG and ODG.
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Affiliation(s)
- Xuefei Cheng
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou, China
| | - Chuandong Wang
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou, China
- Department of Surgical Oncology, Fujian Provincial Hospital, Fuzhou, China
| | - Yi Liu
- Department of Endoscopy, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Xiaojuan Zhang
- Fuzong Clinical Medical College, Fujian Medical University, Fuzhou, China
| | - Liyuan Zhou
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou, China
- Department of Surgical Oncology, Fujian Provincial Hospital, Fuzhou, China
| | - Zhizun Lin
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou, China
- Department of Surgical Oncology, Fujian Provincial Hospital, Fuzhou, China
| | - Wei Zeng
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou, China
- Department of Surgical Oncology, Fujian Provincial Hospital, Fuzhou, China
| | - Lihang Liu
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou, China
- Department of Surgical Oncology, Fujian Provincial Hospital, Fuzhou, China
| | - Changshun Yang
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou, China
- Department of Surgical Oncology, Fujian Provincial Hospital, Fuzhou, China
| | - Weihua Li
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou, China
- Department of Surgical Oncology, Fujian Provincial Hospital, Fuzhou, China
- Correspondence: Weihua Li
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[Pre-operative prognostic nutritional index as a predictive factor for prognosis in non-metastatic renal cell carcinoma treated with surgery]. BEIJING DA XUE XUE BAO. YI XUE BAN = JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2023; 55:149-155. [PMID: 36718704 PMCID: PMC9894816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To evaluate the implications of the prognostic nutrition index (PNI) in non-metastatic renal cell carcinoma (RCC) patients treated with surgery and to compare it with other hematological biomarkers, including neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and systemic immune inflammation index (SII). METHODS A cohort of 328 non-metastatic RCC patients who received surgical treatment between 2010 and 2012 at Peking University First Hospital was analyzed retrospectively. Receiver operating characteristic (ROC) curve analysis was used to determine the optimal cutoff values of the hematological biomarkers. The Youden index was maximum for PNI was value of 47.3. So we divided the patients into two groups (PNI≤ 47. 3 and >47. 3) for further analysis. Categorical variables [age, gender, body mass index (BMI), surgery type, histological subtype, necrosis, pathological T stage and tumor grade] were compared using the Chi-square test and Student' s t test. The association of the biomarkers with overall survival (OS) and disease-free survival (DFS) was analyzed using Kaplan-Meier methods with log-rank test, followed by multivariate Cox proportional hazards model. RESULTS According to the maximum Youden index of ROC curve, the best cut-off value of PNI is 47. 3. Low level of PNI was significantly associated with older age, lower BMI and higher tumor pathological T stage (P < 0.05). Kaplan-Meier univariate analysis showed that lower PNI was significantly correlated with poor OS and DFS (P < 0.05). In addition, older age, lower BMI, tumor necrosis, higher tumor pathological T stage and Fuhrman grade were significantly correlated with poor OS (P < 0.05). Cox multivariate analysis showed that among the four hematological indexes, only PNI was an independent factor significantly associated with OS, whether as a continuous variable (HR=0.9, 95%CI=0.828-0.978, P=0.013) or a classified variable (HR=2.397, 95%CI=1.061-5.418, P=0.036). CONCLUSION Low PNI was a significant predictor for advanced pathological T stage, decreased OS, or DFS in non-metastatic RCC patients treated with surgery. In addition, PNI was superior to the other hematological biomar-kers as a useful tool for predicting prognosis of RCC in our study. It should be externally validated in future research before the PNI can be used widely as a predictor of RCC patients undergoing nephrectomy.
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Wang X, Zheng J, Yang H, Yang X, Cai W, Chen X, Zhang W, Shen X. Prognostic value of the preoperative albumin-bilirubin score among patients with stages I-III gastric cancer undergoing radical resection: A retrospective study. Clin Transl Sci 2023; 16:850-860. [PMID: 36762709 PMCID: PMC10175983 DOI: 10.1111/cts.13493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 12/28/2022] [Accepted: 01/18/2023] [Indexed: 02/11/2023] Open
Abstract
The albumin-bilirubin (ALBI) score was originally used to accurately assess liver dysfunction and predict the prognoses of patients with hepatocellular carcinoma. Following its more recent application to patients with gastrointestinal tumors, this study analyzed the prognostic value of the ALBI score in Chinese patients with advanced resectable (tumor-node-metastasis [TNM] stages I-III) gastric cancer (GC). This study investigated 1185 patients with advanced GC, including 429 with TNM stage I. The patients were divided into training and verifications groups (593 and 592 patients, respectively) in which these patients were classified as high risk (ALBI score ≥ -2.65) or low risk (ALBI score < -2.65). Univariate and multivariate Cox regression analyses were performed, and a visual survival prediction model (nomogram) was created. On Kaplan-Meier analysis, patients who were low-risk and high-risk according to their ALBI scores had significantly different survival rates in both the training and verification groups (p < 0.01). The difference was also significant when analyzing only patients with TNM stage I GC (p = 0.031). Univariate and multivariate analyses showed that the ALBI score (p = 0.014), age (p < 0.001), Nutritional Risk Screening 2002 score (p = 0.024), sarcopenia (p = 0.049), tumor differentiation (p = 0.027), and TNM stage (p < 0.001) were independent risk factors for survival. Our survival prediction model that incorporated the ALBI score accurately predicted the 5-year survival rate of Chinese patients with GC. Therefore, the ALBI score is a valid clinical indicator and good predictor of survival after surgery for progressive GC. Moreover, this score is simple to derive and does not burden patients with additional costs.
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Affiliation(s)
- Xiang Wang
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Zhejiang, China
| | - Jingwei Zheng
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Zhejiang, China
| | - Hui Yang
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Zhejiang, China
| | - Xinxin Yang
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Zhejiang, China
| | - Wentao Cai
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Zhejiang, China
| | - Xiaodong Chen
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang, China
| | - Weiteng Zhang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang, China
| | - Xian Shen
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Zhejiang, China.,Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang, China
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Sun L, Liu J, Wang D. Prognostic value of the preoperative prognostic nutritional index and systemic immuno-inflammatory index in Chinese breast cancer patients: A clinical retrospective cohort study. J Surg Oncol 2023; 127:921-928. [PMID: 36734983 DOI: 10.1002/jso.27210] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/29/2022] [Accepted: 01/06/2023] [Indexed: 02/04/2023]
Abstract
BACKGROUND It has been shown that peripheral blood inflammatory factor ratios correlate with the prognosis of various malignancies. Although indicative of prognosis in some tumors, its value for prognosis in breast cancer patients is unclear. METHODS The clinical data of breast cancer patients diagnosed with breast cancer in the Second Hospital of Jilin University from January 1, 2013, to December 31, 2017, were retrospectively analyzed. The prognostic nutritional index (PNI) optimal cutoff values of the subjects' operating characteristic curves divided the patients into a low PNI group (≤51.05) and a high PNI group (>51.05). Correlations between breast cancer and PNI clinicopathological variables were determined by the χ2 test or Fisher exact test. Kaplan-Meier plots and log-rank tests were used to assess clinical outcomes in terms of disease-free survival (DFS). The prognostic value of PNI was analyzed by univariate and multivariate Cox proportional risk regression models. RESULTS The best cutoff value for predicting DFS by pretreatment PNI was 51.05 and the Youden index when was 0.416, with a sensitivity of 71.4% and specificity of 70.2%. Univariate analysis showed that PNI ≤ 51.05, human epidermal growth factor receptor-2 (HER-2) positivity, and the number of lymph node metastases >4 were risk factors affecting DFS in invasive breast cancer (p < 0.05). Cox multifactor analysis showed that PNI and lymph node status were the most important factors affecting the prognosis of invasive breast cancer. Neutrophils-to-lymphocytes ratio and platelets-to-lymphocytes ratio were not significantly correlated with patient prognosis (p > 0.05). CONCLUSION Preoperative peripheral blood PNI in patients with invasive breast cancer are independent risk factors affecting patients' prognosis, they are positively correlated with prognosis and can be used as indicators to assess prognosis. PNI, HER-2, and lymph node status had the best predictive efficacy with the area under the curve = 0.816 (95% confidence interval: 0.680-0.951, p < 0.001).
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Affiliation(s)
- Lin Sun
- Department of Breast Surgery, Second Affiliated Hospital of Jilin University, Changchun, China
| | - Jiajia Liu
- Department of Breast Surgery, Second Affiliated Hospital of Jilin University, Changchun, China
| | - Dan Wang
- Department of Breast Surgery, Second Affiliated Hospital of Jilin University, Changchun, China
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Zhang Y, Wang Z, Basharat Z, Hu M, Hong W, Chen X. Nomogram of intra-abdominal infection after surgery in patients with gastric cancer: A retrospective study. Front Oncol 2022; 12:982807. [PMID: 36263227 PMCID: PMC9574043 DOI: 10.3389/fonc.2022.982807] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 09/14/2022] [Indexed: 11/30/2022] Open
Abstract
Background Surgical resection is still the primary way to treat gastric cancer. Therefore, postoperative complications such as IAI (intra-abdominal infection) are major problems that front-line clinical workers should pay special attention to. This article was to build and validate IAI’s RF (regression function) model. Furthermore, it analyzed the prognosis in patients with IAI after surgery for stomach cancer. The above two points are our advantages, which were not involved in previous studies. Methods The data of this study was divided into two parts, the training data set and the validation data set. The training data for this article were from the patients treated surgically with gastric cancer in our center from December 2015 to February 2017. We examined IAI’s morbidity, etiological characteristics, and prognosis in the training data set. Univariate and multivariate logistic regression analyses were used to screen risk factors, establish an RF model and create a nomogram. Data from January to March 2021 were used to validate the accuracy of the RF model. Results The incidence of IAI was 7.2%. The independent risk factors for IAI were hypertension (Odds Ratio [OR] = 3.408, P = 0.001), history of abdominal surgery (OR = 2.609, P = 0.041), combined organ excision (OR = 4.123, P = 0.010), and operation time ≥240 min (OR = 3.091, P = 0.005). In the training data set and validation data set, the area under the ROC curve of IAI predicted by the RF model was 0.745 ± 0.048 (P<0.001) and 0.736 ± 0.069 (P=0.003), respectively. In addition, IAI significantly extended the length of hospital stay but had little impact on survival. Conclusions Patients with hypertension, combined organ excision, a history of abdominal surgery, and a surgical duration of 240 min or more are prone to IAI, and the RF model may help to identify them.
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Affiliation(s)
- Yue Zhang
- Department of Otolaryngology, Wenzhou People’s Hospital, Wenzhou, China
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zhengfei Wang
- Department of Hepato-biliary Surgery, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People’s Hospital, Quzhou, China
| | - Zarrin Basharat
- Jamil-ur-Rahman Center for Genome Research, Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences, University of Karachi, Karachi, Pakistan
| | - Mengjun Hu
- Department of Pathology, Zhuji Affiliated Hospital of Wenzhou Medical University, Shaoxing, China
- *Correspondence: Mengjun Hu, ; Wandong Hong, ; Xiangjian Chen,
| | - Wandong Hong
- Department of Gastroenterology and Hepatology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- *Correspondence: Mengjun Hu, ; Wandong Hong, ; Xiangjian Chen,
| | - Xiangjian Chen
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- *Correspondence: Mengjun Hu, ; Wandong Hong, ; Xiangjian Chen,
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Effect of Controlling Nutritional Status Score (CONUT) and Prognostic Nutritional Index (PNI) on patients after spinal tuberculosis surgery. Sci Rep 2022; 12:16056. [PMID: 36163373 PMCID: PMC9513047 DOI: 10.1038/s41598-022-19345-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 08/29/2022] [Indexed: 11/08/2022] Open
Abstract
The controlling nutritional status (CONUT) score and prognostic nutrition index (PNI) are immune-nutritional biomarkers that are related to clinical prognosis. Previous studies have reported using them to predict the prognosis of traumatic brain injury, tumours and other diseases. The purpose of this study was to evaluate the relationship between the PNI and CONUT score and the one-year prognosis of patients with spinal tuberculosis (STB). In this study, the clinical characteristics of 97 patients with STB who underwent debridement and internal fixation at our institution between 2015 and 2020 were retrospectively analysed. According to the receiver operating characteristic (ROC) curve, patients were divided into two groups: a high CONUT group and a low CONUT group. Patients were also divided into a high PNI group and a low PNI group. One-year postoperative prognosis was evaluated by the clinical cure standard. Patients in the favourable group were younger and had a lower rate of pneumonia and urinary tract infection, higher PNI and lower CONUT score than those in the favourable group (P < 0.05). There was an obvious correlation between the PNI and CONUT score (r = - 0.884, P < 0.05). The areas under the curve (AUCs) of the CONUT score and PNI for predicting unfavourable prognosis were 0.888 (95% CI 0.808-0.943, P < 0.001) and 0.896 (95% CI 0.818-0.949, P < 0.001), respectively. The adjusted odds ratios (ORs) of the CONUT score and PNI for predicting unfavourable outcomes were 2.447 (95% CI 1.518-4.043, P < 0.001) and 0.689 (95% CI 0.563-0.843, P < 0.001), respectively. Higher CONUT scores and a lower PNI were associated with adverse outcomes in patients with spinal tuberculosis, and the CONUT score and PNI might be independent predictors of adverse outcomes of spinal tuberculosis postoperatively.
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Bir Yucel K, Karabork Kilic AC, Sutcuoglu O, Yazıcı O, Aydos U, Kilic K, Özdemir N. Effects of Sarcopenia, Myosteatosis, and the Prognostic Nutritional Index on Survival in Stage 2 and 3 Gastric Cancer Patients. Nutr Cancer 2022; 75:368-375. [PMID: 36093734 DOI: 10.1080/01635581.2022.2121845] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND We aimed to evaluate the relationship between sarcopenia, myosteatosis, and systemic inflammatory response biomarkers and their prognostic role in stage 2 and 3 gastric cancer patients. METHODS This study included 84 patients with stage 2 or 3 gastric cancer who underwent a gastrectomy. Computed tomography scans were used to determine the skeletal muscle index (SMI) at the third lumbar vertebra level for sarcopenia and myosteatosis. RESULTS Based on the Asian Working Group of Sarcopenia (AWGS2019) criteria, the sarcopenia incidence was 36.9% and that of myosteatosis 46.4%. Univariate analysis showed that sarcopenia (48 vs. 14 mo, p < 0.001), myosteatosis (45 vs. 16 mo, p = 0.016), a low prognostic nutritional index (60 vs. 15 mo, p = 0.003), stage 3 (104 vs. 21 mo, p = 0.013), and old age (45 vs. 16 mo, p = 0.015) were poor prognostic markers. Multivariate analysis revealed that sarcopenia (AWGS2019), age, and stage significantly affected overall survival (hazard ratio: 3.31, 95% CI: 1.85-5.1; 1.96, 95% CI: 1.06-6.63; 2.5, 95% CI: 1.2-5.1, respectively). CONCLUSION We showed that sarcopenia directly affects overall gastric cancer survival.
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Affiliation(s)
| | | | - Osman Sutcuoglu
- Department of Medical Oncology, Gazi University, Ankara, Turkey
| | - Ozan Yazıcı
- Department of Medical Oncology, Gazi University, Ankara, Turkey
| | - Uguray Aydos
- Department of Nuclear Medicine, Gazi University, Ankara, Turkey
| | - Koray Kilic
- Department of Radiology, Gazi University, Ankara, Turkey
| | - Nuriye Özdemir
- Department of Medical Oncology, Gazi University, Ankara, Turkey
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Nishibeppu K, Sakuramoto S, Matsui K, Ebara G, Fujita S, Fujihata S, Oya S, Lee S, Miyawaki Y, Sugita H, Sato H, Yamashita K. Dismal prognosis of elderly gastric cancer patients who underwent gastrectomy with American Society of Anesthesiologists (ASA) 3. Langenbecks Arch Surg 2022; 407:3413-3421. [PMID: 36066671 DOI: 10.1007/s00423-022-02672-9] [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: 10/23/2021] [Accepted: 08/30/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Although the American Society of Anesthesiologists (ASA) score of 3 is relatively common in elderly patients, there have been few debates on the indications for gastrectomy in elderly gastric cancer (GC) patients with ASA3. Therefore, this study aimed to investigate gastrectomy's clinical relevance in elderly patients with GC and ASA3. METHODS We retrospectively analyzed 228 consecutive elderly GC patients (aged ≥ 75 years) without prior treatments who underwent curative gastrectomy between 2013 and 2017. RESULTS Thirty-three patients with ASA3 showed significantly poorer prognosis than those with ASA1 and 2 (p = 0.004). The multivariate Cox proportional hazards model showed that ASA3 (p = 0.021) and pStage (p = 0.007) were independent prognostic factors, respectively. Elderly GC patients with pStage III and ASA3 exhibited uniquely dismal prognosis (p < 0.001); however, several survivors were still confirmed. Postoperative complications (PCs) were only the final remnant independent prognostic factor (p = 0.020) among the 33 elderly GC patients with ASA3, where dead patients included cancer-specific and other deaths, especially pneumonia. PCs were independently associated with prognostic nutritional index (PNI) (< 42.7) in elderly GC patients, and the most frequent complication was pneumonia, which was significantly associated with ASA3 and marginally associated with PNI in a multivariate analysis. CONCLUSIONS ASA3 has a dismal prognosis after curative gastrectomy in the elderly GC patients, but the number of survivors was confirmed. Curative gastrectomy is not considered contraindicated even in elderly GC with ASA3. Preoperative malnutrition is associated with PCs, which proposing preoperative nutritional intervention in the context of treatment strategy for the elderly GC patients with ASA3.
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Affiliation(s)
- Keiji Nishibeppu
- Division of Digestive Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan.
| | - Shinichi Sakuramoto
- Division of Digestive Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Kazuaki Matsui
- Division of Digestive Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Gen Ebara
- Division of Digestive Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Shohei Fujita
- Division of Digestive Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Shiro Fujihata
- Division of Digestive Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Shuichiro Oya
- Division of Digestive Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Seigi Lee
- Division of Digestive Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Yutaka Miyawaki
- Division of Digestive Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Hirofumi Sugita
- Division of Digestive Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Hiroshi Sato
- Division of Digestive Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Keishi Yamashita
- Department of Upper Gastrointestinal Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0375, Japan
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Effects of EN combined with PN enriched with n-3 polyunsaturated fatty acids on immune related indicators and early rehabilitation of patients with gastric cancer: A randomized controlled trial. Clin Nutr 2022; 41:1163-1170. [DOI: 10.1016/j.clnu.2022.03.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 02/17/2022] [Accepted: 03/11/2022] [Indexed: 02/08/2023]
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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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Significance of Preoperative Prognostic Nutritional Index in the Perioperative Management of Gastric Cancer. J Gastrointest Surg 2022; 26:558-569. [PMID: 34725783 DOI: 10.1007/s11605-021-05168-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 10/02/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Malnutrition leads to accelerated tumor progression through the suppression of tumor immunity. The present study examined the significance of the preoperative prognostic nutritional index (PNI) for predicting postoperative survival outcomes in gastric cancer (GC). METHODS A total of 447 patients who underwent curative gastrectomy for GC were included in the present study. PNI was calculated as 10 × serum albumin (g/dl) + 0.005 × total lymphocyte counts (per mm3). The prognostic impact of preoperative PNI was examined using two multivariate analysis models. RESULTS The optimal cutoff value of preoperative PNI for predicting overall survival (OS) was 48 based on a receiver operating characteristic curve. The 5-year OS rate was 59.5% in the PNI<48 group and 91.3% in the PNI≥48 group (p<0.001). In the first multivariate survival analysis where all explanatory variables were composed of preoperative factors alone, a PNI<48 (hazard ratio [HR] 3.33; 95% confidence interval [CI] 2.01-5.56, p<0.001), upper-third GC and cT2-T4 were identified as independent indicators of a poor OS. In the second survival analysis where explanatory variables were composed of preoperative, intraoperative, and pathological factors, a PNI<48 (HR 2.80; 95% CI 1.65-4.78, p<0.001), hypertension, open gastrectomy, intraoperative blood loss≥100g, pT2-T4, and pN+ were independent prognostic factors. CONCLUSION Preoperative PNI may be a useful predictor of postoperative survival outcomes both before and immediately after surgery in GC. Appropriate perioperative interventions and the meticulous surveillance of GC relapse are necessary for patients with PNI<48.
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Schiefer S, Wirsik NM, Kalkum E, Seide SE, Nienhüser H, Müller B, Billeter A, Büchler MW, Schmidt T, Probst P. Systematic Review of Prognostic Role of Blood Cell Ratios in Patients with Gastric Cancer Undergoing Surgery. Diagnostics (Basel) 2022; 12:diagnostics12030593. [PMID: 35328146 PMCID: PMC8947199 DOI: 10.3390/diagnostics12030593] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 02/17/2022] [Accepted: 02/23/2022] [Indexed: 01/19/2023] Open
Abstract
Various blood cell ratios exist which seem to have an impact on prognosis for resected gastric cancer patients. The aim of this systematic review was to investigate the prognostic role of blood cell ratios in patients with gastric cancer undergoing surgery in a curative attempt. A systematic literature search in MEDLINE (via PubMed), CENTRAL, and Web of Science was performed. Information on survival and cut-off values from all studies investigating any blood cell ratio in resected gastric cancer patients were extracted. Prognostic significance and optimal cut-off values were calculated by meta-analyses and a summary of the receiver operating characteristic. From 2831 articles, 65 studies investigated six different blood cell ratios (prognostic nutritional index (PNI), lymphocyte to monocyte ratio (LMR), systemic immune-inflammation index (SII), monocyte to lymphocyte ratio (MLR), neutrophil to lymphocyte ratio (NLR), and platelet to lymphocyte ratio (PLR)). There was a significant association for the PNI and NLR with overall survival and disease-free survival and for LMR and NLR with 5-year survival. The used cut-off values had high heterogeneity. The available literature is flawed by the use of different cut-off values hampering evidence-based patient treatment and counselling. This article provides optimal cut-off values recommendations for future research.
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Affiliation(s)
- Sabine Schiefer
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany; (S.S.); (H.N.); (B.M.); (A.B.); (M.W.B.); (P.P.)
| | - Naita Maren Wirsik
- Department of General, Visceral, Cancer and Transplant Surgery, University Hospital Cologne, Kerpener Str. 62, 50937 Köln, Germany;
| | - Eva Kalkum
- The Study Center of the German Society of Surgery (SDGC), University of Heidelberg, Im Neuenheimer Feld 130/3, 69120 Heidelberg, Germany;
| | - Svenja Elisabeth Seide
- Institute of Medical Biometry (IMBI), University of Heidelberg, Im Neuenheimer Feld 130/3, 69120 Heidelberg, Germany;
| | - Henrik Nienhüser
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany; (S.S.); (H.N.); (B.M.); (A.B.); (M.W.B.); (P.P.)
| | - Beat Müller
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany; (S.S.); (H.N.); (B.M.); (A.B.); (M.W.B.); (P.P.)
| | - Adrian Billeter
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany; (S.S.); (H.N.); (B.M.); (A.B.); (M.W.B.); (P.P.)
| | - Markus W. Büchler
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany; (S.S.); (H.N.); (B.M.); (A.B.); (M.W.B.); (P.P.)
| | - Thomas Schmidt
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany; (S.S.); (H.N.); (B.M.); (A.B.); (M.W.B.); (P.P.)
- Department of General, Visceral, Cancer and Transplant Surgery, University Hospital Cologne, Kerpener Str. 62, 50937 Köln, Germany;
- Correspondence: ; Tel.: +49-221-478-4804
| | - Pascal Probst
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany; (S.S.); (H.N.); (B.M.); (A.B.); (M.W.B.); (P.P.)
- The Study Center of the German Society of Surgery (SDGC), University of Heidelberg, Im Neuenheimer Feld 130/3, 69120 Heidelberg, Germany;
- Department of Surgery, Cantonal Hospital Thurgau, Pfaffenholzstrasse 4, 8501 Frauenfeld, Switzerland
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Takagi A, Hawke P, Tokuda S, Toda T, Higashizono K, Nagai E, Watanabe M, Nakatani E, Kanemoto H, Oba N. Serum carnitine as a biomarker of sarcopenia and nutritional status in preoperative gastrointestinal cancer patients. J Cachexia Sarcopenia Muscle 2022; 13:287-295. [PMID: 34939358 PMCID: PMC8818668 DOI: 10.1002/jcsm.12906] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 09/05/2021] [Accepted: 11/29/2021] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Sarcopenia is an important factor in the postoperative outcome of gastrointestinal cancer patients. However, little research has been carried out on potential biomarkers of sarcopenia. Carnitine is an amino acid derivative that is stored in skeletal muscle and is essential for muscle energy metabolism. The primary purpose of this study was to investigate whether serum carnitine level is a biomarker of sarcopenia in preoperative patients with gastrointestinal cancer. The secondary purposes were (i) to examine the associations between carnitine, nutritional status, and albumin level, and (ii) to determine whether carnitine is a prognostic factor for postoperative complications. METHODS One hundred fourteen patients scheduled to undergo gastroenterological surgery between August 2016 and January 2017 were enrolled. Their mean age was 68.4 ± 10.5, and 64.9% were male. Serum carnitine fractions [total carnitine (TC), free l-carnitine (FC), and acylcarnitine (AC)] were measured prior to surgery. The correlation between carnitine level and a variety of clinical features was analysed, including skeletal muscle index (SMI), sarcopenia, prognostic nutritional index (PNI), and postoperative complications. RESULTS Tumour locations included the oesophagus (n = 17), stomach (n = 16), pancreas (n = 20), bile duct (n = 9), liver [n = 33; primary liver cancer (n = 18), liver metastasis (n = 15)], and colorectal region (n = 19). TC and FC levels varied significantly by tumour location. TC and FC showed significant positive correlations with SMI [TC (r = 0.295, P = 0.0014), FC (r = 0.286, P = 0.0020)] and PNI [TC (P = 0.0178, r = 0.222), FC (P = 0.0067, r = 0.2526)]. These levels were significantly lower in the sarcopenia group (TC, P = 0.0124; FC, P = 0.0243). In addition, TC and FC showed significant positive correlations with ALB level [TC (P = 0.038 r = 0.19), FC (P = 0.016 r = 0.23)]. When patients were divided into high ALB (≥3.5 g/dL, 96 patients) and low ALB (<3.5 g/dL, 18 patients) groups, these correlations were no longer significant, but in the low ALB group there was a tendency towards a negative relationship between ALB level and both TC and FC. No significant relationship was found between postoperative complications and carnitine level. CONCLUSIONS This study suggests that carnitine level is a biomarker of sarcopenia and nutritional status. However, it did not find an association between carnitine level and postoperative complications.
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Affiliation(s)
- Akihiko Takagi
- Department of Gastroenterological Surgery, Shizuoka General Hospital, Shizuoka, Japan
| | - Philip Hawke
- School of Pharmaceutical Sciences, University of Shizuoka, Shizuoka, Japan
| | - Satoshi Tokuda
- Department of Gastroenterological Surgery, Shizuoka General Hospital, Shizuoka, Japan
| | - Takeo Toda
- Department of Gastroenterological Surgery, Shizuoka General Hospital, Shizuoka, Japan
| | - Kazuya Higashizono
- Department of Gastroenterological Surgery, Shizuoka General Hospital, Shizuoka, Japan
| | - Erina Nagai
- Department of Gastroenterological Surgery, Shizuoka General Hospital, Shizuoka, Japan
| | - Masaya Watanabe
- Department of Gastroenterological Surgery, Shizuoka General Hospital, Shizuoka, Japan
| | - Eiji Nakatani
- Division of Statistical Analysis, Research Support Center, Shizuoka General Hospital, Shizuoka, Japan
| | - Hideyuki Kanemoto
- Department of Gastroenterological Surgery, Shizuoka General Hospital, Shizuoka, Japan
| | - Noriyuki Oba
- Department of Gastroenterological Surgery, Shizuoka General Hospital, Shizuoka, Japan
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Toya K, Tomimaru Y, Kobayashi S, Sasaki K, Iwagami Y, Yamada D, Noda T, Takahashi H, Doki Y, Eguchi H. Preoperative neutrophil-to-lymphocyte ratio predicts healing time for postoperative pancreatic fistula after distal pancreatectomy. Ann Gastroenterol Surg 2022; 6:169-175. [PMID: 35106427 PMCID: PMC8786688 DOI: 10.1002/ags3.12510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 08/31/2021] [Accepted: 09/06/2021] [Indexed: 11/06/2022] Open
Abstract
PURPOSE Postoperative pancreatic fistula is a serious complication of distal pancreatectomy. Although many studies have described the incidence and risk factors associated with postoperative pancreatic fistula (POPF), few have focused on the healing time. This study investigated the healing time and potential factors associated with the healing time of POPF after distal pancreatectomy (DP). METHODS Among 114 patients that underwent DP in our hospital from January 2010 to December 2020, we included 88 that developed POPF. The healing time for a postoperative pancreatic fistula was defined as the interval between the completion of DP and the removal of all drains related to the treatment for POPF. Based on the definition, three cases who required additional treatment after removal of all drains were excluded from this study. Clinical factors associated with the fistula healing times were investigated in the 85 patients. RESULTS The average POPF healing time was 11 ± 10 days (median: 6 days, range: 3-57). We found that the neutrophil-to-lymphocyte ratio, a marker of inflammatory and nutritional status, was the only factor independently associated with the POPF healing time; the mean healing time was significantly shorter in patients with neutrophil-to-lymphocyte ratio ≤2.1 (8 ± 6 days) than in those with neutrophil-to-lymphocyte ratio >2.1 (13 ± 12 days; P = .0139). CONCLUSION We demonstrated that the neutrophil-to-lymphocyte ratio could independently predict the POPF healing time after DP. These findings suggested that improving the neutrophil-to-lymphocyte ratio might shorten the healing times for POPF after DP.
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Affiliation(s)
- Keisuke Toya
- Department of Gastroenterological SurgeryGraduate School of MedicineOsaka UniversityOsakaJapan
| | - Yoshito Tomimaru
- Department of Gastroenterological SurgeryGraduate School of MedicineOsaka UniversityOsakaJapan
| | - Shogo Kobayashi
- Department of Gastroenterological SurgeryGraduate School of MedicineOsaka UniversityOsakaJapan
| | - Kazuki Sasaki
- Department of Gastroenterological SurgeryGraduate School of MedicineOsaka UniversityOsakaJapan
| | - Yoshifumi Iwagami
- Department of Gastroenterological SurgeryGraduate School of MedicineOsaka UniversityOsakaJapan
| | - Daisaku Yamada
- Department of Gastroenterological SurgeryGraduate School of MedicineOsaka UniversityOsakaJapan
| | - Takehiro Noda
- Department of Gastroenterological SurgeryGraduate School of MedicineOsaka UniversityOsakaJapan
| | - Hidenori Takahashi
- Department of Gastroenterological SurgeryGraduate School of MedicineOsaka UniversityOsakaJapan
| | - Yuichiro Doki
- Department of Gastroenterological SurgeryGraduate School of MedicineOsaka UniversityOsakaJapan
| | - Hidetoshi Eguchi
- Department of Gastroenterological SurgeryGraduate School of MedicineOsaka UniversityOsakaJapan
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Liu X, Xue Z, Yu J, Ma Z, Kang W, Ye X, Li Z. Risk factors for cancer-specific survival in elderly gastric cancer patients after curative gastrectomy. Nutr Res Pract 2022; 16:604-615. [PMID: 36238382 PMCID: PMC9523207 DOI: 10.4162/nrp.2022.16.5.604] [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: 09/13/2021] [Revised: 11/29/2021] [Accepted: 01/07/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND/OBJECTIVES This study aimed to investigate cancer-specific survival (CSS) and associated risk factors in elderly gastric cancer (EGC) patients. SUBJECTS/METHODS EGC patients (≥ 70 yrs) who underwent curative gastrectomy between January 2013 and December 2017 at our hospital were included. Clinicopathologic characteristics and survival data were collected. Receiver operating characteristic (ROC) analysis was used to extract the best cutoff point for body mass index (BMI). A Cox proportional hazards model was used to determine the risk factors for CSS. RESULTS In total, 290 EGC patients were included, with a median age of 74.7 yrs. The median follow-up time was 31 (1–77) mon. The postoperative 1-yr, 3-yr and 5-yr CSS rates were 93.7%, 75.9% and 65.1%, respectively. Univariate analysis revealed risk factors for CSS, including age (hazard ratio [HR] = 1.08; 95% confidence interval [CI], 1.01–1.15), intensive care unit (ICU) admission (HR = 1.73; 95% CI, 1.08–2.79), nutritional risk screening (NRS 2002) score ≥ 5 (HR = 2.33; 95% CI, 1.49–3.75), and preoperative prognostic nutrition index score < 45 (HR = 2.06; 95% CI, 1.27–3.33). The ROC curve showed that the best BMI cutoff value was 20.6 kg/m2. Multivariate analysis indicated that a BMI ≤ 20.6 kg/m2 (HR = 2.30; 95% CI, 1.36–3.87), ICU admission (HR = 1.97; 95% CI, 1.17–3.30) and TNM stage (stage II: HR = 5.56; 95% CI, 1.59–19.43; stage III: HR = 16.20; 95% CI, 4.99–52.59) were significantly associated with CSS. CONCLUSIONS Low BMI (≤ 20.6 kg/m2), ICU admission and advanced pathological TNM stages (II and III) are independent risk factors for CSS in EGC patients after curative gastrectomy. Nutrition support, better perioperative management and early diagnosis would be helpful for better survival.
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Affiliation(s)
- Xiao Liu
- Department of Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Zhigang Xue
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
- Graduate School, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Jianchun Yu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Zhiqiang Ma
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Weiming Kang
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Xin Ye
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Zijian Li
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
- Graduate School, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
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Williams DG, Aronson S, Murray S, Fuller M, Villalta E, Haines KL, Wischmeyer P. Validation of the Perioperative Nutrition Screen (PONS) for Prediction of Postoperative Outcomes. JPEN J Parenter Enteral Nutr 2021; 46:1307-1315. [PMID: 34850403 DOI: 10.1002/jpen.2310] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Preoperative nutrition risk is often underrecognized and undertreated. The Perioperative Nutrition Screen (PONS) was recently introduced as an efficient tool to rapidly screen for preoperative nutritional risk. The relationship between identification of "nutritional risk" via PONS and adverse outcomes postoperatively remains undescribed. METHODS Preoperative nutrition risk was assessed via PONS from 1/1/2019-9/30/2020. Key clinical outcomes were compared with individual and composite PONS components. RESULTS 3,151 patients with PONS evaluations were analyzed. Multivariate regression analysis adjusted for key co-variates demonstrated positive responses for specific PONS component questions was associated with adverse clinical outcomes as follows: 1) Unplanned weight loss (>10% in 6-months preoperatively) associated with a 22.4% increased length of stay (LOS) (95%CI: 13.3%-32.1%, p<0 .0001) and increased 30-day readmission rate (OR 2.44, 95%CI: 1.73-3.44, p<0.001); 2) History of < 50% of previous oral intake in past week associated with a 25% increased LOS (95%CI: 15.7%-35.2%, p<0.001); 3) Preoperative albumin <3.0g/l associated with a 29.9% increased LOS (p< 0.001) and increased 30-day readmission rate (OR 2.66 (95% CI: 1.63-4.35, p<0.001); 4) Low BMI (<18.5 kg/m2 ≤65 years old or <20 kg/m2 in ≥65 years old) was not associated with increased LOS by adjusted analysis although was predictive by univariate analysis. CONCLUSIONS The PONS and its individual components appear to predict risk of adverse postoperative outcomes, even independent of a validated malnutrition diagnosis. Further studies are needed to assess the impact of specific preoperative nutrition interventions on adverse outcomes predicted by PONS when delivered to patients identified via PONS screen. This article is protected by copyright. All rights reserved.
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Affiliation(s)
| | - Solomon Aronson
- Departments of Anesthesiology, Duke University School of Medicine.,Population Health, Duke University School of Medicine
| | - Sutton Murray
- Departments of Anesthesiology, Duke University School of Medicine
| | - Matt Fuller
- Departments of Anesthesiology, Duke University School of Medicine
| | | | | | - Paul Wischmeyer
- Departments of Anesthesiology, Duke University School of Medicine
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Nanashima A, Hiyoshi M, Imamura N, Yano K, Hamada T, Kai K, Nishida T, Uchise Y, Sakamoto R, Inomata M. Preoperative Prognostic Nutritional Index is a significant predictive factor for posthepatectomy bile leakage. Ann Hepatobiliary Pancreat Surg 2021; 25:477-484. [PMID: 34845119 PMCID: PMC8639299 DOI: 10.14701/ahbps.2021.25.4.477] [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: 06/08/2021] [Revised: 06/19/2021] [Accepted: 08/23/2021] [Indexed: 11/17/2022] Open
Abstract
Backgrounds/Aims It is known that preoperative nutritional status can influence patient outcomes after hepatectomy. Prognostic Nutritional Index (PNI) is a useful parameter to reflect patient outcomes undergoing gastro-intestinal surgery. The aim of this study was to retrospectively evaluate relationships of nutritional parameters, demographics, and surgical records with postoperative outcomes in a cohort study. Methods Curative hepatectomy was performed for 182 patients at the University of Miyazaki between 2015 and 2018. Each preoperative level of albumin, prealbumin, lymphocyte, total cholesterol, or the comprehensively calculated Onodera's PNI was examined as a nutritional parameter. Results The mean PNI was 39.6 ± 5.1, with PNI below 40 observed in 91 (50.0%) patients. Nutritional parameters were not different among patients with various liver diseases. Serum albumin or prealbumin level was significantly correlated with each hepatic parameter (p < 0.01). Prealbumin and total cholesterol levels were significantly correlated with postoperative prothrombin activity (p < 0.05). Albumin or prealbumin levels and PNI were significantly lower in patients with posthepatectomy complications, particularly bile leakage in comparison those without such complications (p < 0.05). Multiple logistic analysis showed that albumin level was an independent risk factor for complications after hepatectomy (risk ratio [RR]: 1.33) and that lymphocyte count was an independent risk factor for bile leakage (RR: 1.28) (p < 0.05). The cut-off level of albumin was approximately 3.8 mg/dL and that of lymphocyte count was 1,320/mm3. Conclusions Preoperative PNI reflected perioperative liver functional status. It was a predictive parameter for postoperative complications, particularly biliary leakage.
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Affiliation(s)
- Atsushi Nanashima
- Division of Hepato-Biliary-Pancreas Surgery, Department of Surgery, University of Miyazaki Faculty of Medicine, Miyazaki, Japan
| | - Masahide Hiyoshi
- Division of Hepato-Biliary-Pancreas Surgery, Department of Surgery, University of Miyazaki Faculty of Medicine, Miyazaki, Japan
| | - Naoya Imamura
- Division of Hepato-Biliary-Pancreas Surgery, Department of Surgery, University of Miyazaki Faculty of Medicine, Miyazaki, Japan
| | - Koichi Yano
- Division of Hepato-Biliary-Pancreas Surgery, Department of Surgery, University of Miyazaki Faculty of Medicine, Miyazaki, Japan
| | - Takeomi Hamada
- Division of Hepato-Biliary-Pancreas Surgery, Department of Surgery, University of Miyazaki Faculty of Medicine, Miyazaki, Japan
| | - Kengo Kai
- Division of Hepato-Biliary-Pancreas Surgery, Department of Surgery, University of Miyazaki Faculty of Medicine, Miyazaki, Japan
| | - Takahiro Nishida
- Division of Hepato-Biliary-Pancreas Surgery, Department of Surgery, University of Miyazaki Faculty of Medicine, Miyazaki, Japan
| | - Yukako Uchise
- Division of Hepato-Biliary-Pancreas Surgery, Department of Surgery, University of Miyazaki Faculty of Medicine, Miyazaki, Japan
| | - Risa Sakamoto
- Division of Hepato-Biliary-Pancreas Surgery, Department of Surgery, University of Miyazaki Faculty of Medicine, Miyazaki, Japan
| | - Mayu Inomata
- Division of Hepato-Biliary-Pancreas Surgery, Department of Surgery, University of Miyazaki Faculty of Medicine, Miyazaki, Japan
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Lu X, Zhang M, Wei C, Wang Z, Zheng Q, Yu C. The Impact of a Simplified Scoring System on Long-Term Survival Outcomes in Patients with Gastric Cancer Undergoing Gastrectomy. Nutr Cancer 2021; 74:2365-2372. [PMID: 34809498 DOI: 10.1080/01635581.2021.2005807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Gastric cancer (GC) is a worldwide public health concern. We aimed to investigate the association between preoperative prognostic scoring system based on the combination of age, American Society of Anesthesiologists physical status (ASA-PS), and prognostic nutritional index (PNI) and long-term survival outcomes in patients with (GC). Data from 513 patients were analyzed using Cox proportional hazards regression models to evaluate the association between this prognostic score system and risks of all-cause mortality. This simple prognostic score system (0-3 points) was an independent predictor of long-term survival outcomes in patients with GC after radical gastrectomy based on multivariate analyses. Prognostic 1-point score, 2-point score, and 3-point score significantly increased 50% (95% CI, 14%-98%; P = 0.004), 75% (95% CI, 22%-151%; P = 0.003), and 116% (95% CI, 26%-271%; P = 0.005) hazards of 5-year all-cause mortality, respectively, compared to prognostic 0-point score. Five-year overall survival rates were significantly decreased as prognostic scores increased, (0 point, 57.3%; 1-point, 41.3%; 2-ponint, 36.6%; 3-point, 25.9%; P < 0.01; area under the curve [AUC] = 0.62). A prognostic scoring method based on combination of age, ASA-PS, and PNI may serve as an independent risk stratification metric for long-term survival in patients with GC.
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Affiliation(s)
- Xianfu Lu
- Department of Anesthesiology (High-Tech Branch), The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Man Zhang
- Department of Anesthesiology (High-Tech Branch), The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Cuina Wei
- Department of Anesthesiology (High-Tech Branch), The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Zan Wang
- Department of Anesthesiology (High-Tech Branch), The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Qiang Zheng
- Department of Anesthesiology (High-Tech Branch), The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Changjun Yu
- Department of Gastrointestinal Surgery (High-Tech Branch), The First Affiliated Hospital of Anhui Medical University, Hefei, China
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Karimi A, Shobeiri P, Kulasinghe A, Rezaei N. Novel Systemic Inflammation Markers to Predict COVID-19 Prognosis. Front Immunol 2021; 12:741061. [PMID: 34745112 PMCID: PMC8569430 DOI: 10.3389/fimmu.2021.741061] [Citation(s) in RCA: 97] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 09/28/2021] [Indexed: 12/15/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) has resulted in a global pandemic, challenging both the medical and scientific community for the development of novel vaccines and a greater understanding of the effects of the SARS-CoV-2 virus. COVID-19 has been associated with a pronounced and out-of-control inflammatory response. Studies have sought to understand the effects of inflammatory response markers to prognosticate the disease. Herein, we aimed to review the evidence of 11 groups of systemic inflammatory markers for risk-stratifying patients and prognosticating outcomes related to COVID-19. Numerous studies have demonstrated the effectiveness of neutrophil to lymphocyte ratio (NLR) in prognosticating patient outcomes, including but not limited to severe disease, hospitalization, intensive care unit (ICU) admission, intubation, and death. A few markers outperformed NLR in predicting outcomes, including 1) systemic immune-inflammation index (SII), 2) prognostic nutritional index (PNI), 3) C-reactive protein (CRP) to albumin ratio (CAR) and high-sensitivity CAR (hsCAR), and 4) CRP to prealbumin ratio (CPAR) and high-sensitivity CPAR (hsCPAR). However, there are a limited number of studies comparing NLR with these markers, and such conclusions require larger validation studies. Overall, the evidence suggests that most of the studied markers are able to predict COVID-19 prognosis, however NLR seems to be the most robust marker.
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Affiliation(s)
- Amirali Karimi
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Parnian Shobeiri
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Arutha Kulasinghe
- Centre for Genomics and Personalised Health, School of Biomedical Q6 Sciences, Queensland University of Technology, Brisbane, QL, Australia
| | - Nima Rezaei
- Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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Kim GH, Choi KD, Ko Y, Park T, Kim KW, Park SY, Na HK, Ahn JY, Lee JH, Jung KW, Kim DH, Song HJ, Lee GH, Jung HY. Impact of Comorbidities, Sarcopenia, and Nutritional Status on the Long-Term Outcomes after Endoscopic Submucosal Dissection for Early Gastric Cancer in Elderly Patients Aged ≥ 80 Years. Cancers (Basel) 2021; 13:3598. [PMID: 34298811 PMCID: PMC8304160 DOI: 10.3390/cancers13143598] [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: 06/06/2021] [Revised: 07/05/2021] [Accepted: 07/14/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND/AIM We investigated the oncologic outcomes in elderly patients who underwent endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) by focusing on the impact of comorbidities, sarcopenia, and nutritional status. METHODS Between 2005 and 2016, 280 patients aged ≥ 80 years with 289 EGCs underwent ESD at a tertiary care center. The short- and long-term survival outcomes were assessed. Cox regression analysis was used to identify factors associated with survival, including clinicopathologic factors and abdominal muscle area measured by computed tomography. RESULTS The rates of en bloc, R0, and, curative resection were 99.3%, 90.0%, and 69.2%, respectively. The rates of post-ESD bleeding and perforation rates were 2.1% and 3.1%, respectively, and no cases showed significant life-threatening adverse events. Over a median follow-up period of 70.5 months, the 3- and 5-year overall survival (OS) rates were 89.5% and 77.1%, respectively; of the114 patients who died, only four (3.5%) were due to gastric cancer. A total of 173 (61.8%) had sarcopenia, and they had lower rates of 3-year (88.4% vs. 91.4%) and 5-year (73.1% vs. 84.0%; p = 0.046) OS than did those without sarcopenia. In multivariable analyses, prognostic nutritional index (hazard ratio [HR], 0.93; 95% confidence interval [CI]: 0.90-0.98; p = 0.002) and Charlson comorbidity index (HR 1.19; 95% CI: 1.03-1.37; p = 0.018) were significant factors associated with overall survival. CONCLUSIONS ESD was a feasible and safe therapeutic method to use in elderly patients, whose long-term survival was significantly associated with nutritional status and comorbidities. These results suggest the need for a possible extension of the curative criteria for ESD in elderly patients with EGC.
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Affiliation(s)
- Ga Hee Kim
- Asan Medical Center, Department of Gastroenterology, University of Ulsan College of Medicine, Seoul 05505, Korea; (G.H.K.); (H.K.N.); (J.Y.A.); (J.H.L.); (K.W.J.); (D.H.K.); (H.J.S.); (G.H.L.); (H.-Y.J.)
| | - Kee Don Choi
- Asan Medical Center, Department of Gastroenterology, University of Ulsan College of Medicine, Seoul 05505, Korea; (G.H.K.); (H.K.N.); (J.Y.A.); (J.H.L.); (K.W.J.); (D.H.K.); (H.J.S.); (G.H.L.); (H.-Y.J.)
| | - Yousun Ko
- Biomedical Reseach Center, Asan Institute for Life Sciences, University of Ulsan College of Medicine, Seoul 05505, Korea;
| | - Taeyong Park
- Asan Medical Center, Department of Radiology, University of Ulsan College of Medicine, Seoul 05505, Korea; (T.P.); (K.W.K.)
| | - Kyung Won Kim
- Asan Medical Center, Department of Radiology, University of Ulsan College of Medicine, Seoul 05505, Korea; (T.P.); (K.W.K.)
| | - Seo Young Park
- Department of Statistics and Data Science, Korea National Open University, Seoul 05505, Korea;
| | - Hee Kyong Na
- Asan Medical Center, Department of Gastroenterology, University of Ulsan College of Medicine, Seoul 05505, Korea; (G.H.K.); (H.K.N.); (J.Y.A.); (J.H.L.); (K.W.J.); (D.H.K.); (H.J.S.); (G.H.L.); (H.-Y.J.)
| | - Ji Yong Ahn
- Asan Medical Center, Department of Gastroenterology, University of Ulsan College of Medicine, Seoul 05505, Korea; (G.H.K.); (H.K.N.); (J.Y.A.); (J.H.L.); (K.W.J.); (D.H.K.); (H.J.S.); (G.H.L.); (H.-Y.J.)
| | - Jeong Hoon Lee
- Asan Medical Center, Department of Gastroenterology, University of Ulsan College of Medicine, Seoul 05505, Korea; (G.H.K.); (H.K.N.); (J.Y.A.); (J.H.L.); (K.W.J.); (D.H.K.); (H.J.S.); (G.H.L.); (H.-Y.J.)
| | - Kee Wook Jung
- Asan Medical Center, Department of Gastroenterology, University of Ulsan College of Medicine, Seoul 05505, Korea; (G.H.K.); (H.K.N.); (J.Y.A.); (J.H.L.); (K.W.J.); (D.H.K.); (H.J.S.); (G.H.L.); (H.-Y.J.)
| | - Do Hoon Kim
- Asan Medical Center, Department of Gastroenterology, University of Ulsan College of Medicine, Seoul 05505, Korea; (G.H.K.); (H.K.N.); (J.Y.A.); (J.H.L.); (K.W.J.); (D.H.K.); (H.J.S.); (G.H.L.); (H.-Y.J.)
| | - Ho June Song
- Asan Medical Center, Department of Gastroenterology, University of Ulsan College of Medicine, Seoul 05505, Korea; (G.H.K.); (H.K.N.); (J.Y.A.); (J.H.L.); (K.W.J.); (D.H.K.); (H.J.S.); (G.H.L.); (H.-Y.J.)
| | - Gin Hyug Lee
- Asan Medical Center, Department of Gastroenterology, University of Ulsan College of Medicine, Seoul 05505, Korea; (G.H.K.); (H.K.N.); (J.Y.A.); (J.H.L.); (K.W.J.); (D.H.K.); (H.J.S.); (G.H.L.); (H.-Y.J.)
| | - Hwoon-Yong Jung
- Asan Medical Center, Department of Gastroenterology, University of Ulsan College of Medicine, Seoul 05505, Korea; (G.H.K.); (H.K.N.); (J.Y.A.); (J.H.L.); (K.W.J.); (D.H.K.); (H.J.S.); (G.H.L.); (H.-Y.J.)
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Wang L, Miao J, Huang H, Chen B, Xiao X, Zhu M, Liang Y, Xiao W, Huang S, Peng Y, Deng X, Lv X, Xia W, Xiang Y, Guo X, Han F, Zhao C. Long-term Survivals, Toxicities and the Role of Chemotherapy in Early-Stage Nasopharyngeal Carcinoma Patients Treated with Intensity-modulated Radiation Therapy: A Retrospective Study with 15-year Follow-up. Cancer Res Treat 2021; 54:118-129. [PMID: 34098625 PMCID: PMC8756137 DOI: 10.4143/crt.2021.101] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 06/04/2021] [Indexed: 12/08/2022] Open
Abstract
Purpose This study was aimed to investigate long-term survivals and toxicities of early-stage nasopharyngeal carcinoma (NPC) in endemic area, evaluating the role of chemotherapy in stage II patients. Materials and Methods Totally 187 patients with newly diagnosed NPC and restaged American Joint Committee on Cancer/ International Union Against Cancer 8th T1-2N0-1M0 were retrospectively recruited. All received intensity-modulated radiotherapy (IMRT)±chemotherapy (CT) from 2001 to 2010. Results With 15.7-year median follow-up, 10-year locoregional recurrence-free survival, distant metastasis-free survival (DMFS), disease-specific survival (DSS), and overall survival (OS) were 93.3%, 93.5%, 92.9% and 88.2%, respectively. Multivariable analyses showed cervical lymph nodes positive and pre-treatment prognostic nutritional index ≥ 52.0 could independently predict DMFS (p=0.036 and p=0.011), DSS (p=0.014 and p=0.026), and OS (p=0.002 and p < 0.001); Charlson comorbidity index < 3 points could predict DSS (p=0.011); age > 45 years (p=0.002) and pre-treatment lactate dehydrogenase ≥ 240 U/L (p < 0.001) predicted OS. No grade 4 late toxicity happened; grade 3 late toxicities included subcutaneous fibrosis (4.3%), deafness or otitis (4.8%), skin dystrophy (2.1%), and xerostomia (1.1%). No differences on survivals were shown between IMRT+CT vs. IMRT alone in stage II patients, even in T2N1M0 (p > 0.05). Unsurprising, patients in IMRT+CT had more acute gastrointestinal reaction, myelosuppression, mucositis, late ear toxicity, and cranial nerve injury (all p < 0.05) than IMRT alone group. Conclusion Superior tumor control and satisfying long-term outcomes could be achieved with IMRT in early-stage NPC with mild late toxicities. As CT would bring more toxicities, it should be carefully performed to stage II patients.
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Affiliation(s)
- Lin Wang
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Jingjing Miao
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Huageng Huang
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Boyu Chen
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Xiao Xiao
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Manyi Zhu
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Yingshan Liang
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Weiwei Xiao
- Department of Radiotherapy, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Shaomin Huang
- Department of Radiotherapy, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Yinglin Peng
- Department of Radiotherapy, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Xiaowu Deng
- Department of Radiotherapy, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Xing Lv
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Weixiong Xia
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Yanqun Xiang
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Xiang Guo
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Fei Han
- Department of Radiotherapy, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Chong Zhao
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
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Liu JY, Dong HM, Wang WL, Wang G, Pan H, Chen WW, Wang Q, Wang ZJ. The Effect of the Prognostic Nutritional Index on the Toxic Side Effects of Radiochemotherapy and Prognosis After Radical Surgery for Gastric Cancer. Cancer Manag Res 2021; 13:3385-3392. [PMID: 33889027 PMCID: PMC8057790 DOI: 10.2147/cmar.s301140] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 03/11/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE A retrospective analysis was conducted to investigate the effect of the preoperative prognostic nutritional index (PNI) on the severity of toxic side effects of radiochemotherapy and the survival prognosis of patients with gastric cancer to guide the clinical nutritional support for patients with gastric cancer. METHODS Data of 191 patients with gastric cancer in the Department of Gastrointestinal Surgery of Guizhou Cancer Hospital and the Affiliated Hospital of Guizhou Medical University between January 2008 and December 2018 were analyzed retrospectively. Patients were allocated to the high PNI group (with PNI ≥47.7) and the low PNI group (with PNI <47.7) according to the PNI cutoff value, and the incidence of severe toxic side effects of radiochemotherapy and the overall survival time were compared between the high PNI group and low PNI group. In addition, prognostic factor analysis was performed. RESULTS The severe hematologic side effects of radiochemotherapy and shorter postoperative survival time were more likely to occur in the low PNI group than in the high PNI group. The multifactor analysis showed that TNM stage (p = 0.000) and PNI (p = 0.001) were the independent risk factors for the overall postoperative survival time in patients with gastric cancer. CONCLUSION Preoperative PNI might predict the severity of hematologic toxic side effects of adjuvant chemotherapy/radiochemotherapy in patients with gastric cancer after surgery. Patients in the low PNI group were more likely to have severe hematologic toxic side effects, and therefore a low PNI might be one of the important factors affecting the prognosis of gastric cancer.
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Affiliation(s)
- Ji-Yu Liu
- Department of Oncology, Guizhou Medical University, Guizhou, Guiyang, 550001, People’s Republic of China
| | - Hong-Min Dong
- Department of Oncology, Affiliated Hospital of Guizhou Medical University, Guizhou, Guiyang, 550001, People’s Republic of China
- Department of Abdominal Oncology, Guizhou Cancer Hospital, Guizhou, Guiyang, 550001, People’s Republic of China
| | - Wen-Ling Wang
- Department of Oncology, Affiliated Hospital of Guizhou Medical University, Guizhou, Guiyang, 550001, People’s Republic of China
- Department of Abdominal Oncology, Guizhou Cancer Hospital, Guizhou, Guiyang, 550001, People’s Republic of China
| | - Gang Wang
- Department of Oncology, Guizhou Medical University, Guizhou, Guiyang, 550001, People’s Republic of China
- Department of Oncology, Affiliated Hospital of Guizhou Medical University, Guizhou, Guiyang, 550001, People’s Republic of China
- Department of Abdominal Oncology, Guizhou Cancer Hospital, Guizhou, Guiyang, 550001, People’s Republic of China
| | - Huan Pan
- Department of Abdominal Oncology, Guizhou Cancer Hospital, Guizhou, Guiyang, 550001, People’s Republic of China
| | - Wei-Wei Chen
- Department of Oncology, Guizhou Medical University, Guizhou, Guiyang, 550001, People’s Republic of China
- Department of Oncology, Affiliated Hospital of Guizhou Medical University, Guizhou, Guiyang, 550001, People’s Republic of China
- Department of Abdominal Oncology, Guizhou Cancer Hospital, Guizhou, Guiyang, 550001, People’s Republic of China
| | - Qian Wang
- Department of Gastrointestinal Surgery, Affiliated Hospital of Guizhou Medical University, Guizhou, Guiyang, 550001, People’s Republic of China
| | - Ze-Jun Wang
- Department of Gastrointestinal Surgery, Guizhou Cancer Hospital, Guizhou, Guiyang, 550001, People’s Republic of China
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Sun Y, Chen J, Ye C, Lin H, Lu X, Huang Y, Chi P. Pelvimetric and Nutritional Factors Predicting Surgical Difficulty in Laparoscopic Resection for Rectal Cancer Following Preoperative Chemoradiotherapy. World J Surg 2021; 45:2261-2269. [PMID: 33821350 DOI: 10.1007/s00268-021-06080-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2021] [Indexed: 01/01/2023]
Abstract
AIM Laparoscopic total mesorectal excision (LaTME) following preoperative chemoradiotherapy (PCRT) in locally advanced rectal cancer (LARC) is technically demanding. The present study is intended to evaluate predictive factors of surgical difficulty of LaTME following PCRT by using pelvimetric and nutritional factors. METHOD Consecutive LARC patients receiving LaTME after PCRT were included. Surgical difficulty was classified based upon intraoperative (operation time, blood loss, and conversion) and postoperative outcomes (postoperative hospital stay and morbidities). Pelvimetry was performed using preoperative T2-weighted MRI. Nutritional factors such as albumin-to-globulin ratio (AGR) and prognostic nutritional index (PNI) were calculated. Multivariable logistic analysis was used to identify predictors of high surgical difficulty. A predictive nomogram was developed and validated internally. RESULTS Among 294 patients included, 36 (12.4%) patients were graded as high surgical difficulty. Logistic regression analysis demonstrated that previous abdominal surgery (OR = 6.080, P = 0.001), tumor diameter (OR = 1.732, P = 0.003), intersphincteric resection (vs. low anterior resection, OR = 13.241, P < 0.001), interspinous distance (OR = 0.505, P = 0.009), and preoperative AGR (OR = 0.041, P = 0.024) were independently predictive of high surgical difficulty of LaTME after PCRT. Then, a predictive nomogram was built (C-index = 0.867). CONCLUSION Besides previous abdominal surgery, type of surgery (intersphincteric resection), tumor diameter, and interspinous distance, we found that preoperative AGR could be useful for the prediction of surgical difficulty of LaTME after PCRT. A predictive nomogram for surgical difficulty may aid in planning an appropriate approach for rectal cancer surgery after PCRT.
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Affiliation(s)
- Yanwu Sun
- Colorectal Surgery Department, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, PR China
| | - Jianhua Chen
- Radiology Department, Fujian Medical University Union Hospital, Fuzhou, PR China
| | - Chengwei Ye
- Colorectal Surgery Department, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, PR China
| | - Huiming Lin
- Colorectal Surgery Department, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, PR China
| | - Xingrong Lu
- Colorectal Surgery Department, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, PR China
| | - Ying Huang
- Colorectal Surgery Department, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, PR China.
| | - Pan Chi
- Colorectal Surgery Department, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, PR China.
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47
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Tateyama Y, Naganuma A, Suzuki Y, Masuda T, Uehara S, Hoshino T, Yasuoka H, Kudo T, Ogawa Y, Ogawa T, Tateno K, Ishii N, Araki K, Harimoto N, Shirabe K, Kakizaki S. Imatinib and nutritional support can make successful treatment for a case of huge liver metastasis of duodenal gastrointestinal stromal tumor that initially showed jaundice and cachexia. Clin J Gastroenterol 2021; 14:570-576. [PMID: 33507488 DOI: 10.1007/s12328-021-01340-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 01/05/2021] [Indexed: 10/22/2022]
Abstract
It is very difficult to treat patients with liver metastasis presenting with jaundice or cachexia. We herein report a successfully treated case of huge liver metastasis of gastrointestinal stromal tumor (GIST) that initially showed jaundice and cachexia. The patient was a woman in her early 40 s. She had a history of duodenal GIST 4 years before this admission. She was admitted to our hospital for abdominal fullness and anorexia. Abdominal computed tomography revealed huge liver metastasis of GIST. She showed jaundice and cancer cachexia with a modified Glasgow Prognostic Score of 2. After applying nutritional support, 400 mg of imatinib was administered. Although leg edema transiently worsened, the withdrawal of imatinib and administration of diuretics improved it. Imatinib was re-administered, and nutritional support was continued. The total bilirubin level decreased, and the serum albumin level increased. The tumor gradually decreased in size. Finally, she received surgical resection after 16 months of treatment with imatinib. Although adjuvant imatinib administration was continued after surgery, and no recurrence was observed as of 18 months after surgery.
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Affiliation(s)
- Yumeo Tateyama
- Department of Gastroenterology, National Hospital Organization Takasaki General Medical Center, 36 Takamatsu-cho, Takasaki, Gunma, 370-0829, Japan
| | - Atsushi Naganuma
- Department of Gastroenterology, National Hospital Organization Takasaki General Medical Center, 36 Takamatsu-cho, Takasaki, Gunma, 370-0829, Japan
| | - Yuhei Suzuki
- Department of Gastroenterology, National Hospital Organization Takasaki General Medical Center, 36 Takamatsu-cho, Takasaki, Gunma, 370-0829, Japan
| | - Tomoyuki Masuda
- Department of Gastroenterology, National Hospital Organization Takasaki General Medical Center, 36 Takamatsu-cho, Takasaki, Gunma, 370-0829, Japan
| | - Sanae Uehara
- Department of Gastroenterology, National Hospital Organization Takasaki General Medical Center, 36 Takamatsu-cho, Takasaki, Gunma, 370-0829, Japan
| | - Takashi Hoshino
- Department of Gastroenterology, National Hospital Organization Takasaki General Medical Center, 36 Takamatsu-cho, Takasaki, Gunma, 370-0829, Japan
| | - Hidetoshi Yasuoka
- Department of Gastroenterology, National Hospital Organization Takasaki General Medical Center, 36 Takamatsu-cho, Takasaki, Gunma, 370-0829, Japan
| | - Tomohiro Kudo
- Department of Gastroenterology, National Hospital Organization Takasaki General Medical Center, 36 Takamatsu-cho, Takasaki, Gunma, 370-0829, Japan
| | - Yusuke Ogawa
- Nutrition Support Team, National Hospital Organization Takasaki General Medical Center, 36 Takamatsu-cho, Takasaki, Gunma, 370-0829, Japan
| | - Tetsushi Ogawa
- Department of Surgery, National Hospital Organization Takasaki General Medical Center, 36 Takamatsu-cho, Takasaki, Gunma, 370-0829, Japan
| | - Kohei Tateno
- Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Norihiro Ishii
- Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Kenichiro Araki
- Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Norifumi Harimoto
- Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Ken Shirabe
- Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Satoru Kakizaki
- Department of Gastroenterology, National Hospital Organization Takasaki General Medical Center, 36 Takamatsu-cho, Takasaki, Gunma, 370-0829, Japan.
- Department of Clinical Research, National Hospital Organization Takasaki General Medical Center, 36 Takamatsu-cho, Takasaki, Gunma, 370-0829, Japan.
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48
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Fang KH, Chang SW, Lee YC, Huang EI, Lai CH, Chang GH, Tsai MS, Hsu CM, Tsai YT. Preoperative prognostic nutritional index predicts prognosis of patients with oral cavity cancer. Oral Dis 2021; 28:1816-1830. [PMID: 33690959 DOI: 10.1111/odi.13840] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 02/26/2021] [Accepted: 03/07/2021] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To investigate whether prognostic nutritional index (PNI) predicts patient survival outcomes in oral cavity squamous cell carcinoma (OSCC). MATERIALS AND METHODS The data of a total of 360 patients subjected to primary surgery for OSCC were retrospectively analysed. Patients were categorised into high-PNI (≥51.75) and low-PNI (<51.75) groups based on the PNI cut-off value attained from receiver operating characteristic analyses (p < .001), and the intergroup differences in clinicopathological features were determined. The Kaplan-Meier method and Cox proportional hazard model were employed to determine the survival prediction ability of the PNI, and a nomogram based on the PNI was established for individualised survival prediction. RESULTS A low PNI was noted to exhibit a significant association with shorter overall survival (OS) and disease-free survival (DFS) (both p < .001). Multivariate Cox analyses showed that a lower PNI independently indicated shorter OS and DFS (hazard ratio [HR] = 2.187; p = .001 and HR = 1.459; p = .023, respectively). The concordance index and calibration plots of the PNI-based nomogram revealed the high discriminative ability for OS. CONCLUSIONS Preoperative PNI is a valuable biomarker for predicting OSCC prognosis, and the proposed PNI-based nomogram can provide individualised prognostic prediction.
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Affiliation(s)
- Ku-Hao Fang
- Department of Otolaryngology Head and Neck Surgery, Chang Gung Memorial Hospital Linkou Main Branch, Taoyuan, Taiwan
| | - Sheng-Wei Chang
- Department of Radiology, Chang Gung Memorial Hospital Chiayi Branch, Puzi, Taiwan
| | - Yi-Chan Lee
- Department of Otolaryngology Head and Neck Surgery, Chang Gung Memorial Hospital Keelung Branch Library, Keelung, Taiwan
| | - Ethan I Huang
- Department of Otolaryngology Head and Neck Surgery, Chang Gung Memorial Hospital Chiayi Branch, Puzi, Taiwan
| | - Chia-Hsuan Lai
- Department of Radiation Oncology, Chang Gung Memorial Hospital Chiayi Branch, Puzi, Taiwan
| | - Geng-He Chang
- Department of Otolaryngology Head and Neck Surgery, Chang Gung Memorial Hospital Chiayi Branch, Puzi, Taiwan
| | - Ming-Shao Tsai
- Department of Otolaryngology Head and Neck Surgery, Chang Gung Memorial Hospital Chiayi Branch, Puzi, Taiwan
| | - Cheng-Ming Hsu
- Department of Otolaryngology Head and Neck Surgery, Chang Gung Memorial Hospital Chiayi Branch, Puzi, Taiwan
| | - Yao-Te Tsai
- Department of Otolaryngology Head and Neck Surgery, Chang Gung Memorial Hospital Chiayi Branch, Puzi, Taiwan
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Bergkvist E, Zimunhu T, Mbanje C, Hagander L, Muguti GI. Nutritional status and outcome of surgery: A prospective observational cohort study of children at a tertiary surgical hospital in Harare, Zimbabwe. J Pediatr Surg 2021; 56:368-373. [PMID: 33131772 DOI: 10.1016/j.jpedsurg.2020.09.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 09/17/2020] [Accepted: 09/18/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Undernutrition contributes to nearly 50% of all child deaths in the world, yet there is conflicting evidence regarding the association between nutritional status and postoperative complications. The aim was to describe the preoperative nutritional status among pediatric surgery patients in Zimbabwe, and to assess if nutritional status was a risk factor for adverse postoperative outcome of mortality, surgical site infection, reoperation, readmission, and longer length of stay. METHODS This prospective observational cohort study included 136 children undergoing surgery at a tertiary pediatric hospital in Zimbabwe. Nutritional status was standardized using Z-scores for BMI, length, weight, and middle upper arm circumference. Primary outcomes after 30 days included mortality, surgical site infection, reoperation, and readmission. Secondary outcome was length of stay. Univariate and multivariable analyses with logistic regression were performed. RESULTS Of the 136 patients, 31% were undernourished. Postoperative adverse outcome occurred in 20%; the mortality rate was 6%, the surgical site infection rate was 17%, the reoperation rate was 3.5%, and readmission rate was 2.5%. Nutritional status, higher ASA classification, major surgical procedures, and lower preoperative hemoglobin levels were associated with adverse outcome. Univariate logistic regression identified a seven-fold increased risk of postoperative complications among undernourished children (OR 7.3 [2.3-22.8], p = 0.001), and there was a four- to six-fold increased adjusted risk after adjustment for ASA, major surgery, and preoperative hemoglobin. CONCLUSION A third of all pediatric surgery patients were undernourished, and undernourished children had a considerably higher risk of adverse outcome. With a positive correlation identified between undernourishment and increased postoperative complications, future aims would include assessing if preoperative nutritional treatment could be especially beneficial for undernourished children. LEVELS OF EVIDENCE Level II treatment study.
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Affiliation(s)
- Emil Bergkvist
- Pediatric surgery, Department of Clinical Sciences in Lund, Faculty of Medicine, Lund University, Lund, Sweden.
| | - Taurai Zimunhu
- Department of Surgery, College of Health Sciences, University of Zimbabwe, Zimbabwe, Africa
| | - Chenesa Mbanje
- Department of Surgery, College of Health Sciences, University of Zimbabwe, Zimbabwe, Africa
| | - Lars Hagander
- Pediatric surgery, Department of Clinical Sciences in Lund, Faculty of Medicine, Lund University, Lund, Sweden
| | - G I Muguti
- Department of Surgery, College of Health Sciences, University of Zimbabwe, Zimbabwe, Africa.
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50
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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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