Zhang Y, Wang LJ, Li QY, Yuan Z, Zhang DC, Xu H, Yang L, Gu XH, Xu ZK. Prognostic value of preoperative immune-nutritional scoring systems in remnant gastric cancer patients undergoing surgery. World J Gastrointest Surg 2023; 15(2): 211-221 [PMID: 36896300 DOI: 10.4240/wjgs.v15.i2.211]
Corresponding Author of This Article
Xin-Hua Gu, Doctor, Department of Gastrointestinal Surgery, Suzhou Municipal Hospital, Affiliated Suzhou Hospital of Nanjing Medical University, Gusu School of Nanjing Medical University, No. 26 Daoqianjie, Gusu District, Suzhou 215000, Jiangsu Province, China. 1173421755@qq.com
Research Domain of This Article
Surgery
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Surg. Feb 27, 2023; 15(2): 211-221 Published online Feb 27, 2023. doi: 10.4240/wjgs.v15.i2.211
Prognostic value of preoperative immune-nutritional scoring systems in remnant gastric cancer patients undergoing surgery
Yan Zhang, Lin-Jun Wang, Qin-Ya Li, Zhen Yuan, Dian-Cai Zhang, Hao Xu, Li Yang, Xin-Hua Gu, Ze-Kuan Xu
Yan Zhang, Zhen Yuan, Xin-Hua Gu, Department of Gastrointestinal Surgery, Suzhou Municipal Hospital, Affiliated Suzhou Hospital of Nanjing Medical University, Gusu School of Nanjing Medical University, Suzhou 215000, Jiangsu Province, China
Lin-Jun Wang, Qin-Ya Li, Dian-Cai Zhang, Hao Xu, Li Yang, Ze-Kuan Xu, Department of General Surgery, Jiangsu Province Hospital, First Affiliated Hospital of Nanjing Medical University, Nanjing 210003, Jiangsu Province, China
Author contributions: Zhang Y, Wang LJ, and Xu ZK contributed equally to this work; Gu XH and Xu ZK designed the research study; Zhang Y and Wang LJ performed the research; Li QY contributed analytic tools; Yuan Z, Zhang DC, Xu H, and Yang L analyzed the data and wrote the manuscript; all authors have read and approved the final manuscript.
Supported byNational Natural Science Foundation of China, No. 81871946 and No. 82072708; Suzhou Medical Key Discipline, No. SZXK202109; Suzhou Clinical Key Diseases Project, No. LCZX202111; Project of Gusu School of Nanjing Medical University, No. GSKY20210233.
Institutional review board statement: This study was approved by the medical ethics committee of Nanjing Medical University.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xin-Hua Gu, Doctor, Department of Gastrointestinal Surgery, Suzhou Municipal Hospital, Affiliated Suzhou Hospital of Nanjing Medical University, Gusu School of Nanjing Medical University, No. 26 Daoqianjie, Gusu District, Suzhou 215000, Jiangsu Province, China. 1173421755@qq.com
Received: September 15, 2022 Peer-review started: September 15, 2022 First decision: December 12, 2022 Revised: December 14, 2022 Accepted: December 31, 2022 Article in press: December 31, 2022 Published online: February 27, 2023 Processing time: 164 Days and 19.9 Hours
Abstract
BACKGROUND
Remnant gastric cancer (GC) is defined as GC that occurs five years or more after gastrectomy. Systematically evaluating the preoperative immune and nutritional status of patients and analyzing its prognostic impact on postoperative remnant gastric cancer (RGC) patients are crucial. A simple scoring system that combines multiple immune or nutritional indicators to identify nutritional or immune status before surgery is necessary.
AIM
To evaluate the value of preoperative immune-nutritional scoring systems in predicting the prognosis of patients with RGC.
METHODS
The clinical data of 54 patients with RGC were collected and analyzed retrospectively. Prognostic nutritional index (PNI), controlled nutritional status (CONUT), and Naples prognostic score (NPS) were calculated by preoperative blood indicators, including absolute lymphocyte count, lymphocyte to monocyte ratio, neutrophil to lymphocyte ratio, serum albumin, and serum total cholesterol. Patients with RGC were divided into groups according to the immune-nutritional risk. The relationship between the three preoperative immune-nutritional scores and clinical characteristics was analyzed. Cox regression and Kaplan–Meier analysis was performed to analyze the difference in overall survival (OS) rate between various immune-nutritional score groups.
RESULTS
The median age of this cohort was 70.5 years (ranging from 39 to 87 years). No significant correlation was found between most pathological features and immune-nutritional status (P > 0.05). Patients with a PNI score < 45, CONUT score or NPS score ≥ 3 were considered to be at high immune-nutritional risk. The areas under the receiver operating characteristic curves of PNI, CONUT, and NPS systems for predicting postoperative survival were 0.611 [95% confidence interval (CI): 0.460–0.763; P = 0.161], 0.635 (95%CI: 0.485–0.784; P = 0.090), and 0.707 (95%CI: 0.566–0.848; P = 0.009), respectively. Cox regression analysis showed that the three immune-nutritional scoring systems were significantly correlated with OS (PNI: P = 0.002; CONUT: P = 0.039; NPS: P < 0.001). Survival analysis revealed a significant difference in OS between different immune-nutritional groups (PNI: 75 mo vs 42 mo, P = 0.001; CONUT: 69 mo vs 48 mo, P = 0.033; NPS: 77 mo vs 40 mo, P < 0.001).
CONCLUSION
These preoperative immune-nutritional scores are reliable multidimensional prognostic scoring systems for predicting the prognosis of patients with RGC, in which the NPS system has relatively effective predictive performance.
Core Tip: Three preoperative immune-nutritional scores of patients with remnant gastric cancer (RGC) were calculated, including prognostic nutritional index (PNI), controlled nutritional status (CONUT), and Naples prognostic score (NPS). Patients were divided into groups according to the immune-nutritional risk. The three immune-nutritional scoring systems were significantly correlated with overall survival (OS) (PNI: P = 0.002; CONUT: P = 0.039; NPS: P < 0.001). Survival analysis revealed a significant difference in OS between different immune-nutritional groups (PNI: 75 mo vs 42 mo, P = 0.001; CONUT: 69 mo vs 48 mo, P = 0.033; NPS: 77 mo vs 40 mo, P < 0.001). These preoperative immune-nutritional scores are reliable multidimensional RGC prognostic scoring systems.
