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Nutritional predictors for postoperative short-term and long-term outcomes of patients with gastric cancer

View Article: PubMed Central - PubMed

ABSTRACT

Evidence indicates that impaired immunocompetence and nutritional status adversely affect short-term and long-term outcomes of patients with cancer. We aimed to evaluate the clinical significance of preoperative immunocompetence and nutritional status according to Onodera's prognostic nutrition index (PNI) among patients who underwent curative gastrectomy for gastric cancer (GC).

This study included 260 patients with stage II/III GC who underwent R0 resection. The predictive values of preoperative nutritional status for postoperative outcome (morbidity and prognosis) were evaluated. Onodera's PNI was calculated as follows: 10 × serum albumin (g/dL) + 0.005 × lymphocyte count (per mm3).

The mean preoperative PNI was 47.8. The area under the curve for predicting complications was greater for PNI compared with the serum albumin concentration or lymphocyte count. Multivariate analysis identified preoperative PNI < 47 as an independent predictor of postoperative morbidity. Moreover, patients in the PNI < 47 group experienced significantly shorter overall and disease-free survival compared with those in the PNI ≥ 47 group, notably because of a higher prevalence of hematogenous metastasis as the initial recurrence. Subgroup analysis according to disease stage and postoperative adjuvant treatment revealed that the prognostic significance of PNI was more apparent in patients with stage II GC and in those who received adjuvant chemotherapy.

Preoperative PNI is easy and inexpensive to determine, and our findings indicate that PNI served as a significant predictor of postoperative morbidity, prognosis, and recurrence patterns of patients with stage II/III GC.

No MeSH data available.


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(A) Receiver operating characteristic curves for lymphocyte counts, serum albumin, and PNI as predictive factors for postoperative complications. The value of the area under the curve (AUC) was highest for PNI. (B) Incidence of postoperative complications according gastrectomy type and disease stage. PNI = prognostic nutrition index.
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Figure 1: (A) Receiver operating characteristic curves for lymphocyte counts, serum albumin, and PNI as predictive factors for postoperative complications. The value of the area under the curve (AUC) was highest for PNI. (B) Incidence of postoperative complications according gastrectomy type and disease stage. PNI = prognostic nutrition index.

Mentions: Thirty-six patients (14%) had grade III or higher postoperative complications, including anastomosis leakage (n = 17, 7%), leakage of pancreatic fluids (n = 9, 3%), and intra-abdominal abscess (n = 5, 2%). The AUC values indicating the predictive power of the postoperative complications were as follows: BMI, 0.54; TLC, 0.60; hemoglobin, 0.59; platelet count, 0.54; total protein, 0.55; albumin, 0.60; cholesterol, 0.57; cholinesterase, 0.56; urea nitrogen, 0.57; NLR, 0.62; and PLR, 0.63. Onodera's PNI was highest at AUC = 0.65, and the optimal cut-off value for predicting complications was 47 (sensitivity = 72%, specificity = 58%) (Fig. 1A).


Nutritional predictors for postoperative short-term and long-term outcomes of patients with gastric cancer
(A) Receiver operating characteristic curves for lymphocyte counts, serum albumin, and PNI as predictive factors for postoperative complications. The value of the area under the curve (AUC) was highest for PNI. (B) Incidence of postoperative complications according gastrectomy type and disease stage. PNI = prognostic nutrition index.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4998440&req=5

Figure 1: (A) Receiver operating characteristic curves for lymphocyte counts, serum albumin, and PNI as predictive factors for postoperative complications. The value of the area under the curve (AUC) was highest for PNI. (B) Incidence of postoperative complications according gastrectomy type and disease stage. PNI = prognostic nutrition index.
Mentions: Thirty-six patients (14%) had grade III or higher postoperative complications, including anastomosis leakage (n = 17, 7%), leakage of pancreatic fluids (n = 9, 3%), and intra-abdominal abscess (n = 5, 2%). The AUC values indicating the predictive power of the postoperative complications were as follows: BMI, 0.54; TLC, 0.60; hemoglobin, 0.59; platelet count, 0.54; total protein, 0.55; albumin, 0.60; cholesterol, 0.57; cholinesterase, 0.56; urea nitrogen, 0.57; NLR, 0.62; and PLR, 0.63. Onodera's PNI was highest at AUC = 0.65, and the optimal cut-off value for predicting complications was 47 (sensitivity = 72%, specificity = 58%) (Fig. 1A).

View Article: PubMed Central - PubMed

ABSTRACT

Evidence indicates that impaired immunocompetence and nutritional status adversely affect short-term and long-term outcomes of patients with cancer. We aimed to evaluate the clinical significance of preoperative immunocompetence and nutritional status according to Onodera's prognostic nutrition index (PNI) among patients who underwent curative gastrectomy for gastric cancer (GC).

This study included 260 patients with stage II/III GC who underwent R0 resection. The predictive values of preoperative nutritional status for postoperative outcome (morbidity and prognosis) were evaluated. Onodera's PNI was calculated as follows: 10 × serum albumin (g/dL) + 0.005 × lymphocyte count (per mm3).

The mean preoperative PNI was 47.8. The area under the curve for predicting complications was greater for PNI compared with the serum albumin concentration or lymphocyte count. Multivariate analysis identified preoperative PNI < 47 as an independent predictor of postoperative morbidity. Moreover, patients in the PNI < 47 group experienced significantly shorter overall and disease-free survival compared with those in the PNI ≥ 47 group, notably because of a higher prevalence of hematogenous metastasis as the initial recurrence. Subgroup analysis according to disease stage and postoperative adjuvant treatment revealed that the prognostic significance of PNI was more apparent in patients with stage II GC and in those who received adjuvant chemotherapy.

Preoperative PNI is easy and inexpensive to determine, and our findings indicate that PNI served as a significant predictor of postoperative morbidity, prognosis, and recurrence patterns of patients with stage II/III GC.

No MeSH data available.


Related in: MedlinePlus