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Which Nutritional Scoring System Is More Suitable for Evaluating the Short- or Long-Term Prognosis of Patients with Gastric Cancer Who Underwent Radical Gastrectomy?

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Journal of Gastrointestinal Surgery



To evaluate the effects of three nutritional scoring systems: Prognostic Nutritional Index (PNI), Controlling Nutritional Status (CONUT), and Naples Prognostic Score (NPS) on the short- or long-term prognosis of gastric cancer (GC) patients who underwent radical gastrectomy.


The clinicopathological data of 2182 patients who underwent radical gastrectomy at the Fujian Medical University Union Hospital (FMUUH) from 2009 to 2014 were retrospectively analyzed. The effects of the PNI, CONUT, and NPS on the short- or long-term prognosis of GC patients were analyzed.


Overall, 359 (16.5%) patients had postoperative complications. There was no significant association between the PNI, CONUT, and NPS and postoperative complications (P > 0.05); however, high CONUT and NPS were significantly associated with severe postoperative complications (P < 0.05). Univariate analysis showed that PNI, CONUT, and NPS were all associated with overall survival (OS) (P < 0.001). However, multivariate analysis showed that only PNI was an independent risk factor for OS (P = 0.004), and the 5-year OS rate in the low PNI group was significantly lower than that in the normal PNI group (55.5% vs 75.4%, P < 0.05). The area under the curve (AUC) and the c-index of PNI were significantly higher than those of CONUT and NPS. The prognostic efficiency of combining PNI and TNM stage was also significantly better than that of TNM staging alone (P < 0.05).


The current study demonstrated that CONUT and NPS are important for assessing the risk of severe postoperative complications. However, PNI is an independent risk factor for the long-term prognosis of GC patients who underwent radical gastrectomy and can improve the prognostic efficiency of TNM staging.

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Scientific and technological innovation joint capital projects of Fujian Province, China (No. 2016Y9031). Minimally invasive medical center of Fujian Province (No. [2017]171). Project supported by the Science Foundation of the Fujian Province, China (Grant No. 2018J01307). Startup Fund for scientific research, Fujian Medical University (No. 2016QH024).

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Correspondence to Ping Li, Chao-Hui Zheng or Jian-Wei Xie.

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Human Rights Statement and Informed Consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions. Informed consent or substitute for it was obtained from all patients for being included in the study.

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Supplementary Figure 1

The number of patients at risk of malnutrition according to the different nutritional scoring systems. (PNG 29 kb)

High resolution Image (TIF 124 kb)

Supplementary Figure 2

Kaplan-Meier analysis for the OS of GC patients in stages II and stage III according to chemotherapy. (PNG 26 kb)

High resolution Image (TIF 50 kb)

Supplementary Figure 3

ROC curves of PNI, CONUT and NPS for the prediction of severe complications. (PNG 42 kb)

High resolution Image (TIF 71 kb)

Supplementary Figure 4

Stratified analysis of the effect of nutritional scoring on long-term survival was performed according to the surgical method. A,B,C were the patients receiving total gastrectomies, and D,E,F were the patients receiving subtotal gastrectomies. (PNG 63 kb)

High resolution Image (TIF 94 kb)


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Lin, JX., Lin, LZ., Tang, YH. et al. Which Nutritional Scoring System Is More Suitable for Evaluating the Short- or Long-Term Prognosis of Patients with Gastric Cancer Who Underwent Radical Gastrectomy?. J Gastrointest Surg 24, 1969–1977 (2020).

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