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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 Aims and scope

Abstract

Objective

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.

Methods

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.

Results

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).

Conclusion

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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References

  1. Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018;68:394–424.

    Article  Google Scholar 

  2. Noh SH, Park SR, Yang HK, et al. Adjuvant capecitabine plus oxaliplatin for gastric cancer after D2 gastrectomy (CLASSIC): 5-year follow-up of an open?label, randomised phase 3 trial. Lancet Oncol. 2014;15:1389–1396.

    Article  CAS  Google Scholar 

  3. Sasako M, Inoue M, Lin JT, et al. Gastric Cancer Working Group report. Jpn J Clin Oncol. 2010;40(suppl 1):i28–i37.

    Article  Google Scholar 

  4. Paccagnella A, Morassutti I. Nutritional intervention for improving treatment tolerance in cancer patients. Curr Opin Oncol 2011;23:322–330.

    Article  CAS  Google Scholar 

  5. Borre M, Dam GA, Knudsen AW, Gronbaek H. Nutritional status and nutritional risk in patients with neuroendocrine tumors. Scand J Gastroenterol 2018;53(3):284e92.

    Article  Google Scholar 

  6. Fujiya K, Kawamura T, Omae K, Makuuchi R, Irino T, Tokunaga M, et al. Impact of malnutrition after gastrectomy for gastric cancer on long-term survival. Ann Surg Oncol 2018;25(4):974e83.

    Article  Google Scholar 

  7. Maasberg S, Knappe-Drzikova B, Vonderbeck D, et al. Malnutrition predicts clinical outcome in patients with neuroendocrine Neoplasia. Neuroendocrinology. 2017;104:11–25.

    Article  CAS  Google Scholar 

  8. Zhao Y, Xu P, Kang H, et al. Prognostic nutritional index as a prognostic biomarker for survival in digestive system carcinomas. Oncotarget 2016;7:86573–86583.

    Article  Google Scholar 

  9. Kuroda D, Sawayama H, Kurashige J, et al. Controlling nutritional status (CONUT) score is a prognostic marker for gastric cancer patients after curative resection. Gastric Cancer. 2017;21:204–212.

    Article  Google Scholar 

  10. Galizia G, Lieto E, Auricchio A, et al. Naples Prognostic Score, Based on Nutritional and Inflammatory Status, is an Independent Predictor of Long-term Outcome in Patients Undergoing Surgery for Colorectal Cancer. Dis Colon Rectum 2017;60:1273–1284.

    Article  Google Scholar 

  11. Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma. 3rd English edition. Gastric Cancer 14:101–112,2011.

    Article  Google Scholar 

  12. Onodera T, Goseki N, G. K. Prognostic nutritional index in gastrointestinal surgery of malnourished cancer patients. Nippon Geka Gakkai Zasshi. 1984;85:5.

    Google Scholar 

  13. Jiang N, Deng JY, Ding XW, et al. Prognostic nutritional index predicts postoperative complications and long-term outcomes of gastric cancer. World J Gastroenterol 2014;20:10537–10544.

    Article  Google Scholar 

  14. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004; 240: 205–213.

    Article  Google Scholar 

  15. Camp RL, Dolled-Filhart M and Rimm DL. X-tile: a new bio-informatics tool for biomarker assessment and outcome-based cut-point optimization. Clin Cancer Res. 2004; 10(21):7252–7259.

    Article  CAS  Google Scholar 

  16. Schwegler I, von Holzen A, Gutzwiller JP, et al. Nutritional risk is a clinical predictor of postoperative mortality and morbidity in surgery for colorectal cancer. Br J Surg 2010;97:92–97.

    Article  CAS  Google Scholar 

  17. Hu WH, Cajas-Monson LC, Eisenstein S, Parry L, Cosman B, Ramamoorthy S.Preoperative malnutrition assessments as predictors of postoperative mortality and morbidity in colorectal cancer: an analysis of ACS-NSQIP. Nutr J 2015;14:91.

    Article  Google Scholar 

  18. Schueneman AJ, Sugar EA, Uram J, Bigelow E, Herman JM, Edil BH, et al. Low total lymphocyte count is associated with poor survival in patients with resected pancreatic adenocarcinoma receiving a GM-CSF secreting pancreatic tumor vaccine. Ann Surg Oncol. 2013;20(Suppl 3):S725–30.

    Article  Google Scholar 

  19. Lien YC, Hsieh CC, Wu YC, Hsu HS, Hsu WH, Wang LS, Huang MH, Huang BS. Preoperative serum albumin level is a prognostic indicator for adenocarcinoma of the gastric cardia. J Gastrointest Surg 2004;8:1041–1048.

    Article  Google Scholar 

  20. Chan JC, Chan DL, Diakos CI, et al. The Lymphocyte-to-Monocyte Ratio is a Superior Predictor of Overall Survival in Comparison to Established Biomarkers of Resectable Colorectal Cancer. Ann Surg 2017;265:539–546.

    Article  Google Scholar 

  21. Suzuki Y, Okabayashi K, Hasegawa H, et al. Comparison of Preoperative Inflammation-based Prognostic Scores in Patients With Colorectal Cancer. Ann Surg 2018;267:527–531.Shimada H, Takiguchi N, Kainuma O, et al.

  22. Kang R, Li P, Wang T, Li X, Wei Z, Zhang Z, et al. Apolipoprotein E epsilon 2 allele and low serum cholesterol asrisk factors for gastric cancer in a Chinese Han population. Sci Rep.2016;6:19930.

    Article  CAS  Google Scholar 

  23. Yang Y, Gao P, Song Y, et al. The prognostic nutritional index is a predictive indicator of prognosis and postoperative complications in gastric cancer: A meta-analysis. Eur J Surg Oncol 2016; 42:1176–1182.

    Article  CAS  Google Scholar 

  24. Ryo S, Kanda M, Ito S, et al. The Controlling Nutritional Status Score Serves as a Predictor of Short- and Long-Term Outcomes for Patients with Stage 2 or 3 Gastric Cancer: Analysis of a Multi-institutional Data Set [J]. Annals of surgical oncology, 2018,():.

  25. Sun KY, Xu JB, Chen SL, et al. Novel immunological and nutritional-based prognostic index for gastric cancer. World J Gastroenterol 2015;21:5961–5971.

    Article  Google Scholar 

  26. Yoshida N, Harada K, Baba Y, et al. Preoperative controlling nutritional status (CONUT) is useful to estimate the prognosis afteresophagectomy for esophageal cancer. Langenbecks Arch Surg. 2017; 2: 333–341.

  27. Graziosi L, Marino E. Survival comparison in gastric cancer patients between 7th and 8th edition of the AJCC TNM staging system: The first western single center experience. Eur J Surg Oncol 2018;:.

  28. In H, Solsky I, Palis B, et al. Validation of the 8th Edition of the AJCC TNM Staging System for Gastric Cancer using the National Cancer Database. Ann Surg Oncol 2017; 24: 3683–91.

    Article  Google Scholar 

  29. Gao ZM, Wang RY, Deng P, et al. TNM-PNI: a novel prognostic scoring system for patients with gastric cancer and curative D2 resection. Cancer Manag Res 2018; 10: 2925–2933.

    Article  CAS  Google Scholar 

  30. Group G, Paoletti X, Oba K, et al. Benefit of adjuvant chemotherapy for resectable gastric cancer: a meta-analysis. JAMA. 2010;303:1729–1737.

    Article  Google Scholar 

  31. Shimada H, Takiguchi N, Kainuma O, et al. High preoperative neutrophil-lymphocyte ratio predicts poor survival in patients with gastric cancer. Gastric Cancer. 2010;13(3):170–176.

    Article  Google Scholar 

Download references

Funding

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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Author notes

  1. Jian-Xian Lin and Li-Zhen Lin contributed equally to this work.

Authors and Affiliations

  1. Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian Province, China

    Jian-Xian Lin, Li-Zhen Lin, Yi-Hui Tang, Jia-Bin Wang, Jun Lu, Qi-Yue Chen, Long-Long Cao, Mi Lin, Ru-Hong Tu, Chang-Ming Huang, Ping Li, Chao-Hui Zheng & Jian-Wei Xie

  2. Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, 350108, Fujian Province, China

    Jian-Xian Lin, Jia-Bin Wang, Jun Lu, Qi-Yue Chen, Long-Long Cao, Chang-Ming Huang, Ping Li, Chao-Hui Zheng & Jian-Wei Xie

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  1. Jian-Xian Lin
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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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Electronic supplementary material

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). https://doi.org/10.1007/s11605-019-04360-4

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