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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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Kim MK, Choi JH, Cho IR, Lee SH, Ryu JK, Kim YT, Paik WH. Survival benefit of adjuvant treatment for ampullary cancer with lymph nodal involvement: A systematic review and meta-analysis. Hepatobiliary Pancreat Dis Int 2024:S1499-3872(24)00098-5. [PMID: 38997856 DOI: 10.1016/j.hbpd.2024.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 07/01/2024] [Indexed: 07/14/2024]
Abstract
BACKGROUND The efficacy of adjuvant treatment (AT) in ampullary cancer (AmC) remains controversial. This systematic review and meta-analysis aimed to evaluate the role of AT for AmC. DATA SOURCES A comprehensive systematic search was performed in PubMed, EMBASE, Cochrane Library, and Web of Science databases. Studies comparing overall survival (OS) and recurrence-free survival (RFS) of patients who underwent AT or not following AmC resection were included. RESULTS A total of 3971 patients in 21 studies were analyzed. Overall pooled data showed no significant difference in effect on the OS by AT [hazard ratio (HR) = 0.998, 95% confidence interval (CI): 0.768-1.297]. No significant difference in recurrence between the AT and non-AT (nAT) groups was noted (HR = 1.158, 95% CI: 0.764-1.755). In subgroup analysis, patients who received AT showed favorable outcomes in the OS compared with those who received nAT in nodal-positive AmC (HR = 0.627, 95% CI: 0.451-0.870). Neither AT consisted of adjuvant chemotherapy with radiotherapy (HR = 0.804, 95% CI: 0.563-1.149) nor AT with adjuvant chemotherapy (HR = 0.883, 95% CI: 0.642-1.214) showed any significant effect on the OS. CONCLUSIONS The effect of AT in AmC on survival and recurrence did not show a significant benefit. Furthermore, effectiveness according to AT strategies did not show enhancement in survival. AT had an advantage in survival compared with nAT strategy in nodal-positive AmC. In cases of AmC with positive lymph nodal involvement, AT may be warranted regardless of detailed strategies.
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Affiliation(s)
- Min Kyu Kim
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin Ho Choi
- Department of Internal Medicine, Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - In Rae Cho
- Department of Internal Medicine, Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sang Hyub Lee
- Department of Internal Medicine, Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Ji Kon Ryu
- Department of Internal Medicine, Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Yong-Tae Kim
- Department of Internal Medicine, Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Woo Hyun Paik
- Department of Internal Medicine, Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
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Utsumi M, Inagaki M, Kitada K, Tokunaga N, Yonoki K, Sakurai Y, Okabayashi H, Hamano R, Miyasou H, Tsunemitsu Y, Otsuka S. Prognostic Significance of Sarcopenia and Systemic Inflammatory Markers in Biliary Tract Cancer: A Retrospective Cohort Study. J Gastrointest Cancer 2024; 55:888-899. [PMID: 38403714 DOI: 10.1007/s12029-024-01034-6] [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: 02/15/2024] [Indexed: 02/27/2024]
Abstract
PURPOSE To evaluate the prognostic significance of sarcopenia and systemic inflammatory markers in patients with surgically resected biliary tract cancer (BTC). METHODS Between July 2010 and December 2022, 146 patients were recruited. Sarcopenia was assessed using the psoas muscle index. Preoperative inflammatory markers were used to calculate the prognostic nutritional index (PNI), neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio. Cox regression analysis was performed to determine prognostic factors for overall survival (OS) and recurrence-free survival (RFS). P < 0.05 was considered statistically significant. RESULTS Sixty-four patients had sarcopenia. Sarcopenia was associated with body mass index (< 22 kg/m2), lymph node metastasis, and low PNI (< 42). R1/R2 resection (P = 0.02), sarcopenia (P < 0.001), lymph node metastasis (P = 0.007), intrahepatic cholangiocarcinoma (P < 0.001), and low PNI (P = 0.01) were independent predictors of OS, while male sex (P = 0.04), R1/R2 resection (P < 0.001), lymph node metastasis (P = 0.005), intrahepatic cholangiocarcinoma (P < 0.001), tumor differentiation (other than well; P = 0.003), and low PNI (P = 0.03) were independent predictors of RFS. Patients were stratified into no sarcopenia and high PNI (≥ 42; A), sarcopenia or low PNI (B), and sarcopenia and low PNI (C) groups. Group C had worse OS than the other two groups (P < 0.001 and P = 0.02, respectively). CONCLUSION Sarcopenia is associated with the PNI. Sarcopenia and the PNI are independent prognostic factors among patients with resected BTC. Sarcopenia may have better prognostic value when combined with the PNI.
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Affiliation(s)
- Masashi Utsumi
- Department of Surgery, NHO Fukuyama Medical Center, 4-14-17 Okinogami-Cho, Fukuyama, Hiroshima, 720-8520, Japan.
| | - Masaru Inagaki
- Department of Surgery, NHO Fukuyama Medical Center, 4-14-17 Okinogami-Cho, Fukuyama, Hiroshima, 720-8520, Japan
| | - Koji Kitada
- Department of Surgery, NHO Fukuyama Medical Center, 4-14-17 Okinogami-Cho, Fukuyama, Hiroshima, 720-8520, Japan
| | - Naoyuki Tokunaga
- Department of Surgery, NHO Fukuyama Medical Center, 4-14-17 Okinogami-Cho, Fukuyama, Hiroshima, 720-8520, Japan
| | - Kosuke Yonoki
- Department of Surgery, NHO Fukuyama Medical Center, 4-14-17 Okinogami-Cho, Fukuyama, Hiroshima, 720-8520, Japan
| | - Yuya Sakurai
- Department of Surgery, NHO Fukuyama Medical Center, 4-14-17 Okinogami-Cho, Fukuyama, Hiroshima, 720-8520, Japan
| | - Hiroki Okabayashi
- Department of Surgery, NHO Fukuyama Medical Center, 4-14-17 Okinogami-Cho, Fukuyama, Hiroshima, 720-8520, Japan
| | - Ryosuke Hamano
- Department of Surgery, NHO Fukuyama Medical Center, 4-14-17 Okinogami-Cho, Fukuyama, Hiroshima, 720-8520, Japan
| | - Hideaki Miyasou
- Department of Surgery, NHO Fukuyama Medical Center, 4-14-17 Okinogami-Cho, Fukuyama, Hiroshima, 720-8520, Japan
| | - Yousuke Tsunemitsu
- Department of Surgery, NHO Fukuyama Medical Center, 4-14-17 Okinogami-Cho, Fukuyama, Hiroshima, 720-8520, Japan
| | - Shinya Otsuka
- Department of Surgery, NHO Fukuyama Medical Center, 4-14-17 Okinogami-Cho, Fukuyama, Hiroshima, 720-8520, Japan
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Zhu XS, Zhao Y, Ma FY, Wu SK. Value of Preoperative Hematological Parameters in the Prognosis of Gastric Cancer Patients Undergoing a Total Gastrectomy. Curr Med Sci 2022; 42:348-356. [PMID: 35419673 DOI: 10.1007/s11596-022-2514-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 10/20/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE This study aimed to evaluate the relationships between the albumin/globulin ratio (AGR), neutrophil/lymphocyte ratio (NLR), and platelet/lymphocyte ratio (PLR) and clinicopathological information for gastric cancer patients. In addition, the prognostic values of these hematological parameters for resectable gastric cancer patients undergoing a total gastrectomy were determined. METHODS A total of 245 patients with gastric cancer who underwent a total gastrectomy at our hospital between January 1, 2005, and December 30, 2015, were enrolled into this study. The preoperative AGR, NLR, and PLR in the serum samples of the patients were measured. The relationships between the hematological parameters and the disease-free survival (DFS) as well as overall survival (OS) were analyzed by statistical analysis. RESULTS The cutoff values of AGR, NLR, and PLR were 1.57, 3.5, and 193, respectively. Univariate analyses demonstrated that a low AGR, a high NLR, and a high PLR were significant risk factors for a poor prognosis. According to multivariate analysis, a high PLR was found to be independently associated with a poor survival. Additionally, when age was considered as a stratified factor, univariate analyses demonstrated that a low AGR had the tendency to be correlated with a shorter DFS in nonelderly patients (<65 years old). A low AGR was significantly correlated with a shorter DFS and OS in elderly patients (≥65 years old). CONCLUSION AGR, NLR, and PLR are independent risk factors associated with a poor gastric cancer survival by univariate analysis, and AGR is an independent risk factor for predicting DFS and OS in elderly patients (≥65 years old) with gastric cancer after total gastrectomy.
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Affiliation(s)
- Xi-Shan Zhu
- Oncology Department, Peking University First Hospital, Beijing, 100034, China
| | - Ye Zhao
- Pathology Department, Peking University First Hospital, Beijing, 100034, China
| | - Fei-Yan Ma
- Oncology Department, Peking University First Hospital, Beijing, 100034, China
| | - Shi-Kai Wu
- Oncology Department, Peking University First Hospital, Beijing, 100034, China.
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Li Q, Wang Y, Jin T, Lu L, Tong Y. Effect of trimodal pre-rehabilitation on the rehabilitation of patients with gastrointestinal tumors in the perioperative period. Am J Transl Res 2022; 14:967-978. [PMID: 35273699 PMCID: PMC8902580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 12/14/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To explore the effects of trimodal pre-rehabilitation on the rehabilitation of patients with gastrointestinal tumors in the perioperative period. METHODS Clinical data of 878 patients with gastrointestinal tumors undergoing surgical treatment in our hospital were analyzed in this retrospective study. They were divided into a control group and an observation group. The patients in the control group received only routine preoperative education and guidance before operation, while those in the observation group received preoperative trimodal pre-rehabilitation. The nutritional status, sleep quality, psychological status, and physical function of two groups were compared 1 day before operation and at discharge. The postoperative complications, length of hospital stays, and hospitalization expenses were compared. The patients were followed up for three months after discharge from the hospital, and the quality of life between groups was compared. RESULTS The nutritional status of two groups 1 day before operation and at discharge was improved compared with that at admission (all P<0.001). The nutritional status in the observation group was better than that in the control group 1 day before operation. The scores of sleep quality, psychological status, and physical function of the observation group were higher than those in the control group 1 day before surgery and at discharge (all P<0.001). The observation group had shorter hospital stays and lower hospitalization expenses than the control group (all P<0.001). The 3-month follow-up after discharge showed that the observation group had higher quality of life than the control group (all P<0.05). CONCLUSION Trimodal pre-rehabilitation can improve the preoperative nutritional status, sleep quality, psychological state, and physical function of patients with gastrointestinal tumors during the perioperative period. Besides, it can shorten the hospital stays, reduce the total hospitalization expenses, and improve the quality of life of patients after discharge. It is worthy of clinical promotion.
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Affiliation(s)
- Qianju Li
- Department of Gastrointestinal Surgery, Ninghai First HospitalNingbo 315600, Zhejiang Province, China
| | - Yukun Wang
- Department of Gastrointestinal Surgery, Ninghai First HospitalNingbo 315600, Zhejiang Province, China
| | - Tianhao Jin
- Department of Gastrointestinal Surgery, Ninghai First HospitalNingbo 315600, Zhejiang Province, China
| | - Liesheng Lu
- Department of Metabolic Surgery, Shanghai Tenth People’s HospitalShanghai 200072, China
| | - Yifeng Tong
- Department of Gastrointestinal Surgery, Ninghai First HospitalNingbo 315600, Zhejiang Province, China
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Utsumi M, Kitada K, Tokunaga N, Kato T, Narusaka T, Hamano R, Miyasou H, Tsunemitsu Y, Otsuka S, Inagaki M. A combined prediction model for biliary tract cancer using the prognostic nutritional index and pathological findings: a single-center retrospective study. BMC Gastroenterol 2021; 21:375. [PMID: 34645392 PMCID: PMC8513195 DOI: 10.1186/s12876-021-01957-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 10/05/2021] [Indexed: 02/07/2023] Open
Abstract
Background The prognostic nutritional index, a marker of nutritional status and systemic inflammation, is a known biomarker for various cancers. However, few studies have evaluated the predictive value of the prognostic nutritional index in patients with biliary tract cancer. Therefore, we investigated the prognostic significance of the prognostic nutritional index, and developed a risk-stratification system to identify prognostic factors in patients with biliary tract cancer. Methods Between July 2010 and March 2021, 117 patients with biliary tract cancer were recruited to this single-center, retrospective study. The relationship between clinicopathological variables, including the prognostic nutritional index, and overall survival was analyzed using univariate and multivariate analyses. A P < 0.05 was considered statistically significant. Results The median age was 75 (range 38–92) years. Thirty patients had intrahepatic cholangiocarcinoma; 29, gallbladder carcinoma; 27, distal cholangiocarcinoma; 17, ampullary carcinoma; and 13, perihilar cholangiocarcinoma. Curative (R0) resection was achieved in 99 patients. In univariate analysis, the prognostic nutritional index (< 42), lymph node metastasis, carbohydrate antigen 19-9 level (> 20 U/mL), preoperative cholangitis, tumor differentiation, operation time (≥ 360 min), and R1–2 resection were significant risk factors for overall survival. The prognostic nutritional index (P = 0.027), lymph node metastasis (P = 0.040), and tumor differentiation (P = 0.006) were independent prognostic factors in multivariate analysis. A combined score of the prognostic nutritional index and pathological findings outperformed each marker alone, in terms of discriminatory power. Conclusions The prognostic nutritional index, lymph node metastasis, and tumor differentiation were independent prognostic factors after surgical resection in patients with biliary tract cancer. A combined prediction model using the prognostic nutritional index and pathological findings accurately predicted prognosis, and can be used as a novel prognostic factor in patients with biliary tract cancer.
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Affiliation(s)
- Masashi Utsumi
- Department of Surgery, National Hospital Organization Fukuyama Medical Center, 4-14-17 Okinogami-cho, Fukuyama City, Hiroshima, 720-8520, Japan.
| | - Koji Kitada
- Department of Surgery, National Hospital Organization Fukuyama Medical Center, 4-14-17 Okinogami-cho, Fukuyama City, Hiroshima, 720-8520, Japan
| | - Naoyuki Tokunaga
- Department of Surgery, National Hospital Organization Fukuyama Medical Center, 4-14-17 Okinogami-cho, Fukuyama City, Hiroshima, 720-8520, Japan
| | - Takamitsu Kato
- Department of Surgery, National Hospital Organization Fukuyama Medical Center, 4-14-17 Okinogami-cho, Fukuyama City, Hiroshima, 720-8520, Japan
| | - Toru Narusaka
- Department of Surgery, National Hospital Organization Fukuyama Medical Center, 4-14-17 Okinogami-cho, Fukuyama City, Hiroshima, 720-8520, Japan
| | - Ryosuke Hamano
- Department of Surgery, National Hospital Organization Fukuyama Medical Center, 4-14-17 Okinogami-cho, Fukuyama City, Hiroshima, 720-8520, Japan
| | - Hideaki Miyasou
- Department of Surgery, National Hospital Organization Fukuyama Medical Center, 4-14-17 Okinogami-cho, Fukuyama City, Hiroshima, 720-8520, Japan
| | - Yousuke Tsunemitsu
- Department of Surgery, National Hospital Organization Fukuyama Medical Center, 4-14-17 Okinogami-cho, Fukuyama City, Hiroshima, 720-8520, Japan
| | - Shinya Otsuka
- Department of Surgery, National Hospital Organization Fukuyama Medical Center, 4-14-17 Okinogami-cho, Fukuyama City, Hiroshima, 720-8520, Japan
| | - Masaru Inagaki
- Department of Surgery, National Hospital Organization Fukuyama Medical Center, 4-14-17 Okinogami-cho, Fukuyama City, Hiroshima, 720-8520, Japan
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Lu Y, Ren C, Jiang J. The Relationship Between Prognostic Nutritional Index and All-Cause Mortality in Critically Ill Patients: A Retrospective Study. Int J Gen Med 2021; 14:3619-3626. [PMID: 34305408 PMCID: PMC8296707 DOI: 10.2147/ijgm.s318896] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 07/02/2021] [Indexed: 01/21/2023] Open
Abstract
Purpose The effectiveness and prognostic value of the prognostic nutritional index (PNI) in critically ill patients are unknown. Hence, this study aimed to analyze the relationship between the PNI and all-cause mortality in critically ill patients. Patients and Methods Patient data were obtained from the Multiparameter Intelligent Monitoring in Intensive Care III database. The relationship between the PNI and in-hospital mortality was analyzed using receiver operating characteristic curve analysis and a logistic regression model. Propensity score matching (PSM) was used to eliminate the bias caused by confounding factors. The Kaplan-Meier curve and Cox regression model were used to test the effect of the PNI on 30-, 90-, 180-, and 365-day mortality. Results A low PNI score is an independent risk factor for in-hospital mortality in critically ill patients. A total of 3644 cases were successfully matched using PSM. The PSM group with balanced covariates obtained similar results in the three models, which were statistically significant. The Kaplan-Meier curve and Cox regression model showed that the PNI was negatively correlated with 30-, 90-, 180-, and 365-day all-cause mortality. Conclusion The PNI score is an independent risk factor for all-cause mortality in critically ill patients, where a low PNI score is associated with increased mortality.
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Affiliation(s)
- Yan Lu
- Clinical Laboratory, DongYang People's Hospital, Dongyang, 322100, Zhejiang, People's Republic of China
| | - Chaoxiang Ren
- Clinical Laboratory, DongYang People's Hospital, Dongyang, 322100, Zhejiang, People's Republic of China
| | - Jinwen Jiang
- Clinical Laboratory, DongYang People's Hospital, Dongyang, 322100, Zhejiang, People's Republic of China
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Efficacy and safety of adjuvant therapy after curative surgery for ampullary carcinoma: A systematic review and meta-analysis. Surgery 2021; 170:1205-1214. [PMID: 33902926 DOI: 10.1016/j.surg.2021.03.046] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 02/16/2021] [Accepted: 03/16/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND Ampullary carcinoma patients require radical resection for optimal survival; however, the outcomes are often unsatisfactory. The utility of adjuvant therapy among such patients is unclear, probably owing to its potential side effects. Therefore, this study investigated the benefits and safety of adjuvant therapy in resected ampullary carcinoma. METHODS Cochrane, Embase, Medline, and PubMed databases were systematically searched for eligible studies, and those comparing adjuvant therapy and surgical treatment alone were included. Hazard ratios for survival outcomes and the number of adverse events for safety endpoints were extracted and subjected to pooled analyses through a random-effects model. RESULTS In total, 27 studies involving 3,538 patients were included. Adjuvant therapy was significantly associated with decreased mortality risk (hazard ratio, 0.58; 95% confidence interval 0.40-0.84), especially for chemoradiotherapy (hazard ratio, 0.42; 95% confidence interval 0.28-0.62). Furthermore, adjuvant therapy was significantly associated with increased overall survival among high-risk patients (hazard ratio, 0.63; 95% confidence interval 0.48-0.82) or those with the pancreaticobiliary subtype (hazard ratio, 0.53; 95% confidence interval 0.32-0.85). By contrast, adjuvant therapy was not associated with improved overall survival among low-risk patients (hazard ratio, 0.93; 95% confidence interval 0.52-1.68) or those with the intestinal subtype (hazard ratio, 1.06; 95% confidence interval 0.57-1.95). Regarding the safety of adjuvant therapy, no intervention-related mortality occurred, and severe adverse events were within the acceptable range (risk difference, 0.04; 95% confidence interval 0.01-0.08). CONCLUSION The present results suggest that adjuvant therapy is safe and extends survival in high-risk patients or those with the pancreaticobiliary subtype of ampullary carcinoma.
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Xishan Z, Ye Z, Feiyan M, Liang X, Shikai W. The role of prognostic nutritional index for clinical outcomes of gastric cancer after total gastrectomy. Sci Rep 2020; 10:17373. [PMID: 33060715 PMCID: PMC7562903 DOI: 10.1038/s41598-020-74525-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 08/24/2020] [Indexed: 12/13/2022] Open
Abstract
The purpose of this article is to evaluate the relationship between the nutrition-based microenvironment and clinicopathological information for gastric cancer patients and to investigate the prognostic value of nutrition index for gastric cancer patients undergoing total gastrectomy. We retrospectively collected clinical information of 245 gastric cancer patients who underwent total gastrectomy in our hospital between January 1st 2005 and December 30th 2015. According to the prognostic nutritional index (PNI) level, they were divided into low PNI (< 43) group and high PNI (≥ 43) group. The relationship between PNI and the disease-free survival (DFS) and overall survival (OS) were analyzed by statistical analysis. Univariate analyses demonstrated that TNM stage (p = 0.025), patients age (p = 0.042), lymph node metastasis (p = 0.028), tumor differentiation (p = 0.037) and a low PNI (p = 0.033) were closely correlated with a poor prognosis. In multivariate analysis, TNM stage (p = 0.027) and a low PNI (p = 0.041) were found to be independently associated with poor survival. Additionally, when age was considered as a stratified factor, univariate analyses demonstrated that low PNI correlated with shorter DFS in non-elderly (< 65) patients (p = 0.022) and shorter DFS (p = 0.036) and OS (p = 0.047) in elderly (≥ 65) patients. The low prognostic nutritional index is an independent risk factor associated with poor gastric cancer survival which represents the nutritional microenvironment. Patients with low pre-operative prognostic nutritional index levels should be observed more closely after surgery to prevent the occurrence of post-operative complications in the near future.
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Affiliation(s)
- Zhu Xishan
- Oncology Department, Peking University, First Hospital, Cheniandianhutong No.5, Andingmen Street, DongCheng District, Beijing, China
| | - Zhao Ye
- Pathology Department, Peking University, First Hospital, Beijing, China
| | - Ma Feiyan
- Radiotherapy Department, Chengde Medical College, Baoding No.1 Middle Hospital, Baoding, China
| | - Xuan Liang
- Oncology Department, Peking University, First Hospital, Cheniandianhutong No.5, Andingmen Street, DongCheng District, Beijing, China
| | - Wu Shikai
- Oncology Department, Peking University, First Hospital, Cheniandianhutong No.5, Andingmen Street, DongCheng District, Beijing, China.
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