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Silva ACR, Antunes-Correa LDM, Juliani FL, Carrilho LAO, Costa FO, Martinez CAR, Mendes MCS, Carvalheira JBC. Assessing the role of prognostic nutritional index in predicting outcomes for rectal cancer surgery. Clin Nutr ESPEN 2024; 63:644-650. [PMID: 39094853 DOI: 10.1016/j.clnesp.2024.07.1058] [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] [Received: 11/20/2023] [Revised: 05/18/2024] [Accepted: 07/27/2024] [Indexed: 08/04/2024]
Abstract
BACKGROUND & AIMS The association of Prognostic Nutritional Index (PNI) with prognosis has been established for various cancer types, including rectal cancer. However, the precise relationship between PNI and body composition characteristics in patients with non-metastatic rectal cancer remain unclear. This study aimed to investigate the impact of PNI on overall survival and disease-free survival in non-metastatic rectal cancer patients undergoing total surgical resection. Additionally, it sought to assess the inflammatory status and body composition in patients across different PNI levels. METHODS Patients with non-metastatic rectal cancer who underwent total surgical resection, were consecutively enrolled. PNI was calculated using the formula: PNI = (10 × serum albumin [g/dl]) + (0.005 × lymphocytes/μL). Body composition was assessed using CT-derived measurements and laboratory tests performed at diagnosis were used to calculate inflammatory indices. Univariate and multivariate logistic regression analyses as well as Kaplan-Meier curves were used to determine prognostic values. RESULTS A total of 298 patients were included. Patients with low PNI demonstrated significantly reduced overall survival and disease-free survival compared to those with high PNI (Hazard ratio [HR] 1.85; Confidence interval [CI] 1.30-2 0.62; p = 0.001). Moreover, patients with low PNI exhibited heightened systemic inflammatory status and reduced skeletal muscle index, increased muscle radiodensity, as well as a decrease in subcutaneous adipose tissue area, subcutaneous fat index, and low attenuation of both subcutaneous and visceral adipose tissue. CONCLUSION The PNI, assessed prior to treatment initiation, serves as a prognostic biomarker for non-metastatic rectal cancer patients undergoing total surgical resection and is linked with both inflammation and alterations in body composition.
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Affiliation(s)
- Amanda Cristina Ribeiro Silva
- Universidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas, Divisão de Oncologia, Departamento de Anestesiologia, Oncologia e Radiologia, Tessália Vieira de Camargo Street, 126. Cidade Universitária "Zeferino Vaz", 13083-887, Campinas, SP, Brazil
| | - Lígia de Moraes Antunes-Correa
- Universidade Estadual de Campinas (UNICAMP), Escola de Educação Física, Érico Veríssimo Avenue, 701 - Barão Geraldo, 13083-851, Campinas, SP, Brazil
| | - Fabiana Lascala Juliani
- Universidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas, Divisão de Oncologia, Departamento de Anestesiologia, Oncologia e Radiologia, Tessália Vieira de Camargo Street, 126. Cidade Universitária "Zeferino Vaz", 13083-887, Campinas, SP, Brazil
| | - Larissa Ariel Oliveira Carrilho
- Universidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas, Divisão de Oncologia, Departamento de Anestesiologia, Oncologia e Radiologia, Tessália Vieira de Camargo Street, 126. Cidade Universitária "Zeferino Vaz", 13083-887, Campinas, SP, Brazil
| | - Felipe Osório Costa
- Universidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas, Divisão de Oncologia, Departamento de Anestesiologia, Oncologia e Radiologia, Tessália Vieira de Camargo Street, 126. Cidade Universitária "Zeferino Vaz", 13083-887, Campinas, SP, Brazil
| | - Carlos Augusto Real Martinez
- Universidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas, Divisão de Oncologia, Departamento de Anestesiologia, Oncologia e Radiologia, Tessália Vieira de Camargo Street, 126. Cidade Universitária "Zeferino Vaz", 13083-887, Campinas, SP, Brazil
| | - Maria Carolina Santos Mendes
- Universidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas, Divisão de Oncologia, Departamento de Anestesiologia, Oncologia e Radiologia, Tessália Vieira de Camargo Street, 126. Cidade Universitária "Zeferino Vaz", 13083-887, Campinas, SP, Brazil
| | - José Barreto Campello Carvalheira
- Universidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas, Divisão de Oncologia, Departamento de Anestesiologia, Oncologia e Radiologia, Tessália Vieira de Camargo Street, 126. Cidade Universitária "Zeferino Vaz", 13083-887, Campinas, SP, Brazil.
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Toyota K, Mori M, Hirahara S, Yoshioka S, Kubota H, Yano R, Kobayashi H, Hashimoto Y, Sakashita Y, Yokoyama Y, Murakami Y, Miyamoto K. Nutritional Status Indicators Affecting the Tolerability of Postoperative Chemotherapy After Total Gastrectomy in Patients With Gastric Cancer. J Gastric Cancer 2022; 22:56-66. [PMID: 35425654 PMCID: PMC8980594 DOI: 10.5230/jgc.2022.22.e5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 02/14/2022] [Accepted: 02/15/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- Kazuhiro Toyota
- Department of Surgery, Hiroshima Memorial Hospital, Hiroshima, Japan
| | - Masayuki Mori
- Department of Surgery, Hiroshima Memorial Hospital, Hiroshima, Japan
| | - Satoshi Hirahara
- Department of Surgery, Hiroshima Memorial Hospital, Hiroshima, Japan
| | - Shoko Yoshioka
- Department of Surgery, Hiroshima Memorial Hospital, Hiroshima, Japan
| | - Haruna Kubota
- Department of Surgery, Hiroshima Memorial Hospital, Hiroshima, Japan
| | - Raita Yano
- Department of Surgery, Hiroshima Memorial Hospital, Hiroshima, Japan
| | | | - Yasushi Hashimoto
- Department of Surgery, Hiroshima Memorial Hospital, Hiroshima, Japan
| | | | - Yujiro Yokoyama
- Department of Surgery, Hiroshima Memorial Hospital, Hiroshima, Japan
| | - Yoshiaki Murakami
- Department of Surgery, Hiroshima Memorial Hospital, Hiroshima, Japan
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Tamai M, Kiuchi J, Kuriu Y, Arita T, Shimizu H, Ohashi T, Konishi H, Yamamoto Y, Morimura R, Shiozaki A, Ikoma H, Kubota T, Fujiwara H, Okamoto K, Otsuji E. Clinical impact of postoperative prognostic nutritional index in colorectal cancer patients undergoing adjuvant chemotherapy. Am J Cancer Res 2021; 11:4947-4955. [PMID: 34765302 PMCID: PMC8569341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 08/13/2021] [Indexed: 06/13/2023] Open
Abstract
Preoperative Prognostic Nutritional Index (PNI) could be a crucial factor for the prognosis of colorectal cancer (CRC). However, the clinical impact of postoperative PNI is still unclear, and there have been no reports on the significance of postoperative PNI in patients undergoing adjuvant chemotherapy (AC). We retrospectively analysed 227 consecutive patients who underwent AC after radical surgery for high-risk stage II or stage III CRC. PNI value was calculated before radical surgery and before the introduction of AC. In our study, patients with a low PNI value before surgery showed significantly poorer long-term outcomes than those with a high PNI value. Next, we divided the patients into four groups: patients with a high PNI value before surgery and remained after surgery (Group High-High), a high PNI value before surgery but decreased after surgery (Group High-Low), a low PNI value before surgery but recovered after surgery (Group Low-High), and a low PNI value but did not recover after surgery (Group Low-Low). Although the patients in Group Low-Low showed significantly poorer long-term outcomes than those in Group High-High, the prognosis of patients in Group Low-High was the same as that of patients in Group High-High. In addition, in patients with recurrence after AC, those with a high PNI value at the time of recurrence showed a significantly better survival after recurrence than patients with a low PNI value. Postoperative PNI value could be a prognostic biomarker for CRC patients undergoing AC. Even though the PNI value was low before the surgery, recovery of PNI value by the introduction of AC could improve the prognosis of CRC patients.
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Wang F, Tao T, Yu H, Xu Y, Yang Z, Xia X, Wang M, Zong L, Guan W. Prognostic value of Onodera's nutritional index for intermediate- and high-risk gastrointestinal stromal tumors treated with or without tyrosine kinase inhibitors. World J Surg Oncol 2021; 19:227. [PMID: 34344373 PMCID: PMC8336234 DOI: 10.1186/s12957-021-02345-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 07/25/2021] [Indexed: 01/04/2023] Open
Abstract
Background Immunoinflammatory and nutritional markers, such as the peripheral blood neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and Onodera’s prognostic nutritional index (OPNI), have gained considerable attention and have been preliminarily revealed as prognostic markers of gastrointestinal stromal tumors (GISTs). Methods In this study, we first investigated the prognostic value of OPNI in GISTs treated with or without TKIs based on the propensity score matching (PSM) method. All of the patients had received surgical resection for primary GIST, and data from 2010 to 2018 were initially and retrospectively identified from our gastrointestinal center. Recurrence-free survival (RFS) was calculated by the Kaplan–Meier method and compared by the log-rank test. Results The patients were divided into groups treated and not treated with TKIs, and we used the propensity score matching method to homogenize their baseline data. Multivariate Cox proportional hazard regression models were applied to identify associations with outcome variables. A total of 563 GISTs were initially chosen, and 280 of them were included for analysis under the inclusion criteria. After PSM, there were 200 patients included. Multivariate analyses identified OPNI as an independent prognostic marker that was associated with primary site, tumor size, mitotic index, tumor rupture, necrosis, and modified NIH risk classification. Low OPNI (< 42.6; HR 0.409; P < 0.001) was associated with worse RFS. Conclusions Preoperative OPNI is a novel and useful prognostic marker for GISTs both treated and not treated with TKIs. Higher NLR and PLR have negative effects on RFS.
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Affiliation(s)
- Feng Wang
- Department of General Surgery, Drum Tower Clinical Medical College of Nanjing Medical University, Nanjing, Jiangsu Province, People's Republic of China
| | - Tingting Tao
- Department of General Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu Province, People's Republic of China
| | - Heng Yu
- Department of General Surgery, Drum Tower Clinical Medical College of Nanjing Medical University, Nanjing, Jiangsu Province, People's Republic of China
| | - Yingying Xu
- Department of General Surgery, Yizhen People's Hospital, Clinical Medical College, Yangzhou University, Yangzhou, Jiangsu Province, People's Republic of China
| | - Zhi Yang
- Department of General Surgery, Drum Tower Clinical Medical College of Nanjing Medical University, Nanjing, Jiangsu Province, People's Republic of China
| | - Xuefeng Xia
- Department of General Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu Province, People's Republic of China
| | - Meng Wang
- Department of General Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu Province, People's Republic of China.
| | - Liang Zong
- Department of Gastrointestinal Surgery, Changzhi People's Hospital, The Affiliated Hospital of Changzhi Medical College, Changzhi, Shanxi Province, People's Republic of China.
| | - Wenxian Guan
- Department of General Surgery, Drum Tower Clinical Medical College of Nanjing Medical University, Nanjing, Jiangsu Province, People's Republic of China.
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Uludag SS, Sanli AN, Zengin AK, Ozcelik MF. Systemic Inflammatory Biomarkers as Surrogate Markers for Stage in Colon Cancer. Am Surg 2021; 88:1256-1262. [PMID: 33596111 DOI: 10.1177/0003134821995059] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND This study aimed to investigate whether the systemic inflammatory parameters currently in use in staging the disease can be used as biomarker tests operated colon cancer patients. Neutrophil, lymphocyte, monocyte, platelet, neutrophil/lymphocyte ratio (NLR), lymphocyte/monocyte ratio (LMR), platelet/lymphocyte ratio (PLR), neutrophil/monocyte ratio (NMR), CRP, albumin, lymphocyte/CRP ratio, CRP/albumin ratio, and neutrophil/albumin ratio as systemic inflammatory biomarkers and prognostic nutritional index (PNI) were evaluated. METHODS This retrospective study included 592 patients. Patients with colon cancer in the cohort were divided into 2 subgroups: Tumor, nodes, metastases (TNM) stage 0, TNM stage 1, and TNM stage 2; early stage (n: 332) and TNM stage 3 and TNM stage 4; late stage (n: 260) colon cancer patients. RESULTS LDH (P < .001), NLR (P < .001), PLR (P < .05), CRP/albumin (P < .01), and neutrophil/albumin (P < .01) were significantly higher, while monocyte count (P < .05) and PNI (P < .01) were found to be significantly lower in late stage colon cancer patients than in early stage colon cancer patients. Moderate negative correlation was found between the PNI and the neutrophil/albumin ratio in late stage colon cancer patients (r: -.568, P < .001). CONCLUSIONS Our data suggest that high serum LDH, NLR, PLR, CRP/albumin, and neutrophil/albumin may be useful predictive markers for advanced stage in colon cancer. According to the receiver operating characteristic analysis results, CRP/albumin ratio can be used to discriminate early from late stage. Preoperative low monocyte count and PNI are associated with postoperative staging patients with colon cancer.
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Affiliation(s)
- Server Sezgin Uludag
- Department of Surgery, Cerrahpasa Medicine Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ahmet Necati Sanli
- Department of Surgery, Cerrahpasa Medicine Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Abdullah Kagan Zengin
- Department of Surgery, Cerrahpasa Medicine Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Mehmet Faik Ozcelik
- Department of Surgery, Cerrahpasa Medicine Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
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Sato R, Oikawa M, Kakita T, Okada T, Abe T, Yazawa T, Tsuchiya H, Akazawa N, Sato M, Ohira T, Harada Y, Okano H, Ito K, Tsuchiya T. The prognostic value of the prognostic nutritional index and inflammation-based markers in obstructive colorectal cancer. Surg Today 2020; 50:1272-1281. [PMID: 32346761 DOI: 10.1007/s00595-020-02007-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 04/03/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE Inflammation-based markers predict long-term outcomes of various malignancies. We investigated the relationship between these markers and the long-term survival in obstructive colorectal cancer (OCRC) patients with self-expandable metallic colonic stents (SEMSs) who subsequently received curative surgery. METHODS We retrospectively analyzed 72 consecutive pathological stage II and III OCRC patients between 2013 and 2019. The prognostic significance of the prognostic nutritional index (PNI), neutrophil-lymphocyte ratio (NLR), lymphocyte-monocyte ratio (LMR), and platelet-lymphocyte ratio (PLR) was evaluated. RESULTS The overall survival (OS), cancer-specific survival, and disease-free survival (DFS) were significantly shorter in the PNI < 35 group than in the PNI ≥ 35 group (p = 0.006, p < 0.001, and p = 0.003, respectively), and multivariate analyses revealed the PNI to be the only inflammation-based marker independently associated with the survival. A PNI < 35 was significantly associated with an elevated CA 19-9 level (p = 0.04) and longer postoperative hospital stay (p = 0.03). Adjuvant chemotherapy was also significantly associated with the OS (p = 0.040) and DFS (p = 0.011) in multivariate analyses. CONCLUSION The results showed that the PNI was a potent prognostic indicator. For OCRC patients, both systemic inflammation and the nutrition status seem to be important for predicting the prognosis, and administering adjuvant chemotherapy was very important.
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Affiliation(s)
- Ryuichiro Sato
- Department of Gastroenterological Surgery, Sendai City Medical Center Sendai Open Hospital, 5-22-1 Tsurugaya, Miyagino-ku, Sendai, 983-0824, Japan.
| | - Masaya Oikawa
- Department of Gastroenterological Surgery, Sendai City Medical Center Sendai Open Hospital, 5-22-1 Tsurugaya, Miyagino-ku, Sendai, 983-0824, Japan
| | - Tetsuya Kakita
- Department of Gastroenterological Surgery, Sendai City Medical Center Sendai Open Hospital, 5-22-1 Tsurugaya, Miyagino-ku, Sendai, 983-0824, Japan
| | - Takaho Okada
- Department of Gastroenterological Surgery, Sendai City Medical Center Sendai Open Hospital, 5-22-1 Tsurugaya, Miyagino-ku, Sendai, 983-0824, Japan
| | - Tomoya Abe
- Department of Gastroenterological Surgery, Sendai City Medical Center Sendai Open Hospital, 5-22-1 Tsurugaya, Miyagino-ku, Sendai, 983-0824, Japan
| | - Takashi Yazawa
- Department of Gastroenterological Surgery, Sendai City Medical Center Sendai Open Hospital, 5-22-1 Tsurugaya, Miyagino-ku, Sendai, 983-0824, Japan
| | - Haruyuki Tsuchiya
- Department of Gastroenterological Surgery, Sendai City Medical Center Sendai Open Hospital, 5-22-1 Tsurugaya, Miyagino-ku, Sendai, 983-0824, Japan
| | - Naoya Akazawa
- Department of Gastroenterological Surgery, Sendai City Medical Center Sendai Open Hospital, 5-22-1 Tsurugaya, Miyagino-ku, Sendai, 983-0824, Japan
| | - Masaki Sato
- Department of Gastroenterological Surgery, Sendai City Medical Center Sendai Open Hospital, 5-22-1 Tsurugaya, Miyagino-ku, Sendai, 983-0824, Japan
| | - Tetsuya Ohira
- Department of Gastroenterology, Sendai City Medical Center Sendai Open Hospital, 5-22-1 Tsurugaya, Miyagino-ku, Sendai, 983-0824, Japan
| | - Yoshihiro Harada
- Department of Gastroenterology, Sendai City Medical Center Sendai Open Hospital, 5-22-1 Tsurugaya, Miyagino-ku, Sendai, 983-0824, Japan
| | - Haruka Okano
- Department of Gastroenterology, Sendai City Medical Center Sendai Open Hospital, 5-22-1 Tsurugaya, Miyagino-ku, Sendai, 983-0824, Japan
| | - Kei Ito
- Department of Gastroenterology, Sendai City Medical Center Sendai Open Hospital, 5-22-1 Tsurugaya, Miyagino-ku, Sendai, 983-0824, Japan
| | - Takashi Tsuchiya
- Department of Gastroenterological Surgery, Sendai City Medical Center Sendai Open Hospital, 5-22-1 Tsurugaya, Miyagino-ku, Sendai, 983-0824, Japan
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