Department of General Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China.
Department of General Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China.
Eur J Surg Oncol. 2019 Mar;45(3):425-431. doi: 10.1016/j.ejso.2018.09.004. Epub 2018 Oct 19.
Advanced gastric cancer (AGC) causes debilitating malnutrition and leads to deterioration of the immune response. However, the concept of the prognostic nutritional index (PNI) is controversial when applied to patients with AGC. The aim of the present study was to evaluate the effect of the PNI after gastrectomy in patients with AGC.
A multicenter retrospective study was conducted using propensity score matching (PSM) in gastric adenocarcinoma patients who underwent resection via laparoscopic or open surgery between 2014 and 2017. To overcome selection bias, we performed 1:1 matching using 5 covariates.
The resection margins (P < 0.001) and LNM (P = 0.004) were significantly different between the two groups. In univariate analysis, poor tumor differentiation (P = 0.038) (R1+R2, P = 0.004), vascular and neural invasion (P < 0.001), and a PNI<50 (P < 0.001) were associated with poor recurrence-free survival (RFS). In multivariate analysis, a PNI<50 (hazard ratio (HR), 12.993; P < 0.001) was a risk factor for RFS. Univariate analysis for overall survival (OS) revealed that a PNI<50 (P < 0.001) (R1+R2,P = 0.006) and vascular and neural invasion (P < 0.001) were risk factors. In subsequent multivariate analysis, a PNI<50 (HR, 24.501; P < 0.001) was a significant risk factor for OS. Clinical assessments performed during a 12.34 (±5.050) month follow-up revealed that OS (P < 0.001) and RFS (P < 0.001) were worse in patients with a low PNI (<50) than in matched patients with a high PNI.
A low PNI is a strong predictor of unfavorable RFS and OS in patients with AGC.
晚期胃癌（AGC）导致使人虚弱的营养不良，并导致免疫反应恶化。然而，当应用于 AGC 患者时，预后营养指数（PNI）的概念存在争议。本研究旨在评估 AGC 患者胃切除术后 PNI 的影响。
使用倾向评分匹配（PSM）对 2014 年至 2017 年间接受腹腔镜或开放手术切除的胃腺癌患者进行多中心回顾性研究。为了克服选择偏差，我们使用 5 个协变量进行了 1:1 匹配。
两组之间的切缘（P<0.001）和 LNM（P=0.004）差异有统计学意义。单因素分析显示，肿瘤分化差（P=0.038）（R1+R2，P=0.004）、血管和神经侵犯（P<0.001）以及 PNI<50（P<0.001）与无复发生存率（RFS）不良相关。多因素分析显示，PNI<50（危险比（HR），12.993；P<0.001）是 RFS 的危险因素。OS 的单因素分析显示，PNI<50（P<0.001）（R1+R2，P=0.006）和血管和神经侵犯（P<0.001）是危险因素。随后的多因素分析显示，PNI<50（HR，24.501；P<0.001）是 OS 的显著危险因素。在 12.34（±5.050）个月的随访期间进行的临床评估显示，PNI 较低（<50）的患者的 OS（P<0.001）和 RFS（P<0.001）均比匹配的 PNI 较高的患者差。
PNI 较低是 AGC 患者不良 RFS 和 OS 的有力预测指标。
