Department of Gastroduodenal and Pancreatic Surgery, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China.
Department of Gastroenterology and Urology, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China.
Eur J Clin Nutr. 2020 Apr;74(4):555-564. doi: 10.1038/s41430-019-0502-1. Epub 2019 Sep 23.
BACKGROUND/OBJECTIVE: To investigate the impact of preoperative immunological and nutritional status, using the prognostic nutritional index (PNI), on completion of planned adjuvant chemotherapy (AC), and the potential additive effects of low PNI and incomplete AC on gastric cancer-specific survival (CSS) after curative resection of stage II/III gastric cancer (GC).
Medical records of 1288 consecutive stage II/III GC patients who underwent curative resection and planned to receive AC between November 2010 and December 2017 were retrospectively reviewed. The optimal cut-off value of PNI for CSS was determined by X-tile. The independent predictive factors for incomplete AC were identified using univariate and multivariate analyses. Cox regression analyses assessed the association of low PNI, incomplete AC and CSS.
Of the 1288 patients, 406 (31.5%) completed at least six cycles of AC within 6 months following initial of AC (complete AC). Low PNI (<43.9, n = 386) was identified to be an independent risk factor for incomplete AC (<6 cycles). Both low PNI and incomplete AC independently predicted poor CSS (hazard ratio (HR): 1.287, 95% confidence interval (CI): 1.058-1.565; HR: 1.667, 95% CI: 1.342-2.071). Further analyses confirmed an additive effect with those with both low PNI and incomplete AC having an even worse CSS.
Low preoperative PNI significantly affects completion of AC. Low PNI and incomplete AC has an additive effect and is associated with even worse outcomes. Further prospective studies are needed to clarify whether perioperative nutrition intervention could improve completion of AC and improve prognosis of GC patients.
背景/目的：研究使用预后营养指数（PNI）评估术前免疫和营养状态对计划辅助化疗（AC）完成情况的影响，并评估低 PNI 和不完整 AC 对 II/III 期胃癌（GC）根治性切除后胃癌特异性生存（CSS）的潜在附加影响。
回顾性分析了 2010 年 11 月至 2017 年 12 月期间接受根治性切除术且计划接受 AC 的 1288 例连续 II/III 期 GC 患者的病历。通过 X-tile 确定 PNI 对 CSS 的最佳截断值。使用单因素和多因素分析确定不完整 AC 的独立预测因素。Cox 回归分析评估低 PNI、不完整 AC 和 CSS 之间的关系。
在 1288 例患者中，有 406 例（31.5%）在初始 AC 后 6 个月内完成了至少 6 个周期的 AC（完全 AC）。低 PNI（<43.9，n=386）被确定为不完整 AC（<6 个周期）的独立危险因素。低 PNI 和不完整 AC 均独立预测 CSS 不良（风险比（HR）：1.287，95%置信区间（CI）：1.058-1.565；HR：1.667，95% CI：1.342-2.071）。进一步的分析证实了两者的相加效应，即同时存在低 PNI 和不完整 AC 的患者 CSS 更差。
术前低 PNI 显著影响 AC 的完成情况。低 PNI 和不完整 AC 具有相加效应，并与更差的结果相关。需要进一步的前瞻性研究来阐明围手术期营养干预是否可以提高 AC 的完成率并改善 GC 患者的预后。
