Department of Anesthesiology and Pain Medicine, International St. Mary's Hospital, Catholic Kwandong University School of Medicine, Incheon, South Korea.
Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
J Thorac Cardiovasc Surg. 2020 Jul;160(1):276-285.e1. doi: 10.1016/j.jtcvs.2019.10.105. Epub 2019 Nov 6.
The prognostic nutritional index is a score that represents a patient's immune-nutritional status based on the lymphocyte count and serum albumin concentration. We hypothesized that preoperative prognostic nutritional index is associated with postoperative complications and long-term outcomes after curative resection of lung cancer.
We retrospectively analyzed 1011 patients with pathologic stage I-III adenocarcinoma and squamous cell carcinoma who underwent open thoracotomy for curative resection of lung cancer. The preoperative prognostic nutritional index was calculated as follows based on preoperative laboratory data: 10 × serum albumin (g/dL) + 5 × total lymphocyte count (/nL). The cutoff value of prognostic nutritional index (cutoff value: 50) was obtained by receiver operating characteristics curve and patients were classified as high and low groups. Outcomes were compared with the use of propensity scores and inverse probability weighting adjustment to reduce treatment selection bias.
The low group exhibited more postoperative complications (34% [96/285] vs 24% [174/726]; P = .002) especially pneumonia (13% [36/285] vs 6% [41/756]; P < .001) and delirium (10% [29/285] vs 5% [36/726]; P = .002), and greater in-hospital mortality (4% [11/285] vs 1% [9/726]; P = .007) than the high group. A low prognostic nutritional index was associated with greater postoperative pulmonary complications [odds ratio, 1.7; 95% confidence interval, 1.3-2.3], lower recurrence-free survival (hazard ratio, 1.3; 95% confidence interval, 1.1-1.5), and overall survival (hazard ratio, 1.5; 95% confidence interval, 1.2-1.8) after balancing the covariables.
The preoperative prognostic nutritional index was associated with postoperative pulmonary complications and long-term outcomes after curative resection of non-small cell lung cancer.
预后营养指数是一种基于淋巴细胞计数和血清白蛋白浓度的患者免疫营养状态的评分。我们假设术前预后营养指数与肺癌根治性切除术后的术后并发症和长期预后相关。
我们回顾性分析了 1011 例病理分期 I-III 期腺癌和鳞癌患者，这些患者接受开胸手术根治性切除肺癌。根据术前实验室数据计算术前预后营养指数：10×血清白蛋白（g/dL）+5×总淋巴细胞计数（/nL）。通过接收者操作特征曲线获得预后营养指数的临界值（临界值：50），并将患者分为高组和低组。通过倾向评分和逆概率加权调整来比较结果，以减少治疗选择偏差。
低组术后并发症发生率较高（34%[285/96]比 24%[174/726]；P=0.002），特别是肺炎（13%[285/96]比 6%[756/41]；P<0.001）和谵妄（10%[285/285]比 5%[726/36]；P=0.002），住院死亡率较高（4%[285/96]比 1%[726/9]；P=0.007）。低预后营养指数与术后肺部并发症增加相关[比值比，1.7；95%置信区间，1.3-2.3]，无复发生存率降低（风险比，1.3；95%置信区间，1.1-1.5）和总生存率降低（风险比，1.5；95%置信区间，1.2-1.8），在平衡了协变量后。
术前预后营养指数与非小细胞肺癌根治性切除术后的肺部并发症和长期预后相关。
