Department of Essential Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, People's Republic of China.
Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, 410078, People's Republic of China.
Int J Clin Oncol. 2020 Nov;25(11):1960-1968. doi: 10.1007/s10147-020-01743-5. Epub 2020 Jul 11.
This study was aimed to investigate the correlation between preoperative prognostic nutritional index (PNI) and permanent stoma (PS) in patients with defunctioning stoma (DS) after anterior resections and, based on it, to reveal the clinical value of PNI on clinical strategies about the selection of stoma location.
A total of 281 consecutive rectal cancer patients who accepted anterior resection and DS in the National Hepatobiliary and Enteric Surgery Research Center, Xiangya Hospital, Central South University from June 2008 to June 2018 were enrolled in this study. Receiver operating characteristic (ROC) curve for PNI was performed to discriminate PS. Univariate and multivariate analysis were conducted to identify the clinical characteristics and risk factors for PS. Specific reasons for patients with DS turned into PS were reviewed.
ROC curve analysis defined PNI cutoff level of 45.85 corresponding to PS (area under the curve (AUC) = 0.71, 77% sensitivity, 56.9% specificity). Low PNI (OR = 3.23, P = 0.005), tumor crossing the peritoneal reflection (PR) (OR = 3.42, P = 0.003), postoperative distant metastasis (OR = 6.31, P < 0.001) were independently associated with PS. Besides, anastomotic complications (31.4%), poor oncological outcomes (35.3%), and personal preferences (33.3%) were the specific reasons for patients turning into PS.
Preoperative PNI is an independent prognostic factor to predict PS in patients who underwent anterior resection and DS. Therefore, combined with other clinical characteristics and predictors, preoperative measurements of PNI could provide a significant support for clinical decision on patients prepared to accept anterior resection and DS.
本研究旨在探讨术前预后营养指数（PNI）与直肠癌前切除术后预防性造口（DS）永久性造口（PS）之间的相关性，并基于此揭示 PNI 对造口位置选择临床策略的临床价值。
回顾性分析 2008 年 6 月至 2018 年 6 月在中南大学湘雅医院国家肝胆肠外科研究中心接受前切除术和 DS 的 281 例连续直肠癌患者的临床资料。采用受试者工作特征（ROC）曲线分析 PNI 对 PS 的预测价值。采用单因素和多因素分析确定 PS 的临床特征和危险因素。分析发生 DS 转为 PS 的具体原因。
ROC 曲线分析确定 PNI 截断值为 45.85，对应 PS（曲线下面积（AUC）=0.71，77%敏感性，56.9%特异性）。低 PNI（OR=3.23，P=0.005）、肿瘤越过腹膜反射（OR=3.42，P=0.003）、术后远处转移（OR=6.31，P<0.001）与 PS 独立相关。此外，吻合口并发症（31.4%）、不良肿瘤学结果（35.3%）和个人偏好（33.3%）是导致患者转为 PS 的具体原因。
术前 PNI 是预测接受前切除术和 DS 的患者发生 PS 的独立预后因素。因此，结合其他临床特征和预测因素，术前 PNI 的测量可为接受前切除术和 DS 的患者的临床决策提供重要支持。
