Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan.
Department of Surgery, Faculty of Medicine, Kindai University, Osaka-Sayama, Japan.
Ann Surg Oncol. 2021 Nov;28(12):7173-7182. doi: 10.1245/s10434-021-09779-1. Epub 2021 Apr 9.
The Charlson Comorbidity Index (CCI), an indicator that objectively quantifies comorbidities, reduces nutritional status; however, the impact of the CCI on the postoperative nutrition indexes of patients with esophageal cancer remains unclear.
In total, 336 patients with esophageal cancer who underwent surgery between January 2011 and April 2017 were included in this study. We investigated the relationship between the CCI and postoperative nutrition indexes.
Patients were divided into two groups: CCI ≤1 (low CCI group) and CCI ≥2 (high CCI group). A high CCI was significantly associated with shortened overall survival (OS; 3-year OS rate of 77.9% in the low CCI group versus 59.7% in the high CCI group; p = 0.008). Nutritional indexes, such as the Prognostic Nutritional Index (PNI), at 1 month after esophagectomy were significantly lower in the high CCI group than in the low CCI group (p = 0.031); however, the PNI at 6 months after surgery was similar between the high and low CCI groups. Multivariate analysis identified high CCI as an independent risk factor associated with PNI <45 in esophageal cancer patients at 1 month after esophagectomy (p = 0.047).
This study showed that CCI ≥2 was significantly associated with poor PNI at 1 month after surgery for esophageal cancer, indicating that it is necessary to administer effective nutritional interventions for patients with postoperative malnutrition, especially those with multiple comorbidities.
Charlson 合并症指数(CCI)是一种客观量化合并症的指标,会降低营养状况;然而,CCI 对食管癌患者术后营养指标的影响尚不清楚。
本研究共纳入 2011 年 1 月至 2017 年 4 月期间接受手术治疗的 336 例食管癌患者,研究了 CCI 与术后营养指标之间的关系。
患者被分为两组:CCI≤1(低 CCI 组)和 CCI≥2(高 CCI 组)。高 CCI 与总生存期(OS)显著缩短相关(低 CCI 组的 3 年 OS 率为 77.9%,而高 CCI 组为 59.7%;p=0.008)。手术后 1 个月,高 CCI 组的营养指标,如预后营养指数(PNI)显著低于低 CCI 组(p=0.031);然而,高 CCI 组和低 CCI 组在手术后 6 个月时的 PNI 相似。多因素分析表明,CCI≥2 是食管癌患者手术后 1 个月时 PNI<45 的独立危险因素(p=0.047)。
本研究表明,CCI≥2 与食管癌患者术后 1 个月时 PNI 差显著相关,表明对于术后营养不良的患者,尤其是合并多种合并症的患者,有必要进行有效的营养干预。