Konishi Tomoki, Kosuga Toshiyuki, Inoue Hiroyuki, Konishi Hirotaka, Shiozaki Atsushi, Kubota Takeshi, Okamoto Kazuma, Fujiwara Hitoshi, Otsuji Eigo
Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan.
Department of Surgery, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, Japan.
J Gastrointest Surg. 2022 Mar;26(3):558-569. doi: 10.1007/s11605-021-05168-x. Epub 2021 Nov 1.
Malnutrition leads to accelerated tumor progression through the suppression of tumor immunity. The present study examined the significance of the preoperative prognostic nutritional index (PNI) for predicting postoperative survival outcomes in gastric cancer (GC).
A total of 447 patients who underwent curative gastrectomy for GC were included in the present study. PNI was calculated as 10 × serum albumin (g/dl) + 0.005 × total lymphocyte counts (per mm). The prognostic impact of preoperative PNI was examined using two multivariate analysis models.
The optimal cutoff value of preoperative PNI for predicting overall survival (OS) was 48 based on a receiver operating characteristic curve. The 5-year OS rate was 59.5% in the PNI<48 group and 91.3% in the PNI≥48 group (p<0.001). In the first multivariate survival analysis where all explanatory variables were composed of preoperative factors alone, a PNI<48 (hazard ratio [HR] 3.33; 95% confidence interval [CI] 2.01-5.56, p<0.001), upper-third GC and cT2-T4 were identified as independent indicators of a poor OS. In the second survival analysis where explanatory variables were composed of preoperative, intraoperative, and pathological factors, a PNI<48 (HR 2.80; 95% CI 1.65-4.78, p<0.001), hypertension, open gastrectomy, intraoperative blood loss≥100g, pT2-T4, and pN+ were independent prognostic factors.
Preoperative PNI may be a useful predictor of postoperative survival outcomes both before and immediately after surgery in GC. Appropriate perioperative interventions and the meticulous surveillance of GC relapse are necessary for patients with PNI<48.
营养不良通过抑制肿瘤免疫导致肿瘤进展加速。本研究探讨了术前预后营养指数（PNI）对预测胃癌（GC）术后生存结局的意义。
本研究共纳入447例行根治性胃癌切除术的患者。PNI计算公式为10×血清白蛋白（g/dl）+0.005×总淋巴细胞计数（每立方毫米）。使用两个多变量分析模型检验术前PNI的预后影响。
根据受试者工作特征曲线，术前PNI预测总生存期（OS）的最佳截断值为48。PNI<48组的5年OS率为59.5%，PNI≥48组为91.3%（p<0.001）。在第一个多变量生存分析中，所有解释变量仅由术前因素组成，PNI<48（风险比[HR]3.33；95%置信区间[CI]2.01-5.56，p<0.001）、胃上部癌和cT2-T4被确定为OS不良的独立指标。在第二个生存分析中，解释变量由术前因素、术中因素和病理因素组成，PNI<48（HR 2.80；95%CI 1.65-4.78，p<0.001）、高血压、开腹胃切除术、术中失血≥100g、pT2-T4和pN+是独立的预后因素。
术前PNI可能是GC手术前后术后生存结局的有用预测指标。对于PNI<48的患者，围手术期进行适当干预并密切监测GC复发是必要的。
