Tamai Mizuki, Kiuchi Jun, Kuriu Yoshiaki, Arita Tomohiro, Shimizu Hiroki, Ohashi Takuma, Konishi Hirotaka, Yamamoto Yusuke, Morimura Ryo, Shiozaki Atsushi, Ikoma Hisashi, Kubota Takeshi, Fujiwara Hitoshi, Okamoto Kazuma, Otsuji Eigo
Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine Kyoto 602-8566, Japan.
Am J Cancer Res. 2021 Oct 15;11(10):4947-4955. eCollection 2021.
Preoperative Prognostic Nutritional Index (PNI) could be a crucial factor for the prognosis of colorectal cancer (CRC). However, the clinical impact of postoperative PNI is still unclear, and there have been no reports on the significance of postoperative PNI in patients undergoing adjuvant chemotherapy (AC). We retrospectively analysed 227 consecutive patients who underwent AC after radical surgery for high-risk stage II or stage III CRC. PNI value was calculated before radical surgery and before the introduction of AC. In our study, patients with a low PNI value before surgery showed significantly poorer long-term outcomes than those with a high PNI value. Next, we divided the patients into four groups: patients with a high PNI value before surgery and remained after surgery (Group High-High), a high PNI value before surgery but decreased after surgery (Group High-Low), a low PNI value before surgery but recovered after surgery (Group Low-High), and a low PNI value but did not recover after surgery (Group Low-Low). Although the patients in Group Low-Low showed significantly poorer long-term outcomes than those in Group High-High, the prognosis of patients in Group Low-High was the same as that of patients in Group High-High. In addition, in patients with recurrence after AC, those with a high PNI value at the time of recurrence showed a significantly better survival after recurrence than patients with a low PNI value. Postoperative PNI value could be a prognostic biomarker for CRC patients undergoing AC. Even though the PNI value was low before the surgery, recovery of PNI value by the introduction of AC could improve the prognosis of CRC patients.
术前预后营养指数（PNI）可能是结直肠癌（CRC）预后的关键因素。然而，术后PNI的临床影响仍不明确，且尚无关于辅助化疗（AC）患者术后PNI意义的报道。我们回顾性分析了227例连续接受高危II期或III期CRC根治性手术后进行AC的患者。在根治性手术前和开始AC前计算PNI值。在我们的研究中，术前PNI值低的患者长期预后明显比PNI值高的患者差。接下来，我们将患者分为四组：术前PNI值高且术后仍保持高值的患者（高高组）、术前PNI值高但术后降低的患者（高低组）、术前PNI值低但术后恢复的患者（低高组）以及PNI值低且术后未恢复的患者（低低组）。尽管低低组患者的长期预后明显比高高组患者差，但低高组患者的预后与高高组患者相同。此外，在AC后复发的患者中，复发时PNI值高的患者复发后的生存率明显高于PNI值低的患者。术后PNI值可能是接受AC的CRC患者的预后生物标志物。即使术前PNI值低，通过AC使PNI值恢复也可改善CRC患者的预后。
