Department of Admissions and Employment, Changsha Health Vocational College, 410010, Changsha, Hunan, China.
Department of Thyroid and Breast Surgery, Wuhan University Zhongnan Hospital, 430071, Wuhan, Hubei, China.
Eur J Clin Nutr. 2022 Oct;76(10):1449-1456. doi: 10.1038/s41430-022-01120-7. Epub 2022 Mar 30.
BACKGROUND/OBJECTIVE: To investigate the influence of pre-operative immunological and nutritional status, assessed by the prognostic nutritional index (PNI) score, on post-operative infection, and the potential additive effects of low PNI and infection on prognosis after radical resection of stage II/III gastric cancer (GC).
The medical records of 2352 consecutive stage II/III GC patients who underwent radical gastrectomy were retrospectively reviewed. The independent predictors for infections were identified using univariate and multivariate analyses. Cox regression analysis was used to assess any associations between PNI, infection and OS.
A total of 160 (6.8%) cases developed infections and low PNI (< 43.9) was confirmed as an independent predictor. Both PNI < 43.9 and infections independently predicted poor OS (hazard ratio: 1.163, 95% confidence interval: 1.007-1.343; HR: 1.347, 95%CI: 1.067-1.700), and an additive effect was confirmed as patients with both low PNI and infection had worst OS. Further stratified analyses showed that complete peri-operative adjuvant chemotherapy (PAC, ≥ 6 cycles) could significantly improve OS in patients with low PNI and/or infection, which was comparable to those with PNI ≥ 43.9 and/or infection (P = 0.160).
Infection was the most common complication after gastrectomy and PNI < 43.9 was identified as an independent predictor. Low PNI was associated with poorer OS in stage II/III GC, independent of infections, and low PNI and infections had a synergistic effect that was associated with worst OS. However, complete PAC could significantly improve OS in these patients. Thus, strategies to decrease infection and complete PAC should be further investigated.
背景/目的：本研究旨在探讨术前通过预后营养指数（PNI）评分评估的免疫和营养状态对术后感染的影响，以及低 PNI 和感染对 II/III 期胃癌（GC）根治性切除术后预后的潜在叠加效应。
回顾性分析了 2352 例连续接受根治性胃切除术的 II/III 期 GC 患者的病历。采用单因素和多因素分析确定感染的独立预测因素。采用 Cox 回归分析评估 PNI、感染与 OS 之间的任何关联。
共有 160 例（6.8%）发生感染，低 PNI（<43.9）被确认为独立预测因素。PNI<43.9 和感染均独立预测 OS 不良（风险比：1.163，95%置信区间：1.007-1.343；HR：1.347，95%CI：1.067-1.700），且存在叠加效应，即同时存在低 PNI 和感染的患者 OS 最差。进一步的分层分析显示，完全围手术期辅助化疗（PAC，≥6 个周期）可显著改善低 PNI 和/或感染患者的 OS，与 PNI≥43.9 和/或感染患者相当（P=0.160）。
感染是胃切除术后最常见的并发症，PNI<43.9 被确定为独立预测因素。低 PNI 与 II/III 期 GC 的 OS 不良相关，独立于感染因素，低 PNI 和感染具有协同作用，与最差的 OS 相关。然而，完全的 PAC 可显著改善这些患者的 OS。因此，应进一步研究降低感染和完成 PAC 的策略。
