Kim Harin, Shin Dong-Min, Lee Jae-Hoon, Cho Eun-Suk, Lee Hye Sun, Shin Su-Jin, Park Eun Jung, Baik Seung Hyuk, Lee Kang Young, Kang Jeonghyun
Yonsei University College of Medicine, Seoul, Republic of Korea.
Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
Front Oncol. 2023 Jan 30;13:1026824. doi: 10.3389/fonc.2023.1026824. eCollection 2023.
This study compared the prognostic significance of various nutritional and inflammatory indicators such as neutrophil-to-lymphocyte ratio, lymphocyte-to-monocyte ratio and platelet-to-lymphocyte ratio, prognostic nutritional index, and controlling nutritional status score. In addition, we aimed to establish a more accurate prognostic indicator.
We retrospectively evaluated 1112 patients with stage I-III colorectal cancer between January 2004 and April 2014. The controlling nutritional status scores were classified as low (0-1), intermediate (2-4), and high (5-12) scores. The cut-off values for prognostic nutritional index and inflammatory markers were calculated using the X-tile program. P-CONUT, a combination of prognostic nutritional index and the controlling nutritional status score, was suggested. The integrated areas under the curve were then compared.
The multivariable analysis showed that prognostic nutritional index was an independent prognostic factor for overall survival, whereas the controlling nutritional status score, neutrophil-to-lymphocyte ratio, lymphocyte-to-monocyte ratio, and platelet-to-lymphocyte ratio were not. The patients were divided into three P-CONUT groups as follows: G1, controlling nutritional status (0-4) and high prognostic nutritional index; G2, controlling nutritional status (0-4) and low prognostic nutritional index; and G3, controlling nutritional status (5-12) and low prognostic nutritional index. There were significant survival differences between the P-CONUT groups (5-year overall survival of G1, G2, and G3 were 91.7%, 81.2%, and 64.1%, respectively; < 0.0001). The integrated areas under the curve of P-CONUT (0.610, CI: 0.578-0.642) was superior to those of the controlling nutritional status score alone (bootstrap integrated areas under the curve mean difference=0.050; 95% CI=0.022-0.079) and prognostic nutritional index alone (bootstrap integrated areas under the curve mean difference=0.012; 95% CI=0.001-0.025).
Prognostic effect of P-CONUT may be better than inflammatory markers such as neutrophil-to-lymphocyte ratio, lymphocyte-to-monocyte ratio and platelet-to-lymphocyte ratio. Thus, it could be used as a reliable nutritional risk stratification tool in patients with colorectal cancer.
本研究比较了多种营养和炎症指标的预后意义，如中性粒细胞与淋巴细胞比值、淋巴细胞与单核细胞比值、血小板与淋巴细胞比值、预后营养指数以及控制营养状况评分。此外，我们旨在建立一个更准确的预后指标。
我们回顾性评估了2004年1月至2014年4月期间的1112例I - III期结直肠癌患者。控制营养状况评分分为低（0 - 1）、中（2 - 4）和高（5 - 12）分。使用X-tile程序计算预后营养指数和炎症标志物的临界值。提出了P-CONUT，即预后营养指数与控制营养状况评分的组合。然后比较曲线下的综合面积。
多变量分析显示，预后营养指数是总生存的独立预后因素，而控制营养状况评分、中性粒细胞与淋巴细胞比值、淋巴细胞与单核细胞比值以及血小板与淋巴细胞比值则不是。患者被分为三个P-CONUT组，如下：G1组，控制营养状况（0 - 4）且预后营养指数高；G2组，控制营养状况（0 - 4）且预后营养指数低；G3组，控制营养状况（5 - 12）且预后营养指数低。P-CONUT组之间存在显著的生存差异（G1、G2和G3组的5年总生存率分别为91.7%、81.2%和64.1%；<0.0001）。P-CONUT的曲线下综合面积（0.610，CI：0.578 - 0.642）优于单独的控制营养状况评分（自抽样曲线下综合面积平均差异 = 0.050；95%CI = 0.022 - 0.079）和单独的预后营养指数（自抽样曲线下综合面积平均差异 = 0.012；95%CI = 0.001 - 0.025）。
P-CONUT的预后效果可能优于中性粒细胞与淋巴细胞比值、淋巴细胞与单核细胞比值和血小板与淋巴细胞比值等炎症标志物。因此，它可作为结直肠癌患者可靠的营养风险分层工具。
