Zhang Yan, Wang Lin-Jun, Li Qin-Ya, Yuan Zhen, Zhang Dian-Cai, Xu Hao, Yang Li, Gu Xin-Hua, Xu Ze-Kuan
Department of Gastrointestinal Surgery, Suzhou Municipal Hospital, Affiliated Suzhou Hospital of Nanjing Medical University, Gusu School of Nanjing Medical University, Suzhou 215000, Jiangsu Province, China.
Department of General Surgery, Jiangsu Province Hospital, First Affiliated Hospital of Nanjing Medical University, Nanjing 210003, Jiangsu Province, China.
World J Gastrointest Surg. 2023 Feb 27;15(2):211-221. doi: 10.4240/wjgs.v15.i2.211.
Remnant gastric cancer (GC) is defined as GC that occurs five years or more after gastrectomy. Systematically evaluating the preoperative immune and nutritional status of patients and analyzing its prognostic impact on postoperative remnant gastric cancer (RGC) patients are crucial. A simple scoring system that combines multiple immune or nutritional indicators to identify nutritional or immune status before surgery is necessary.
To evaluate the value of preoperative immune-nutritional scoring systems in predicting the prognosis of patients with RGC.
The clinical data of 54 patients with RGC were collected and analyzed retrospectively. Prognostic nutritional index (PNI), controlled nutritional status (CONUT), and Naples prognostic score (NPS) were calculated by preoperative blood indicators, including absolute lymphocyte count, lymphocyte to monocyte ratio, neutrophil to lymphocyte ratio, serum albumin, and serum total cholesterol. Patients with RGC were divided into groups according to the immune-nutritional risk. The relationship between the three preoperative immune-nutritional scores and clinical characteristics was analyzed. Cox regression and Kaplan-Meier analysis was performed to analyze the difference in overall survival (OS) rate between various immune-nutritional score groups.
The median age of this cohort was 70.5 years (ranging from 39 to 87 years). No significant correlation was found between most pathological features and immune-nutritional status ( > 0.05). Patients with a PNI score < 45, CONUT score or NPS score ≥ 3 were considered to be at high immune-nutritional risk. The areas under the receiver operating characteristic curves of PNI, CONUT, and NPS systems for predicting postoperative survival were 0.611 [95% confidence interval (CI): 0.460-0.763; = 0.161], 0.635 (95%CI: 0.485-0.784; = 0.090), and 0.707 (95%CI: 0.566-0.848; = 0.009), respectively. Cox regression analysis showed that the three immune-nutritional scoring systems were significantly correlated with OS (PNI: = 0.002; CONUT: = 0.039; NPS: < 0.001). Survival analysis revealed a significant difference in OS between different immune-nutritional groups (PNI: 75 mo 42 mo, = 0.001; CONUT: 69 mo 48 mo, = 0.033; NPS: 77 mo 40 mo, < 0.001).
These preoperative immune-nutritional scores are reliable multidimensional prognostic scoring systems for predicting the prognosis of patients with RGC, in which the NPS system has relatively effective predictive performance.
残胃癌（GC）定义为胃切除术后5年或更长时间发生的胃癌。系统评估患者术前的免疫和营养状况，并分析其对术后残胃癌（RGC）患者预后的影响至关重要。需要一个结合多种免疫或营养指标的简单评分系统来识别手术前的营养或免疫状况。
评估术前免疫营养评分系统对RGC患者预后的预测价值。
回顾性收集并分析54例RGC患者的临床资料。通过术前血液指标，包括绝对淋巴细胞计数、淋巴细胞与单核细胞比值、中性粒细胞与淋巴细胞比值、血清白蛋白和血清总胆固醇，计算预后营养指数（PNI）、控制营养状况（CONUT）和那不勒斯预后评分（NPS）。根据免疫营养风险将RGC患者分组。分析三种术前免疫营养评分与临床特征之间的关系。进行Cox回归和Kaplan-Meier分析，以分析不同免疫营养评分组之间总生存期（OS）率的差异。
该队列的中位年龄为70.5岁（范围为39至87岁）。大多数病理特征与免疫营养状况之间未发现显著相关性（>0.05）。PNI评分<45、CONUT评分或NPS评分≥3的患者被认为处于高免疫营养风险。PNI、CONUT和NPS系统预测术后生存的受试者工作特征曲线下面积分别为0.611[95%置信区间（CI）：0.460-0.763；P=0.161]、0.635（95%CI：0.485-0.784；P=0.090）和0.707（95%CI：0.566-0.848；P=0.009）。Cox回归分析表明，三种免疫营养评分系统与OS均显著相关（PNI：P=0.002；CONUT：P=0.039；NPS：P<0.001）。生存分析显示不同免疫营养组之间的OS存在显著差异（PNI：75个月对42个月，P=0.001；CONUT：69个月对48个月，P=0.033；NPS：77个月对40个月，P<0.001）。
这些术前免疫营养评分是预测RGC患者预后的可靠多维度预后评分系统，其中NPS系统具有相对有效的预测性能。
