Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.
Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, China.
Cancer Control. 2024 Jan-Dec;31:10732748241230888. doi: 10.1177/10732748241230888.
To explore the effect of combined hematological and physical measurement indicators on the prognosis of patients undergoing surgery for gastric or colorectal cancer and to screen for the best prognostic indicators.
Gastric and colorectal cancer is a widespread health concern worldwide and one of the major contributors to cancer-related death. The hematological and physical measurement indicators have been shown to associate with the prognosis of patients undergoing surgery for gastric or colorectal cancer, respectively, but it is still unclear whether the combination of the two can reflect the prognosis more effectively.
Thirteen hematological indicators and 5 physical measurement indicators were selected in this study, and the most promising ones were screened using LASSO regression. Then, the best prognostic indicators were selected by time-ROC curves. Survival curves were constructed using the Kaplan-Meier method, and the effects of hematological and physical measurement indicators on the prognosis of patients undergoing surgery for gastric or colorectal cancers were evaluated by Cox proportional risk regression analysis. In addition, the relationship between hematological and physical measurement indicators on secondary outcomes, including length of stay, hospitalization costs, intensive care unit (ICU) admission, and patients' subjective global assessment scores (PGSGA), was explored.
After initial screening, among the hematological indicators, the geriatric nutritional risk index (GNRI) showed the highest mean area under the curve (AUC) values. Among body measures, calf circumference (CC) showed the highest mean AUC value. Further analyses showed that the combination of combined nutritional prognostic index (GNRI) and calf circumference (CC) (GNRI-CC) had the best performance in predicting the prognosis of patients undergoing surgery for gastric or colorectal cancers. Low GNRI, low CC, and low GNRI-low CC increased the risk of death by 44%, 48%, and 104%, respectively. Sensitivity analyses showed the same trend. In addition, low GNRI-low CC increased the risk of malnutrition by 17%.
This study emphasizes that a combination of blood measures and body measures is essential to accurately assess the prognosis of patients undergoing surgery for gastric or colorectal cancers. The GNRI-CC is a good prognostic indicator and can also assess the risk of possible malnutrition.
探讨联合血液学和物理测量指标对胃或结直肠癌手术患者预后的影响，并筛选出最佳预后指标。
胃和结直肠癌是全球普遍存在的健康问题，也是癌症相关死亡的主要原因之一。血液学和物理测量指标已被证明分别与胃或结直肠癌手术患者的预后相关，但尚不清楚两者的联合是否能更有效地反映预后。
本研究共选择了 13 项血液学指标和 5 项物理测量指标，使用 LASSO 回归筛选最有前途的指标。然后，通过时间 ROC 曲线选择最佳预后指标。使用 Kaplan-Meier 方法构建生存曲线，并通过 Cox 比例风险回归分析评估血液学和物理测量指标对胃或结直肠癌手术患者预后的影响。此外，还探讨了血液学和物理测量指标与次要结局（包括住院时间、住院费用、重症监护病房（ICU）入住率和患者主观整体评估评分（PGSGA））之间的关系。
经过初步筛选，在血液学指标中，老年营养风险指数（GNRI）的曲线下面积（AUC）均值最高。在身体测量指标中，小腿围（CC）的 AUC 均值最高。进一步分析表明，联合营养预后指数（GNRI）和小腿围（CC）（GNRI-CC）在预测胃或结直肠癌手术患者的预后方面表现最佳。低 GNRI、低 CC 和低 GNRI-低 CC 使死亡风险分别增加了 44%、48%和 104%。敏感性分析也显示出相同的趋势。此外，低 GNRI-低 CC 使营养不良的风险增加了 17%。
本研究强调，血液测量和身体测量的结合对于准确评估胃或结直肠癌手术患者的预后至关重要。GNRI-CC 是一个很好的预后指标，也可以评估可能发生营养不良的风险。
