Universidade de São Paulo, Hospital das Clínicas, Instituto do Câncer do Estado de São Paulo, Department of Gastroenterology - São Paulo (SP), Brazil.
Arq Bras Cir Dig. 2024 Jun 17;37:e1805. doi: 10.1590/0102-6720202400012e1805. eCollection 2024.
Predicting short- and long-term outcomes of oncological therapies is crucial for developing effective treatment strategies. Malnutrition and the host immune status significantly affect outcomes in major surgeries.
To assess the value of preoperative prognostic nutritional index (PNI) in predicting outcomes in gastric cancer patients.
A retrospective cohort analysis was conducted on patients undergoing curative-intent surgery for gastric adenocarcinoma between 2009 and 2020. PNI was calculated as follows: PNI=(10 x albumin [g/dL])+(0.005 x lymphocytes [nº/mm3]). The optimal cutoff value was determined by the receiver operating characteristic curve (PNI cutoff=52), and patients were grouped into low and high PNI.
Of the 529 patients included, 315 (59.5%) were classified as a low-PNI group (PNI<52) and 214 (40.5%) as a high-PNI group (PNI≥52). Older age (p=0.050), male sex (p=0.003), American Society of Anesthesiologists score (ASA) III/IV (p=0.001), lower hemoglobin level (p<0.001), lower body mass index (p=0.001), higher neutrophil-lymphocyte ratio (p<0.001), D1 lymphadenectomy, advanced pT stage, pN+ and more advanced pTNM stage were related to low-PNI patient. Furthermore, 30-day (1.4 vs. 4.8%; p=0.036) and 90-day (3.3 vs. 10.5%; p=0.002) mortality rates were higher in low-PNI compared to high-PNI group. Disease-free and overall survival were worse in low-PNI patients compared to high-PNI (p<0.001 for both). ASA III/IV score, low-PNI, pT3/T4, and pN+ were independent risk factors for worse survival.
Preoperative PNI can predict short- and long-term outcomes of patients with gastric cancer after curative gastrectomy. Low PNI is an independent factor related to worse disease-free and overall survival.
预测肿瘤治疗的短期和长期结果对于制定有效的治疗策略至关重要。营养不良和宿主免疫状态显著影响重大手术的结果。
评估术前预后营养指数（PNI）在预测胃腺癌患者治疗结果中的价值。
对 2009 年至 2020 年间接受根治性胃腺癌手术的患者进行回顾性队列分析。PNI 计算如下：PNI=(10 x 白蛋白 [g/dL])+(0.005 x 淋巴细胞 [nº/mm3])。通过受试者工作特征曲线（PNI 截断值=52）确定最佳截断值，并将患者分为低 PNI 组和高 PNI 组。
在纳入的 529 例患者中，315 例（59.5%）被归类为低 PNI 组（PNI<52），214 例（40.5%）为高 PNI 组（PNI≥52）。年龄较大（p=0.050）、男性（p=0.003）、美国麻醉医师协会评分（ASA）III/IV 级（p=0.001）、血红蛋白水平较低（p<0.001）、体质量指数较低（p=0.001）、中性粒细胞与淋巴细胞比值较高（p<0.001）、D1 淋巴结清扫术、进展期 pT 分期、pN+和更晚期 pTNM 分期与低 PNI 患者相关。此外，低 PNI 组的 30 天（1.4%比 4.8%；p=0.036）和 90 天（3.3%比 10.5%；p=0.002）死亡率均高于高 PNI 组。低 PNI 患者的无病生存和总生存均较 PNI 患者差（均为 p<0.001）。ASA III/IV 评分、低 PNI、pT3/T4 和 pN+是生存不良的独立危险因素。
术前 PNI 可预测接受根治性胃切除术的胃癌患者的短期和长期结果。低 PNI 是与无病生存和总生存较差相关的独立因素。
