Universidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas, Divisão de Oncologia, Departamento de Anestesiologia, Oncologia e Radiologia, Tessália Vieira de Camargo Street, 126. Cidade Universitária "Zeferino Vaz", 13083-887, Campinas, SP, Brazil.
Universidade Estadual de Campinas (UNICAMP), Escola de Educação Física, Érico Veríssimo Avenue, 701 - Barão Geraldo, 13083-851, Campinas, SP, Brazil.
Clin Nutr ESPEN. 2024 Oct;63:644-650. doi: 10.1016/j.clnesp.2024.07.1058. Epub 2024 Jul 31.
BACKGROUND & AIMS: The association of Prognostic Nutritional Index (PNI) with prognosis has been established for various cancer types, including rectal cancer. However, the precise relationship between PNI and body composition characteristics in patients with non-metastatic rectal cancer remain unclear. This study aimed to investigate the impact of PNI on overall survival and disease-free survival in non-metastatic rectal cancer patients undergoing total surgical resection. Additionally, it sought to assess the inflammatory status and body composition in patients across different PNI levels.
Patients with non-metastatic rectal cancer who underwent total surgical resection, were consecutively enrolled. PNI was calculated using the formula: PNI = (10 × serum albumin [g/dl]) + (0.005 × lymphocytes/μL). Body composition was assessed using CT-derived measurements and laboratory tests performed at diagnosis were used to calculate inflammatory indices. Univariate and multivariate logistic regression analyses as well as Kaplan-Meier curves were used to determine prognostic values.
A total of 298 patients were included. Patients with low PNI demonstrated significantly reduced overall survival and disease-free survival compared to those with high PNI (Hazard ratio [HR] 1.85; Confidence interval [CI] 1.30-2 0.62; p = 0.001). Moreover, patients with low PNI exhibited heightened systemic inflammatory status and reduced skeletal muscle index, increased muscle radiodensity, as well as a decrease in subcutaneous adipose tissue area, subcutaneous fat index, and low attenuation of both subcutaneous and visceral adipose tissue.
The PNI, assessed prior to treatment initiation, serves as a prognostic biomarker for non-metastatic rectal cancer patients undergoing total surgical resection and is linked with both inflammation and alterations in body composition.
预后营养指数（PNI）与各种癌症类型的预后有关，包括直肠癌。然而，非转移性直肠癌患者的 PNI 与身体成分特征之间的确切关系尚不清楚。本研究旨在探讨 PNI 对接受全直肠切除的非转移性直肠癌患者总生存和无病生存的影响。此外，还评估了不同 PNI 水平患者的炎症状态和身体成分。
连续纳入接受全直肠切除的非转移性直肠癌患者。PNI 通过公式计算：PNI =（10×血清白蛋白[g/dl]）+（0.005×淋巴细胞/μL）。使用 CT 衍生的测量值评估身体成分，并使用诊断时进行的实验室测试计算炎症指数。使用单变量和多变量逻辑回归分析以及 Kaplan-Meier 曲线来确定预后价值。
共纳入 298 例患者。与高 PNI 相比，低 PNI 患者的总生存和无病生存明显降低（风险比 [HR] 1.85；置信区间 [CI] 1.30-2.06；p = 0.001）。此外，低 PNI 患者表现出更高的全身炎症状态和更低的骨骼肌指数，增加的肌肉放射性密度，以及减少的皮下脂肪组织面积、皮下脂肪指数和皮下及内脏脂肪组织的低衰减。
治疗前评估的 PNI 可作为接受全直肠切除术的非转移性直肠癌患者的预后生物标志物，与炎症和身体成分改变有关。
