Tatsuta Kyota, Sakata Mayu, Kojima Tadahiro, Akai Toshiya, Shimizu Mikihiro, Morita Yoshifumi, Kikuchi Hirotoshi, Hiramatsu Yoshihiro, Kurachi Kiyotaka, Takeuchi Hiroya
Department of Surgery Hamamatsu University School of Medicine Hamamatsu Shizuoka Japan.
Center for Clinical Research Hamamatsu University School of Medicine Hamamatsu Shizuoka Japan.
Ann Gastroenterol Surg. 2024 May 30;8(5):817-825. doi: 10.1002/ags3.12826. eCollection 2024 Sep.
To assess the impact of perioperative prognostic nutritional index (PNI) changes on prognosis and recurrence after colorectal cancer surgery.
A total of 475 patients who underwent curative resection for primary colorectal adenocarcinoma and were diagnosed with pathological stage (pStage) II/III were retrospectively reviewed. The patients were divided into two groups: the high group (preoperative PNI ≤ postoperative PNI, = 290) and the low group (preoperative PNI > postoperative PNI, = 185).
The low group exhibited significantly higher recurrence and mortality rates (all < 0.001). Kaplan-Meier analysis showed worse overall and recurrence-free survival in the low group (all < 0.001). Perioperative PNI changes predicted prognosis and recurrence independent of preoperative nutritional conditions. Subgroup analyses showed better overall survival and recurrence-free survival in the high group across various parameters, such as patient background, surgical outcomes, adjuvant chemotherapy, and pathological characteristics. Multivariate analysis revealed that the low group based on perioperative PNI changes (hazard ratio [HR]: 5.809, 95% confidence interval [CI]: 3.451-9.779, < 0.001), pathological T stage (HR: 1.962, 95% CI: 1.184-3.253, = 0.009), and pathological N stage (HR: 3.434, 95% CI: 1.964-6.004, < 0.001) were identified as independent predictors of worse overall survival.
Patients with pStage II/III colorectal cancer who demonstrate a lower postoperative PNI levels compared to preoperative had poorer overall survival and recurrence-free survival. Perioperative PNI changes can serve as useful biomarkers for predicting survival and recurrence.
评估围手术期预后营养指数（PNI）变化对结直肠癌手术后预后及复发的影响。
回顾性分析475例行原发性结直肠腺癌根治性切除术且病理分期为（pStage）II/III期的患者。将患者分为两组：高组（术前PNI≤术后PNI，n = 290）和低组（术前PNI＞术后PNI，n = 185）。
低组的复发率和死亡率显著更高（均P＜0.001）。Kaplan-Meier分析显示低组的总生存期和无复发生存期更差（均P＜0.001）。围手术期PNI变化可独立于术前营养状况预测预后和复发。亚组分析显示，在患者背景、手术结果、辅助化疗和病理特征等各种参数方面，高组的总生存期和无复发生存期更好。多因素分析显示，基于围手术期PNI变化的低组（风险比[HR]：5.809，95%置信区间[CI]：3.451 - 9.779，P＜0.001）、病理T分期（HR：1.962，95% CI：1.184 - 3.253，P = 0.009）和病理N分期（HR：3.434，95% CI：1.964 - 6.004，P＜0.001）被确定为总生存期较差的独立预测因素。
pStage II/III期结直肠癌患者术后PNI水平低于术前者，其总生存期和无复发生存期较差。围手术期PNI变化可作为预测生存和复发的有用生物标志物。
