Han Youwei, Zhou Peng, Wang Liping, Tang Yu, Ding Yuyan, Yang Yujiao, Qiu Chen, Li Yuyang, Xia Jiazeng
Department of General Surgery, The Affiliated Wuxi No.2 People's Hospital of Nanjing Medical University, Wuxi, China.
Department of General Surgery, Institute of General Surgical Research, School of Medicine, Jiangnan University Medical Center, Jiangnan University, Wuxi, China.
Sci Rep. 2025 Jul 15;15(1):25647. doi: 10.1038/s41598-025-10574-1.
Despite the Prognostic Nutritional Index (PNI) serving as a crucial prognostic marker for predicting survival outcomes in cancer patients, its association with the risk of Colorectal Cancer (CRC) is not well comprehended. We hypothesized that lower PNI levels are associated with a higher risk of CRC. The datasets from the National Health and Nutrition Examination Survey (NHANES) spanning from 2007 to 2016 were employed in this study, incorporating data on demographics, laboratory tests, and questionnaires. Participants aged ≥ 20 years were included, while those with missing tumor history or incomplete laboratory data for PNI calculation (serum albumin or lymphocyte count) were excluded. A total of 26,229 participants who met the inclusion criteria were evaluated, of which 176 had a history of CRC. The PNI was calculated as 0.005 × absolute lymphocyte count + 10 × serum albumin, and categorized into quartiles. CRC status was determined via self-reported medical history. To investigate the linear relationship between PNI and CRC, multivariable logistic regression models, restricted cubic spline analysis, and subgroup analyses were used. Covariates were adjusted using multiple imputation, and all analyses were conducted using DecisionLinnc v1.0. Statistical significance was set at P < 0.05. The average PNI score was 42.55 ± 3.42. Fully adjusted multivariable logistic regression models identified a significant inverse relationship between higher PNI scores and lower odds of CRC. Specifically, each one-unit increase in PNI was associated with a 6.43% reduction in the odds of CRC [OR: 0.9357; 95% CI: 0.8942, 0.9807; p = 0.005]. Restricted cubic spline analysis further validated a linear association between PNI and CRC risk. Subgroup analyses demonstrated that the association remained consistent across factors including gender, age, marital status, education level, BMI, alcohol consumption, smoking habits, history of hypertension, hyperlipidemia, and diabetes. Males exhibited a more pronounced inverse correlation between PNI and CRC risk. Higher PNI scores are independently associated with reduced odds of CRC. PNI may serve as a valuable risk biomarker for identifying individuals at elevated CRC risk and could enhance large-scale screening strategies.
尽管预后营养指数(PNI)作为预测癌症患者生存结局的关键预后标志物,但其与结直肠癌(CRC)风险的关联尚未得到充分理解。我们假设较低的PNI水平与较高的CRC风险相关。本研究采用了2007年至2016年美国国家健康与营养检查调查(NHANES)的数据集,其中包含人口统计学、实验室检查和问卷调查数据。纳入年龄≥20岁的参与者,排除有肿瘤病史缺失或用于计算PNI(血清白蛋白或淋巴细胞计数)的实验室数据不完整的参与者。共有26229名符合纳入标准的参与者接受评估,其中176人有CRC病史。PNI计算方法为0.005×绝对淋巴细胞计数 + 10×血清白蛋白,并分为四分位数。CRC状态通过自我报告的病史确定。为了研究PNI与CRC之间的线性关系,使用了多变量逻辑回归模型、受限立方样条分析和亚组分析。使用多重填补法对协变量进行调整,所有分析均使用DecisionLinnc v1.0进行。统计学显著性设定为P < 0.05。平均PNI评分为42.55±3.42。完全调整后的多变量逻辑回归模型显示,较高的PNI评分与较低的CRC发病几率之间存在显著的负相关关系。具体而言,PNI每增加一个单位,CRC发病几率降低6.43%[比值比(OR):0.9357;95%置信区间(CI):0.8942,0.9807;P = 0.005]。受限立方样条分析进一步验证了PNI与CRC风险之间的线性关联。亚组分析表明,在性别、年龄、婚姻状况、教育水平、体重指数、饮酒、吸烟习惯、高血压、高脂血症和糖尿病等因素中,这种关联保持一致。男性中PNI与CRC风险之间的负相关更为明显。较高的PNI评分与较低的CRC发病几率独立相关。PNI可能是识别CRC风险升高个体的有价值的风险生物标志物,并可加强大规模筛查策略。