A Nomogram Model Involving Preoperative Fibrinogen and Prognostic Nutritional Index Score for Predicting Postoperative Outcome in Patients with Gastric Cancer

Abstract

Background: Inflammation and nutrition play vital roles in the development of gastric cancer (GC). We combined the preoperative fibrinogen with prognostic nutritional index (PNI) to create a novel scoring system named as the fibrinogen and prognostic nutritional index (FPNI) score and establish a more effective model. Patients and Methods: A total of 689 patients with gastric adenocarcinoma who underwent gastrectomy from January 2012 to December 2016 were reviewed. We measured correlations between FPNI score and clinicopathological variables and overall survival (OS). A nomogram predicting OS was constructed. Its predictive performance was verified using the concordance index, calibration curves, receiver operating characteristic curves, decision curve analysis and time-dependent receiver operating characteristic analysis. Results: We observed that the FPNI score was an independent predictor of OS in patients with gastric cancer (P < 0.05). A high FPNI score was significantly related to older age at surgery, tumor size ≥4.6 cm, high ASA score, advanced TNM stage and poor outcome (both P < 0.05). And the FPNI score remained an independent indicator at various TNM stages (P < 0.05). Ultimately, the nomogram based on FPNI score, age, tumor size, histological grade and TNM stage showed a better predictive ability than TNM alone. Conclusion:The preoperative FPNI score is a novel, simple, and effective predictor of OS in patients with GC. Furthermore, the nomogram involving FPNI score will help clinicians to optimize individualized treatment plans.

A novel nomogram based on the prognostic nutritional index for predicting postoperative outcomes in patients with stage I–III gastric cancer undergoing robotic radical gastrectomy

“…The postoperative nutritional management might improve the quality of life of people with radical gastrectomy. Although TNM stage is an important reference for the prognostic evaluation of cancer patients, an increasing number of clinical studies have recently demonstrated that novel prediction models based on PNI could further improve the staging of GC and achieve a better prediction of patient outcomes, which has profound clinical significance for guiding the individualized treatment of GC patients ( 15 – 18 ). As an easily obtainable biological indicator, PNI has been widely considered to dynamically reflect the immune function and nutritional status of the whole body ( 19 ).…”

“…Since the innovative application of PNI by Onodera T for assessing the surgical risk and prognosis of patients with gastrointestinal malignancies, numerous studies ( 20 – 23 ), including our work, have demonstrated that PNI could be a significant prognostic factor for evaluating both short- and long-term outcomes of GC patients. Wang et al ( 15 ) found that the fibrinogen and PNI (FPNI) score was significantly associated with advanced age, large tumor size, high American Society of Anesthesiologists (ASA) scores, late TNM stage, and poor prognosis ( P < 0.01). According to multivariate analyses, preoperative PNI was an independent risk factor for disease progression and shortened survival in GC patients.…”