Influences of the Charlson Comorbidity Index and Nutrition Status on Prognosis After Esophageal Cancer Surgery

Kubo, Yuto; Yamasaki, Makoto; Yamashita, Kotaro; Makino, Tomoki; Saito, Takuro; Yamamoto, Keiji; Takahashi, Tsuyoshi; Kurokawa, Yukinori; Motoori, Masaaki; Kimura, Yutaka; Nakajima, Kiyokazu; Eguchi, Hidetoshi; Doki, Yuichiro

doi:10.1245/s10434-021-09779-1

Cited by 28 publications

(15 citation statements)

References 32 publications

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“…There is a growing body of evidence showing that nutritional status is significantly associated with prognosis in various malignancies, including GC ( 9 – 15 ). Potential mechanisms include suppression of the immune system, which plays an inevitable role in eliminating cancer cells and preventing metastasis ( 9 , 12 , 24 ). BMI can be easily calculated and is a widely used indicator to assess patients’ nutritional status in the clinic.…”

Section: Discussionmentioning

confidence: 99%

“…There is a growing body of evidence showing that nutritional status not only relates to postoperative morbidity but also oncological outcomes of different types of cancer ( 9 – 12 ). Body mass index (BMI) is a simple and commonly used indicator for assessing nutritional status in the clinic, and several studies have found that low BMI is a significant predictor of poor prognosis in GC patients ( 13 – 15 ).…”

Section: Introductionmentioning

confidence: 99%

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Body Mass Index and Prognosis of Patients With Stage II/III Gastric Cancer After Curative Gastrectomy: Completion of Perioperative Adjuvant Chemotherapy May Be a Confounding Factor

et al. 2022

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ObjectiveTo investigate the association between body mass index (BMI) and overall survival (OS) of patients with stage II/III gastric cancer (GC) after radical gastrectomy, and evaluate the potential influence of perioperative adjuvant chemotherapy (PAC).MethodsMedical records of 2,510 consecutive stage II/III GC patients who underwent curative resection between November 2010 and December 2020 were retrospectively reviewed. The optimal cutoff value of BMI for OS was determined by X-tile. The independent predictive factors for completeness of PAC were identified using univariate and multivariate logistic regression analyses. Cox regression analyses assessed the association among BMI, completeness of PAC, and OS.ResultsOf the 2,510 patients, 813 cases with BMI < 20.3 kg/m2 were classified as belonging in the low BMI group. Further analyses confirmed that low BMI was an independent predictor for incomplete PAC (< 6 cycles, n = 920) and poorer OS (hazard ratio: 1.317, 95% confidence interval: 1.162-1.494, P < 0.001), but neo-adjuvant chemotherapy (NAC) was a protective factor. An additive effect was found in those with both low BMI and incomplete PAC, as they had even worse OS. However, in patients with low BMI, completion of PAC (≥ 6 cycles) significantly improved OS, which became comparable to that in the high BMI group (P = 0.143).ConclusionsLow preoperative BMI independently affects completion of PAC and prognosis of patients with stage II/III GC, but completing PAC can compensate for the adverse influence of low BMI on OS. Thus, strategies designed to ensure the completion of PAC, such as NAC and nutritional support, should be further investigated.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Body Mass Index and Prognosis of Patients With Stage II/III Gastric Cancer After Curative Gastrectomy: Completion of Perioperative Adjuvant Chemotherapy May Be a Confounding Factor

et al. 2022

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“…The CCI is an objective quantification of comorbidity, and it has been shown that a CCI ≥ 2 shortened OS by 3 years in patients with esophageal cancer (23). In our research, we used an age-adjusted CCI, where patients with a CCI ≥ 2 and a higher risk of malnutrition (as defined by GLIM) exhibited low OS.…”

Section: Discussionmentioning

confidence: 99%

Global leaders malnutrition initiative-defined malnutrition affects long-term survival of different subgroups of patients with gastric cancer: A propensity score-matched analysis

Cai

Yang²,

Zheng³

et al. 2022

Front. Nutr.

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As defined by the Global Leaders Malnutrition Initiative (GLIM), malnutrition is strongly associated with a lower quality of life and poor prognosis in gastric cancer patients. However, few studies have precisely explored the predictors of malnutrition, as defined by the GLIM, for overall survival (OS) after gastric cancer surgery in subgroups of patients stratified according to population characteristics. Our research aimed to analyze whether the predictors of malnutrition defined by the GLIM for postoperative OS in gastric cancer patients differ across subgroups. Patients who underwent radical gastric cancer surgery at our center between July 2014 and February 2019 were included in the study. Propensity score matching (PSM) was used to minimize bias. The study population was divided into malnourished and normal groups based on whether they were malnourished as defined by the GLIM. Univariate and multivariate analyses were performed to identify the risk factors affecting OS. The Kaplan–Meier curve and log-rank test were performed to determine the survival rate difference between subgroups. Overall, 1,007 patients were enrolled in the research. Multivariate analysis showed that malnutrition among the patients was 33.47%. Additionally, GLIM-defined malnutrition was an independent risk factor [hazard ratio (HR): 1.429, P = 0.001] for a shorter OS in gastric cancer patients. Furthermore, subgroup analysis showed that the GLIM was more appropriate for predicting OS in older aged patients (≥65 years), females, those with comorbidities (Charlson comorbidity index ≥ 2), and those with advanced gastric cancer (TNM stage = 3). GLIM-defined malnutrition affects the long-term survival of gastric cancer patients, especially older patients, females, patients with comorbidities, and patients with advanced gastric cancer.

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“…The patients in the PNI ≥ 45 group had a signi cant longer median OS in this study. Nutritional status and immunity are closely related to the prognosis of patients with malignant tumors, according to many studies [21][22][23][24][25]. PNI is an easily accessible index that considers nutritional and immunologic factors.The preoperative nutritional index was rst proposed by Buzby et al[26] in 1980 and was initially used to assess preoperative nutritional status, surgical risk, and postoperative complications (PNI = 5×total lymphocyte count (10 9 /L) + serum albumin (g/L)).…”

Section: Discussionmentioning

confidence: 99%

The Efficacy and Safety of Nab-Paclitaxel Plus Gemcitabine versus mFOLFIRINOX in the First-Line Treatment of Metastatic Pancreatic Cancer: A Retrospective Study.

Liu

Wang

et al. 2022

Preprint

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Background Nab-paclitaxel plus Gemcitabine (AG) and modified FOLFIRINOX (FFX) are two systemic therapies that have been widely used as standard first-line chemotherapy regimens in metastatic pancreatic cancer. However, since there is no clinical trial to directly compare the efficacy and safety of the two regimens, it is not clear which regimen is more effective. In this study, we aim to examine and compare the efficacy and safety of AG and FFX as first-line chemotherapy regimens in Chinese patients with metastatic pancreatic cancer in a real-world setting. Methods We retrospectively evaluated the outcomes of 41 patients who diagnosed with metastatic pancreatic cancer and were treated with either AG (n = 21) or FFX (n = 20) as first-line chemotherapy between March 2017 and February 2022 at Zhongnan hospital of Wuhan University. Results Of 41 patients in this study, 21 were treated with AG and 20 were treated with FFX as first-line chemotherapy. No significant differences in baseline characteristics were found between the two groups. The objective response rate (ORR)was 14.3% in the AG group and 20.0% in the FFX group. The disease control rate (DCR) was 71.4% in the AG group and 60.0% in the FFX group. There was no significant difference in PFS or OS between the AG group and the FFX group.The median progression-free survival (PFS) was 5.27 months (95% confidence interval [CI], 4.08–6.46) in the AG group and 3.67 months (95% CI, 2.28–5.05, p = 0.192)in the FFX group.The median overall survival (OS) was 10.03 months (95% CI, 7.33–12.63) in the AG group and 9.02 months (95% CI,6.02–11.98, p = 0.464) in the FFX group.The second-line treatment rate was 47.1% in the AG group and 55.0% in the FFX group. Immune checkpoint inhibitors (ICIs) based regimens are common second-line treatment options whether in AG or FFX group. Significantly more grade 3–4 peripheral neuropathy occurred in the AG than the FFX groups (4 (19.0%) vs 0 (0.0%), p = 0.040*).The patients in the PNI(Prognostic nutrition index) ≥ 45 group had a significant longer median OS (PNI ≥ 45 vs PNI < 45: 10.34 vs 6.90 mo, P = 0.005). Conclusion AG and FFX showed comparable efficacy outcomes in patients with metastatic pancreatic cancer. Pancreatic cancer patients receiving first-line chemotherapy with good nutritional status are likely to have a better prognosis.

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Influences of the Charlson Comorbidity Index and Nutrition Status on Prognosis After Esophageal Cancer Surgery

Cited by 28 publications

References 32 publications

Body Mass Index and Prognosis of Patients With Stage II/III Gastric Cancer After Curative Gastrectomy: Completion of Perioperative Adjuvant Chemotherapy May Be a Confounding Factor

Body Mass Index and Prognosis of Patients With Stage II/III Gastric Cancer After Curative Gastrectomy: Completion of Perioperative Adjuvant Chemotherapy May Be a Confounding Factor

Global leaders malnutrition initiative-defined malnutrition affects long-term survival of different subgroups of patients with gastric cancer: A propensity score-matched analysis

The Efficacy and Safety of Nab-Paclitaxel Plus Gemcitabine versus mFOLFIRINOX in the First-Line Treatment of Metastatic Pancreatic Cancer: A Retrospective Study.

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