Postoperative complication rate and survival of patients with gastric cancer undergoing immunonutrition: A retrospective study

Claudino, Mariana Moreira; Lopes, Jessica Rodrigues; Rodrigues, V.D.; Pinho, Nivaldo Barroso de; Martucci, Renata Brum

doi:10.1016/j.nut.2019.110590

Cited by 16 publications

(18 citation statements)

References 39 publications

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“…However, there is currently no evidence to show that perioperative immunonutrition actually improves the long-term outcomes of GC patients. It also currently remains unclear whether preoperative immunonutrition reduces morbidity rates after gastrectomy for GC [ 44 – 46 ]. Xin et al [ 47 ] has recently shown by a systematic review and a meta-analysis that enteral nutrition feeding tube support is an essential intervention to elevate patients’ immunity, depress levels of inflammation, and reduce the risk of complications after gastrectomy for GC.…”

Section: Discussionmentioning

confidence: 99%

Significance of a preoperative systemic immune-inflammation index as a predictor of postoperative survival outcomes in gastric cancer

et al. 2021

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Background Since inflammation and the immune system contribute to the development and progression of malignancies, parameters that reflect a host’s immune-inflammatory status may be useful prognostic indicators of gastric cancer (GC). The present study examined the clinical significance of a preoperative systemic immune-inflammation index (SII) for predicting postoperative survival outcomes in GC. Methods A total of 447 patients who underwent curative gastrectomy for GC were included in the present study. SII was calculated as platelet count × neutrophil count/lymphocyte count. The prognostic impact of preoperative SII was examined using univariate and multivariate analyses. Results Preoperative SII ranged between 105 and 4455 (median 474), and the optimal cutoff value for predicting overall survival (OS) was 395 based on a receiver operating characteristic curve. The 5-year OS rate of the SII ≥ 395 group was 80.0%, which was significantly worse than that (92.7%) of the SII < 395 group (p < 0.001). The multivariate analysis identified SII ≥ 395 (hazard ratio [HR] 2.95; 95% confidence interval [CI] 1.49–6.39; p = 0.001), heart disease (HR 2.14, 95% CI 1.07–4.07), C-reactive protein ≥ 0.5 (HR 2.45, 95% CI 1.15–4.94), pT4 (HR 4.46, 95% CI 2.44–8.14), and pN+ (HR 4.02, 95% CI 2.10–7.93) as independent predictors of worse OS. Peritoneal recurrence was more frequent in the high SII group than in the low SII group (p = 0.028). Conclusion Preoperative SII may be a useful predictor of postoperative survival outcomes in GC. The meticulous surveillance of GC relapse, particularly peritoneal dissemination, is necessary for patients with SII ≥ 395 even after curative gastrectomy.

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Section: Discussionmentioning

confidence: 99%

Significance of a preoperative systemic immune-inflammation index as a predictor of postoperative survival outcomes in gastric cancer

et al. 2021

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“…A total of 2165 distinctive studies were found, of which 10 studies (between 2005 and 2020) satisfied the inclusion criteria and were comprised in the study 8,12‐20 . This meta‐analysis study based on 10 studies included 1056 subjects with gastric cancer undergoing a total gastrectomy at the start of the study: 505 were provided with enteral immunonutrition, and 551 were enteral nutrition.…”

Section: Resultsmentioning

confidence: 99%

“…A total of 2165 distinctive studies were found, of which 10 studies (between 2005 and 2020) satisfied the inclusion criteria and were comprised in the study. 8 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 This meta‐analysis study based on 10 studies included 1056 subjects with gastric cancer undergoing a total gastrectomy at the start of the study: 505 were provided with enteral immunonutrition, and 551 were enteral nutrition. All studies evaluated the effect of enteral immunonutrition compared with enteral nutrition on surgical wound infection, immune and inflammatory factors, serum proteins, and cellular immunity in subjects with gastric cancer undergoing a total gastrectomy.…”

Section: Resultsmentioning

confidence: 99%

“…This meta-analysis study based on 10 studies included 1056 subjects with gastric cancer undergoing a total gastrectomy at the start of the study: 505 of them were provided with enteral immunonutrition, and 551 were enteral nutrition. 8,[12][13][14][15][16][17][18][19][20] Enteral immunonutrition had no significant difference in the surgical wound infection, infectious complication, systemic inflammatory response syndrome, CD8+ level, CD4+ level, CD4+/CD8+, lymphocyte, and transferrin compared with enteral nutrition in subjects with gastric cancer undergoing a total gastrectomy. However, enteral immunonutrition had significantly higher proalbumin, IgM, and IgG compared with enteral nutrition in subjects with gastric cancer undergoing a total gastrectomy.…”

Section: Discussionmentioning

confidence: 99%

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Effect of enteral immunonutrition compared with enteral nutrition on surgical wound infection, immune and inflammatory factors, serum proteins, and cellular immunity in subjects with gastric cancer undergoing a total gastrectomy: A meta‐analysis

Fu¹,

Li²,

Liang³

2022

International Wound Journal

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We performed a meta‐analysis to evaluate the effect of enteral immunonutrition compared with enteral nutrition on surgical wound infection, immune and inflammatory factors, serum proteins, and cellular immunity in subjects with gastric cancer undergoing a total gastrectomy. A systematic literature search up to November 2021 was done, and 10 studies included 1056 subjects with gastric cancer undergoing a total gastrectomy at the start of the study: 505 of them were provided with enteral immunonutrition, and 551 were enteral nutrition. They were reporting relationships about the effect of enteral immunonutrition compared with enteral nutrition on surgical wound infection, immune and inflammatory factors, serum proteins, and cellular immunity in subjects with gastric cancer undergoing a total gastrectomy. We calculated the odds ratio (OR) or mean difference (MD) with 95% confidence intervals (CIs) to assess the effect of enteral immunonutrition compared with enteral nutrition on surgical wound infection, immune and inflammatory factors, serum proteins, and cellular immunity in subjects with gastric cancer undergoing a total gastrectomy using the dichotomous or contentious method with a random or fixed‐effect model. Enteral immunonutrition had no significant difference in the surgical wound infection (OR, 0.77; 95% CI, 0.50‐1.19, P = .24), the infectious complication (OR, 0.72; 95% CI, .48‐1.09, P = .13), the systemic inflammatory response syndrome (MD, ‐0.50; 95% CI, −1.40 to 0.39, P = .27), the CD8+ level (MD, 1.34; 95% CI, 0‐2.68, P = .05), the CD4+ level (MD, 1.21; 95% CI, −7.65 to 10.07, P = .79), the CD4‐CD8+ (MD, 0.55; 95% CI, 0‐1.10, P = .05), the lymphocyte (MD, −0.77; 95% CI, −1.87 to 0.33, P = .17), and the transferrin (MD, 0.03; 95% CI, −0.01 to 0.08, P = .14) compared with enteral nutrition in subjects with gastric cancer undergoing a total gastrectomy. However, enteral immunonutrition had significantly higher proalbumin (MD, 22.15; 95% CI, 3.57‐40.72, P = .02), IgM (MD, 0.47; 95% CI, 0.43‐0.50, P < .001), and IgG (MD, 1.98; 95% CI, 1.08‐2.89, P < .001) compared with enteral nutrition in subjects with gastric cancer undergoing a total gastrectomy. Enteral immunonutrition had no significant difference in the surgical wound infection, the infectious complication, the systemic inflammatory response syndrome, the CD8+ level, the CD4+ level, the CD4+/CD8+, the lymphocyte, and the transferrin, and had significantly higher proalbumin, IgM, and IgG compared with enteral nutrition in subjects with gastric cancer undergoing a total gastrectomy. Further studies are required to validate these findings or to affect the confidence level.

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“…The Prognostic Nutritional Index (PNI) is a tool for measuring the nutritional and immunological status and is calculated based on serum albumin concentration and total lymphocyte count [8]. PNI is associated with mortality and prognosis in cancer patients and has been shown to predict postoperative complications following gastrointestinal system surgery [9,10].…”

Section: Introductionmentioning

confidence: 99%

Effect of the prognostic nutritional index on prognosis in patients undergoing gastric cancer surgery

et al. 2021

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The leading concern among cancer patients is posttreatment complications and survival, which are associated with patient-related, tumor-related and treatment-related factors. We present here an analysis of the Prognostic Nutritional Index as a preoperatively improvable prognostic factor.Material and methods: A retrospective review was made of 228 patients operated on for gastric cancer between January 2011 and October 2019. The patients were divided into two groups based on Prognostic Nutritional Index (PNI <45 and PNI ≥45). The clinicopathological characteristics and prognosis of the patients were recorded and analyzed.Results: Prognostic Nutritional Index was ≥45 in 162 patients and <45 in 66 patients. An examination of the patients' clinicopathological and demographic characteristics revealed a statistically significant difference in postoperative complications (p=0.014), age (p=0.054), tumor size (p=0.027), and Body Mass Index (BMI) (p=0.041) between the two groups. Using a Kaplan-Meier test, overall survival analysis revealed a difference between the two groups (p=0.001). A multivariate Cox regression analysis of the factors impacting overall survival revealed the T stage (p=0.031), N stage (p<0.001), and PNI (p=0.041) to be significant. Conclusion:The prognostic nutritional index is easy to calculate, a simple and practical approach to assessing nutritional status. Based on the present study's findings, the preoperative calculation of the prognostic nutritional index can serve as an indicator of postoperative complications and prognosis. The most important benefit of this marker is that it can be improved preoperatively.

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Postoperative complication rate and survival of patients with gastric cancer undergoing immunonutrition: A retrospective study

Cited by 16 publications

References 39 publications

Significance of a preoperative systemic immune-inflammation index as a predictor of postoperative survival outcomes in gastric cancer

Significance of a preoperative systemic immune-inflammation index as a predictor of postoperative survival outcomes in gastric cancer

Effect of enteral immunonutrition compared with enteral nutrition on surgical wound infection, immune and inflammatory factors, serum proteins, and cellular immunity in subjects with gastric cancer undergoing a total gastrectomy: A meta‐analysis

Effect of the prognostic nutritional index on prognosis in patients undergoing gastric cancer surgery

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