Preoperative nutritional risk index and postoperative one-year skeletal muscle loss can predict the prognosis of patients with gastric adenocarcinoma: a registry-based study

Abstract

Background Patients with gastric cancer have an increased nutritional risk and experience a significant skeletal muscle loss after surgery. We aimed to determine whether muscle loss during the first postoperative year and preoperative nutritional status are indicators for predicting prognosis. Methods From a gastric cancer registry, a total of 958 patients who received curative gastrectomy followed by chemotherapy for stage 2 and 3 gastric cancer and survived longer than 1 year were investigated. Clinical and laboratory data were collected. Skeletal muscle index (SMI) was assessed based on the muscle area at the L3 level on abdominal computed tomography. Results Preoperative nutritional risk index (NRI) and postoperative decrement of SMI (dSMI) were significantly associated with overall survival (hazards ratio: 0.976 [95% CI: 0.962–0.991] and 1.060 [95% CI: 1.035–1.085], respectively) in a multivariate Cox regression analysis. Recurrence, tumor stage, comorbidity index were also significant prognostic indicators. Kaplan-Meier analyses exhibited that patients with higher NRI had a significantly longer survival than those with lower NRI (5-year overall survival: 75.8% vs. 63.0%, P < 0.001). In addition, a significantly better prognosis was observed in a patient group with less decrease of SMI (5-year overall survival: 75.7% vs. 66.2%, P = 0.009). A logistic regression analysis demonstrated that the performance of preoperative NRI and dSMI in mortality prediction was quite significant (AUC: 0.63, P < 0.001) and the combination of clinical factors enhanced the predictive accuracy to the AUC of 0.90 (P < 0.001). This prognostic relevance of NRI and dSMI was maintained in patients experiencing tumor recurrence and highlighted in those with stage 3 gastric adenocarcinoma. Conclusions Preoperative NRI is a predictor of overall survival in stage 2 or 3 gastric cancer patients and skeletal muscle loss during the first postoperative year was significantly associated with the prognosis regardless of relapse in stage 3 tumors. These factors could be valuable adjuncts for accurate prediction of prognosis in gastric cancer patients.

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

“…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).…”

Preoperative Prognostic Nutritional Index May Be a Strong Predictor of Hepatocellular Carcinoma Recurrence Following Liver Transplantation

“…In recent years, it evolved to a widely accepted biomarker in many cancer entities, including HCC. [10][11][12][13][14][15][16] Two meta-analyses reported on an…”

“…In recent years, it evolved to a widely accepted biomarker in many cancer entities, including HCC. 10–16 Two meta-analyses reported on an independent prognostic value of PNI in patients following hepatectomy and non-surgical treatments, whereas predictive significance in the LT setting remained undetermined. 24 , 25 …”

“…According to the respective formula, low-PNI results from hypoalbuminemia and/or lymphopenia. 9 , 10 Lower serum albumin levels may be related to liver dysfunction, which in turn is discussed as tumor-promoting factor also in the LT setting. 19 Hypoalbuminemia was also reported to correlate with unfavorable tumor characteristics.…”

“…Originally introduced to determine the perioperative risk in gastrointestinal surgery, 9 it subsequently developed to an established biomarker in a wide range of different cancer entities, including gastric, esophageal, colorectal, and lung cancer. [10][11][12][13] Recently, there is growing evidence in HCC patients that PNI correlates with prognosis following non-surgical treatment and liver resection. [14][15][16] Its predictive significance in the LT setting remained, however, so far undetermined.…”