Prognostic Nutritional Index Predicts Severe Complications, Recurrence, and Poor Prognosis in Patients With Colorectal Cancer Undergoing Primary Tumor Resection

Tokunaga, Ryuma; Sakamoto, Yasuo; Nakagawa, Shigeki; Miyamoto, Yuji; Yoshida, Naoya; Oki, Eiji; Watanabe, Masayuki; Baba, Hideo

doi:10.1097/dcr.0000000000000458

Cited by 226 publications

(197 citation statements)

References 25 publications

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“…The observation was supported by previous studies which indicated that poor nutritional status was significantly parallel to tumor progression [30]. Tokunaga et al recently demonstrated in a cohort of 556 patients with colorectal cancer undergoing surgery that poor nutritional status was correlated with tumors invading muscular or deeper layers, distant metastasis, tumor recurrence, and poor survival [31].…”

Section: Discussionsupporting

confidence: 54%

Preoperative Nutritional Deficiency Is a Useful Predictor of Postoperative Outcome in Patients Undergoing Curative Resection for Gastric Cancer

Liu

Qiu

et al. 2016

Translational Oncology

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BACKGROUND: Preoperative nutritional deficiency (ND) has been shown to be a valuable prognostic factor in urologic malignancies. We aimed to investigate the prognostic value of ND in patients with gastric cancer (GC). METHODS: A single-center cohort of 1026 GC patients undergoing curative resection between 2003 and 2012 was categorized to ND and nutritionally replete (NR) groups. Patients with body mass index <18.5 kg/m2, preoperative albumin <35 g/l, or preoperative weight loss ≥5% of body weight were defined as ND. RESULTS: Of the 1026 patients included in the study, 585 (57.0%) were categorized as ND. Overall survival (OS) at 5 years was 68.5% for ND patients and 44.0% for NR patients (P < .001). Multivariate analysis revealed that ND was a significant predictor of OS (hazard ratio: 1.954; 95% confidence interval: 1.552-2.460; P < .001). In stage-stratified analysis, it was still independently associated with OS in tumor-nodes-metastasis stage II and III (P = .004 and P < .001, respectively). Of note, the prognostic significance of ND was still maintained when stratified by age, sex, anemia, and adjuvant chemotherapy (all Ps < .05). CONCLUSION: Preoperative ND is a novel predictor of outcome in GC, especially in stage II to III GC, and may help clinicians identify high-risk patients for proactive nutritional interventions.

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Section: Discussionsupporting

confidence: 54%

Preoperative Nutritional Deficiency Is a Useful Predictor of Postoperative Outcome in Patients Undergoing Curative Resection for Gastric Cancer

Liu

Qiu

et al. 2016

Translational Oncology

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“…[9,10,35] Further, we linked decreased PNI to increased risk of hematogenous metastasis but not peritoneal dissemination. A reasonable explanation for these findings is that immunocompetence and nutritional status are more relevant to hematogenous metastasis of circulating tumor cells because of the effects of compromised tumor immunity associated with the types and levels of circulating cytokines.…”

Section: Discussionmentioning

confidence: 99%

“…Since the concept of a prognostic nutrition index (PNI) was 1st suggested in 1980, various PNIs were considered as integral parameters that can reflect immunocompetence and nutritional status with greater accuracy compared with that of a single variable. [8–10] Onodera's PNI (10 × albumin g/dL) + (0.005 × lymphocyte count/mm 3 ) is associated with outcomes of patients with different malignancies. [9,11–13] Advanced GC causes debilitating malnutrition and deterioration of the immune response.…”

Section: Introductionmentioning

confidence: 99%

Nutritional predictors for postoperative short-term and long-term outcomes of patients with gastric cancer

et al. 2016

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Evidence indicates that impaired immunocompetence and nutritional status adversely affect short-term and long-term outcomes of patients with cancer. We aimed to evaluate the clinical significance of preoperative immunocompetence and nutritional status according to Onodera's prognostic nutrition index (PNI) among patients who underwent curative gastrectomy for gastric cancer (GC).This study included 260 patients with stage II/III GC who underwent R0 resection. The predictive values of preoperative nutritional status for postoperative outcome (morbidity and prognosis) were evaluated. Onodera's PNI was calculated as follows: 10 × serum albumin (g/dL) + 0.005 × lymphocyte count (per mm3).The mean preoperative PNI was 47.8. The area under the curve for predicting complications was greater for PNI compared with the serum albumin concentration or lymphocyte count. Multivariate analysis identified preoperative PNI < 47 as an independent predictor of postoperative morbidity. Moreover, patients in the PNI < 47 group experienced significantly shorter overall and disease-free survival compared with those in the PNI ≥ 47 group, notably because of a higher prevalence of hematogenous metastasis as the initial recurrence. Subgroup analysis according to disease stage and postoperative adjuvant treatment revealed that the prognostic significance of PNI was more apparent in patients with stage II GC and in those who received adjuvant chemotherapy.Preoperative PNI is easy and inexpensive to determine, and our findings indicate that PNI served as a significant predictor of postoperative morbidity, prognosis, and recurrence patterns of patients with stage II/III GC.

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“…Patients with colorectal cancer and a low PNI have a poor prognosis [26]. A PNI of less than the COV of 45.5 has been reported to be an independent risk factor for serious complications, such as myocardial infarction and pulmonary embolism [27]. …”

Section: Discussionmentioning

confidence: 99%

Risk scores as useful predictors of perioperative complications in patients with rectal cancer who received radical surgery

et al. 2016

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BackgroundRectal cancer is associated with a higher rate of surgical complications. The ability to predict the risk of complications before treatment would facilitate the design of personalized treatment strategies optimally suited for each patient.MethodsWe retrospectively studied 260 patients with rectal cancer who underwent radical surgery to examine the relations between complications and 5 types of risk scores.ResultsComplications developed in 56 patients (21.5%). Nineteen patients had infectious complications, 16 had intestinal obstruction, and 12 had other complications. Twelve patients out of 187 patients who received low anterior resection had anastomotic leakage. Estimation of Physiologic Ability and Surgical Stress Comprehensive Risk Score (E-PASS CRS) and Neutrophil-to-lymphocyte Ratio (NLR) were significantly related to all complications, infectious complications, and anastomotic leakage. Surgical Apgar Score was significantly related to infectious complications. Prognostic Nutritional Index was significantly related to all complications and intestinal obstruction. Colorectal Physiologic and Operative Severity Score for the Enumeration of Mortality and Morbidity was significantly related to all complications, and infectious complications. A multivariate analysis showed that body-mass index, E-PASS CRS, and NLR were independent risk factors for anastomotic leakage. In particular, NLR was the only score that could be evaluated before surgery.ConclusionsFive types of risk scores were useful methods for evaluating the risks of complications in patients with rectal cancer. NLR is a score that can be evaluated before surgery and predicted the risk of anastomotic leakage, suggesting that it is useful for assessing the need for a diverting colostomy.

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Prognostic Nutritional Index Predicts Severe Complications, Recurrence, and Poor Prognosis in Patients With Colorectal Cancer Undergoing Primary Tumor Resection

Cited by 226 publications

References 25 publications

Preoperative Nutritional Deficiency Is a Useful Predictor of Postoperative Outcome in Patients Undergoing Curative Resection for Gastric Cancer

Preoperative Nutritional Deficiency Is a Useful Predictor of Postoperative Outcome in Patients Undergoing Curative Resection for Gastric Cancer

Nutritional predictors for postoperative short-term and long-term outcomes of patients with gastric cancer

Risk scores as useful predictors of perioperative complications in patients with rectal cancer who received radical surgery

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