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

Aziz Serkan Senger 1 * , Selcuk Gulmez 1, Orhan Uzun 1, Deniz Avan 2, Ayhan Oz 1, Cem Batuhan Ofluoglu 1, Omer Ozduman 1, Erdal Polat 1, Mustafa Duman 1
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1 Department of Gastrointestinal Surgery, Kartal Kosuyolu Higher Specialty Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
2 Department of Anesthesia and Reanimation CliniC, Kartal Kosuyolu Higher Specialty Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
* Corresponding Author
J CLIN MED KAZ, Volume 18, Issue 1, pp. 69-73. https://doi.org/10.23950/jcmk/9668
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ABSTRACT

Objective: 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 (PNI) 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 PNI (PNI <45 and PNI ≥45). The clinicopathological characteristics and prognosis of the patients were recorded and analyzed.
Results: PNI 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.
Keywords: Prognostic Nutritional Index, Gastric Cancer, Prognosis, Complications

CITATION

Senger AS, Gulmez S, Uzun O, Avan D, Oz A, Ofluoglu CB, et al. Effect of the prognostic nutritional index on prognosis in patients undergoing gastric cancer surgery. J CLIN MED KAZ. 2021;18(1):69-73. https://doi.org/10.23950/jcmk/9668

REFERENCES

  • Santos, M.O., & Silva, J.G. (2018). Estimate 2018: Cancer Incidence in Brazil Estimativa 2018: Incidência de Câncer no Brasil Estimación 2018 : incidencia de Cáncer en brasil.
  • Kamiya S, Rouvelas I, Lindblad M, Nilsson M. Current trends in gastric cancer treatment in Europe. J Cancer Metastasis Treat. 2018; 4(7):35. http://dx.doi.org/10.20517/2394-4722.2017.76.
  • Yaprak G, Tataroglu D, Dogan B, Pekyurek M. Prognostic factors for survival in patients with gastric cancer: single instution experience. North Clin Istanbul. 2019; 7(2):146–52. doi: 10.14744/nci.2019.73549
  • Zhou J, Hiki N, Mine S, Kumagai K, Ida S, Jiang X, et al. Role of Prealbumin as a Powerful and Simple Index for Predicting Postoperative Complications After Gastric Cancer Surgery. Ann Surg Oncol. 2017; 24(2):510–7. doi:10.1245/s10434-016-5548-x
  • Lis CG, Gupta D, Lammersfeld CA, Markman M, Vashi PG. Role of nutritional status in predicting quality of life outcomes in cancer - A systematic review of the epidemiological literature. Nutr J. 2012; 11(1). doi:10.1186/1475-2891-11-27
  • Leandro-Merhi VA, de Aquino JLB. Determinants of malnutrition and post-operative complications in hospitalized surgical patients. J Heal Popul Nutr. 2014; 32(3):400–10. https://doi.org/10.1016/S0261-5614(13)60457-4
  • Claudino MM, Lopes JR, Rodrigues VD, de Pinho NB, Martucci RB. Postoperative complication rate and survival of patients with gastric cancer undergoing immunonutrition: A retrospective study. Nutrition [Internet]. 2020; 70:110590. https://doi.org/10.1016/j.nut.2019.110590.
  • Okadome K, Baba Y, Yagi T, Kiyozumi Y, Ishimoto T, Iwatsuki M, et al. Prognostic Nutritional Index, Tumor-infiltrating Lymphocytes, and Prognosis in Patients with Esophageal Cancer. Ann Surg. 2020; 271(4):693–700. doi: 10.1097/SLA.0000000000002985.
  • Miao Y, Li S, Yan Q, Li B, Feng Y. Prognostic significance of preoperative prognostic nutritional index in epithelial ovarian cancer patients treated with platinum-based chemotherapy. Oncol Res Treat. 2016; 39(11):712–9. https://doi.org/10.1159/000452263.
  • Luvián-Morales J, González-Trejo S, Carrillo JF, Herrera-Goepfert R, Aiello-Crocifoglio V, Gallardo-Rincón D, et al. Association of the prognostic nutritional index and overall survival in patients with colorectal cancer: A STROBE compliant retrospective cohort study. Cancer Med. 2019; 8(7):3379–88. https://doi.org/10.1002/cam4.2212.
  • Jiang N, Deng JY, Ding XW, Ke B, Liu N, Zhang RP, et al. Prognostic nutritional index predicts postoperative complications and long-term outcomes of gastric cancer. World J Gastroenterol. 2014; 20(30):10537–44. doi: 10.3748/wjg.v20.i30.10537.
  • Amin MB, Edge SB, Greene FL, Gershenwald JE, Brookland RK, Meyer L. et al. The AJCC Cancer Staging Manual, 8th ed.; Springer: New York, NY, USA, 2016.
  • Özbilgin Ş, Hanci V, Ömür D, Özbilgin M, Tosun M, Yurtlu S, et al. Morbidity and mortality predictivity of nutritional assessment tools in the postoperative care unit. Medicine. 2016; 95(40):1–7. http://dx.doi.org/10.1097/MD.0000000000005038.
  • Tsujinaka T, Sasako M, Yamamoto S, Sano T, Kurokawa Y, Nashimoto A, et al. Influence of overweight on surgical complications for gastric cancer: Results from a randomized control trial comparing D2 and extended para-aortic D3 lymphadenectomy (JCOG9501). Ann Surg Oncol. 2007; 14(2):355–61. doi: 10.1245/s10434-006-9209-3.
  • Feng F, Zheng G, Guo X, Liu Z, Xu G, Wang F, et al. Impact of body mass index on surgical outcomes of gastric cancer. BMC Cancer. 2018; 18(1):1–8. https://doi.org/10.1186/s12885-018-4063-9.
  • Kamachi K, Ozawa S, Hayashi T, Kazuno A, Ito E, Makuuchi H. Impact of body mass index on postoperative complications and long-term survival in patients with esophageal squamous cell cancer. Dis Esophagus. 2016; 29(3):229–35. doi: 10.1111/dote.12327.
  • Li C, Oh SJ, Kim S, Hyung WJ, Yan M, Zhu ZG, et al. Risk factors of survival and surgical treatment for advanced gastric cancer with large tumor size. J Gastrointest Surg. 2009; 13(5):881–5. doi: 10.1007/s11605-009-0800-3.
  • Zhao LY, Zhang WH, Chen XZ, Yang K, Chen XL, Liu K, et al. Prognostic significance of tumor size in 2405 patients with gastric cancer a retrospective cohort study. Medicine. 2015; 94(50):1–10. doi: 10.1097/MD.0000000000002288.
  • Jiang N, Deng JY, Ding XW, Zhang L, Liu HG, Liang YX, et al. Effect of complication grade on survival following curative gastrectomy for carcinoma. World J Gastroenterol. 2014; 20(25):8244–52. DOI: 10.3748/wjg.v20.i25.8244.
  • Climent M, Hidalgo N, Vidal, Puig S, Iglesias M, Cuatrecasas M, et al. Postoperative complications do not impact on recurrence and survival after curative resection of gastric cancer. Eur J Surg Oncol. 2016; 42(1):132–9. http://dx.doi.org/10.1016/j.ejso.2015.08.163.
  • Wang S, Xu L, Wang Q, Li J, Bai B, Li Z, et al. Postoperative complications and prognosis after radical gastrectomy for gastric cancer: A systematic review and meta-analysis of observational studies. World J Surg Oncol. 2019; 17(1):18–20. https://doi.org/10.1186/s12957-019-1593-9.
  • Argilés JM. Cancer-associated malnutrition. Eur J Oncol Nurs. 2005; 9(2). doi:10.1016/j.ejon.2005.09.006.