Background. Clinically relevant postoperative pancreatic fistula (CR-POPF) is a severe complication which may be caused by a perioperative nutrition problem. We aimed to study whether patients with high nutritional risk ( NRS 2002 score ≥ 5 ) might benefit from preoperative nutrition support regarding the risk of CR-POPF after open pancreaticoduodenectomy. Methods. Consecutive patients undergoing open pancreaticoduodenectomy with complete record of NRS2002 at two Chinese institutions between 2013 and 2018 were analysed. CR-POPF was diagnosed following the 2016 ISGPS criteria. Nutrition support included oral nutrition supplement and enteral and parenteral nutrition. Clinical and economic outcomes were analysed. Results. 522 cases were included. 135 cases (25.9%) were at high nutritional risk ( NRS 2002 score ≥ 5 ), among which 41 cases (30.4%) received preoperative nutrition support. The CR-POPF rate was significantly lower in the preoperative nutrition support group compared with the no nutrition support group (12.2% versus 28.7%, P = 0.038 ). Multivariate analysis showed that preoperative nutrition support was a protective factor for CR-POPF in patients at high risk [OR 0.339, 95% CI (0.115-0.965), P = 0.039 ]. Higher albumin and a larger diameter of the main pancreatic duct were found to be other protectors for CR-POPF. Conclusions. Patients with high nutritional risk ( NRS 2002 score ≥ 5 ) may profit from preoperative nutritional support manifested in the reduction of CR-POPF.
is still the definitive operation to treat tumors in the pancreatic head and peri-ampullary region. Despite the decreased mortality of PD in high-volume institutions, the rate of postoperative complications remains high. [1][2][3][4][5] Postoperative pancreatic fistula (POPF) is the most common complication and the prevalence is 5%-30%. 6,7 POPF may cause serious severe secondary complications, such as post-pancreatectomy hemorrhage (PPH), intra-abdominal infection, and even death, which may lead to prolonged length of hospital stay and increased hospital costs.The International Study Group for Pancreatic Fistula (ISGPF) standardized the definition and classification of POPFs in 2005. 8 By reviewing studies for more than 10 years,
Objective The neutrophil-to-albumin ratio (NAR) and fibrinogen are significantly related to tumor progression. The present study evaluated the prognostic impact of the NAR plus fibrinogen concentration in gastrointestinal stromal tumor (GIST) cases. Methods The baseline characteristics, postoperative NAR, and fibrinogen concentrations were retrospectively analyzed for 229 Chinese patients who underwent radical gastrectomy for GIST. Receiver operating characteristic (ROC) curves were applied to estimate the optimal critical points for NAR and fibrinogen. Cox regression analysis was applied to determine significant prognostic variables. Results Multivariate analyses revealed that poor recurrence-free survival was associated with elevated values for fibrinogen (hazard ratio [HR]: 5.015, 95% confidence interval [CI]: 1.993–12.619, P=0.001) and NAR (HR: 4.669, 95% CI: 1.776–12.273, P = 0.002). Combining fibrinogen and the NAR into the NARFIB score provided an area under the ROC curve of 0.833, which was greater than the areas for NAR (0.708) or fibrinogen (0.778). When the NAR and fibrinogen were replaced by the NARFIB score in the multivariate analysis, the independent prognosticators were tumor site (HR: 2.927, 95% CI: 1.417–6.045, P=0.004), mitotic index (HR: 2.661, 95% CI: 1.110–6.380, P=0.028), and the NARFIB score (HR: 14.116, 95% CI: 3.243–61.443, P<0.001). The NARFIB score retained its prognostic significance in various subgroup analyses and was significantly related to gender, surgical approach, tumor size, mitosis, tumor site, risk classification, and recurrence. Conclusion These results suggest that the NARFIB score may help guide prognostication and risk stratification for GIST, which might benefit from targeted therapy.
Background Radiofrequency ablation (RFA) is an effective treatment option for hepatocellular carcinoma (HCC). This study aimed to analyze the prognostic factors of HCC patients treated with RFA and to develop nomograms for outcome prediction. Methods A total of 3142 HCC patients treated with RFA were recruited, and their data were collected from the Surveillance, Epidemiology, and End Results database. Univariate and multifactor Cox analyses were performed to identify independent prognostic factors. These factors were integrated into a nomogram to predict 3- and 5-year cancer-specific survival (CSS) and overall survival (OS). Consistency indices and calibration plots were used to assess the accuracy of the nomograms in both the internal and external cohorts. Results The median follow-up periods for HCC patients treated with RFA were 27 and 29 months for OS and CSS, respectively. Marital status, age, race, histological grade of differentiation, tumor size, T stage, and serum alpha-fetoprotein levels at the time of diagnosis were identified as prognostic factors for OS and CSS. Additionally, M stage was identified as risk factors for OS. These risk factors are included in the nomogram. The calibration plots of the OS and CSS nomograms showed excellent consistency between actual survival and nomogram predictions. The bootstrap-corrected concordance indices of the OS and CSS nomograms were 0.637 (95% CI, 0.628–0.646) and 0.670 (95% 0.661–0.679), respectively. Importantly, our nomogram performed better discriminatory compared with 8th edition tumor-node-metastasis (TNM) stage system for predicting OS and CSS. Conclusions We identified prognostic factors for HCC patients treated with RFA and provided an accurate and personalized survival prediction scheme.
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