Impact of the preoperative prognostic nutritional index on postoperative and survival outcomes in colorectal cancer patients who underwent primary tumor resection: a systematic review and meta-analysis

Sun, Guangwei; Li, Yalun; Peng, Yangjie; Lu, Dapeng; Zhang, Fuqiang; Cui, Xueyang; Zhang, Qingyue; Li, Zhuang

doi:10.1007/s00384-019-03241-1

Cited by 57 publications

(48 citation statements)

References 44 publications

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“…31 In the case of CRC, PNI has shown to be a robust prognostic factor for OS. 31,32 In this study, an important association between the PNI and OS in a large cohort of patients with CRC is reported. The final multivariate model strongly suggests that PNI is an independent explanatory variable, and it is relevant in conjunction with the neoplasm's location in the colorectum, TNM stage, differentiation degree, and several other wellestablished prognostic factors.…”

Section: Discussionmentioning

confidence: 76%

“…This allows the Cox's Proportional Hazards model to establish a much more accurate forecast model. This is the first report on the association of PNI in CRC in Latin-America and it is interesting to compare with the study of Sun et al 32 which is a meta-analysis performed mainly in Asian patients, including 6372 patients from ten centers. In our study, 3301 patients mainly from central Mexico were treated in a single cancer center.…”

Section: Discussionmentioning

confidence: 94%

“…38 Several cutoff points for the PNI are reported, usually range from 35 to 50. 32 In our study, a cut-off value for PNI is intentionally not defined, because the association of PNI and OS yielded a clear biological gradient by bivariate analysis (Figure 1). A forecast using the PNI as a continuous variable has enormous advantages from a statistical point of view.…”

Section: Discussionmentioning

confidence: 97%

“…As part of those immunonutritional factors that can be measured in blood, PNI is thought to reflect patient's nutritional and immunological status and has been reported to be an important prognostic factor in several neoplasms such as gastric, hepatocellular, pancreatic, esophageal carcinoma, and malignant pleural mesothelioma . In the case of CRC, PNI has shown to be a robust prognostic factor for OS …”

Section: Discussionmentioning

confidence: 99%

“…Several reports on CRC emphasize that a cut‐off value of PNI of 44.5 or more is associated to less frequent postoperative complications and a longer OS; a PNI above 36 in patients who underwent elective low anterior resection with colorectal anastomosis, is associated with a longer disease‐free survival . Several cutoff points for the PNI are reported, usually range from 35 to 50 …”

Section: Discussionmentioning

confidence: 99%

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Association of the prognostic nutritional index and overall survival in patients with colorectal cancer: A STROBE compliant retrospective cohort study

et al. 2019

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Background The TNM classification does not completely reflect the prognosis of patients with colorectal cancer (CRC). Several clinical factors have been used to increase its prognostic value, but factors pertaining to the patient's immunonutritional status have not usually been addressed. The aim of this study is to evaluate the role of Prognostic nutritional index (PNI) and other well‐known prognostic factors by multivariate analysis in a cohort of patients with CRC. Methods This is a retrospective cohort study of consecutive patients with CRC managed in a cancer center between January 1992 and December 2016. Cox's model was used to define the association of the PNI and other factors with Overall survival (OS). Results A total of 3301 patients were included: 47.7% were female and 52.3% were male, with a mean age of 58.7 years. By bivariate analysis, PNI was strongly associated with OS (Risk ratio [RR] 0.968, 95% Confidence interval [CI] 0.962‐0.974; P < 0.001). On multivariate analysis, PNI was an independent explanatory variable (as continuous variable and as categorized variable; RR 0.732, 95% CI 0.611‐0.878; RR 0.656, 95% CI 0.529‐0.813 and RR 0.646, 95% CI 0.521‐0.802, for quintiles 2, 3, and 4‐5, respectively); a biological gradient effect was demonstrated. The final prognostic model included PNI, location of the neoplasia in the colorectum, basal hemoglobin, lymphocyte count, neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, TNM stage, differentiation degree, R classification, and postoperative complications. Conclusions PNI is a significant and independent prognostic factor in patients with CRC. Its prognostic value adds precision to the TNM staging system including specific subgroups of patients with CRC; it should be evaluated in prospective clinical studies.

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Section: Discussionmentioning

confidence: 76%

Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Association of the prognostic nutritional index and overall survival in patients with colorectal cancer: A STROBE compliant retrospective cohort study

et al. 2019

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Frailty is an independent risk factor for recurrence and mortality following curative resection of stage I–III colorectal cancer

Mima

Miyanari

Morito

et al. 2020

Annals of Gastroent Surgery

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Aim With population aging, the number of frail patients with colorectal cancer has increased. The Clinical Frailty Scale (CFS) is a validated tool for assessing frailty, and higher scores indicate worse clinical outcomes following cardiovascular procedures. This retrospective study aimed to examine preoperative frailty in relation to recurrence and mortality following curative resection of colorectal cancer. Methods We retrospectively analyzed data for 729 consecutive patients undergoing curative resection of stage I–stage III colon and rectal adenocarcinoma between January 2009 and December 2016. Frailty was assessed using the CFS: 1 (very fit) to 9 (terminally ill), and frailty was defined as CFS ≥ 4. Recurrence‐free survival (RFS) and overall survival (OS) were compared between frail and nonfrail patients. Cox proportional hazards model was used to calculate hazard ratios (HRs), controlling for potential confounders. Results CFS score was negatively correlated with the Barthel index of activities of daily living (Spearman's ρ = −0.83). Of the 729 patients, 253 (35%) were frail. In multivariable analyses adjusting for potential confounders including age and disease stage, frailty was independently associated with shorter RFS (multivariable HR: 1.70, 95% confidence interval: 1.25‐2.31, P < .001) and OS (multivariable HR: 2.04, 95% confidence interval: 1.40‐2.99, P < .001). There were no significant interactions of frailty with age and disease stage regarding RFS and OS ( P interaction > .72). Conclusion Preoperative frailty was independently associated with shorter RFS and OS following resection of nonmetastatic colorectal cancer, regardless of age and disease stage. Further trials are needed to establish treatment strategies for frail patients with colorectal cancer.

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Comparison of nutritional and immunological scoring systems predicting prognosis in T1-2N0 colorectal cancer

Pian

2021

Int J Colorectal Dis

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Purpose Previous studies have shown that the new nutritional and immunological status scoring systems of the Naples prognostic score (NPS), controlling nutritional status score (CONUT), and the older prognostic nutritional index (PNI) are independent predictors in colorectal cancer. This study compares the prognostic value of NPS, CONUT, and PNI in T1-2N0 colorectal cancer. Methods We retrospectively evaluated 305 consecutive stage I (T1-2N0M0) colorectal cancer patients who underwent radical surgery from January 2010 to December 2015 at our hospital. The NPS results were divided into 3 groups (0, 1, and 2 groups), and the PNI and CONUT results were divided into 2 groups (low and high groups). ResultsThe patients with low PNI had worse overall survival (OS) and disease-free survival (DFS) than those with high PNI (P < 0.001 and P < 0.001, respectively). Multivariate analysis showed that PNI was independently associated with OS and DFS (P < 0.001 and P < 0.001, respectively), but NPS and CONUT results were not. ConclusionThe PNI is an independent predictor in stage I colorectal cancer, but NPS and CONUT results are not.

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Impact of the preoperative prognostic nutritional index on postoperative and survival outcomes in colorectal cancer patients who underwent primary tumor resection: a systematic review and meta-analysis

Cited by 57 publications

References 44 publications

Association of the prognostic nutritional index and overall survival in patients with colorectal cancer: A STROBE compliant retrospective cohort study

Association of the prognostic nutritional index and overall survival in patients with colorectal cancer: A STROBE compliant retrospective cohort study

Frailty is an independent risk factor for recurrence and mortality following curative resection of stage I–III colorectal cancer

Comparison of nutritional and immunological scoring systems predicting prognosis in T1-2N0 colorectal cancer

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