Malnutrition Identified by the Nutritional Risk Index and Poor Prognosis in Advanced Epithelial Ovarian Carcinoma

Yim, Ga Won; Eoh, Kyung Jin; Kim, Sang Wun; Nam, Eun Ji; Kim, Young Tae

doi:10.1080/01635581.2016.1159702

Cited by 55 publications

(45 citation statements)

References 36 publications

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“…Several studies have suggested that the progression of hypoalbuminemia is secondary to the serum elevation of CRP, as many cancer patients with hypoalbuminemia already have increased serum CRP levels [32, 33]. Malnutrition, in turn, is related to poor prognosis in patients with cancer [34]. Several previous studies reported that pre-operative low serum albumin levels are an independent predictor of poor survival in ovarian cancer [35, 36].…”

Section: Discussionmentioning

confidence: 99%

The prognostic value of the preoperative c-reactive protein/albumin ratio in ovarian cancer

et al. 2017

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Background: Inflammation plays an important role in the pathogenesis of ovarian cancer. This study sought to investigate the association between the preoperative c-reactive protein/albumin ratio (CRP/Alb) and oncological outcomes in ovarian cancer patients. Methods: Two hundred patients with histologically verified ovarian cancer between June 2006 and July 2012 were retrospectively reviewed. Overall survival was evaluated by the Kaplan-Meier method and log-rank test. The significance of risk factors for overall survival was evaluated with the Cox proportional hazards model. Additionally, area under the receiver operating characteristic curve (AUC) was used to compare the predictive ability of CRP/Alb, Glasgow Prognostic Score (GPS), modified GPS (mGPS), neutrophil lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), prognostic index (PI) and prognostic nutritional index (PNI). Results: The optimal cutoff value of CRP/Alb was 0.68. Increased CRP/Alb (≥0.68) was associated with advanced stage, residual tumor, ascites, elevated serum carbohydrate antigen(CA)-125 level, GPS, and mGPS (all p < 0.05). Patients with high CRP/Alb had poor overall survival compared to those with low CRP/Alb (p < 0.001). Multivariable analysis showed that CRP/Alb (Hazard Ratio (HR) 1.330, 95% confidence interval (CI) 1.131-1.564, p = 0.001), tumor stage (HR 1.577, 95% CI 1.189-2.091, p = 0.002), residual tumor (HR 2.337, 95% CI 1.518-3.597, p < 0.001) and age (HR 1.017, 95% CI 1.000-1.035, p = 0.046) were independent prognostic factors for overall survival. Additionally, the CRP/Alb showed greater AUC values at 1 year (0.692), 3 years (0.659), and 5 years (0.682) than GPS, mGPS and PNI. Conclusions: The CRP/Alb is a novel independent marker of poor prognosis among ovarian cancer patients and shows superior prognostic ability compared to the established inflammation-based prognostic indices.

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Section: Discussionmentioning

confidence: 99%

The prognostic value of the preoperative c-reactive protein/albumin ratio in ovarian cancer

et al. 2017

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“…Over the past decades, the relationship between malnutrition and patient outcome has been well established in many cancers 6-9. Several preoperative nutritional-based scores are designed in order to evaluate nutritional risk, postoperative complications and long-term prognosis, such as the Nutritional Risk Index, Mini Nutritional Assessment, and Geriatric assessment 10-12. Despite recommendations, they fail to gain widespread consensus in GC.…”

Section: Introductionmentioning

confidence: 99%

A Novel Prognostic Score, Based on Preoperative Nutritional Status, Predicts Outcomes of Patients after Curative Resection for Gastric Cancer

Liu¹,

Qiu²,

Li³

et al. 2016

J. Cancer

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PURPOSE: We aimed to determine whether preoperative nutritional status (PNS) was a valuable predictor of outcome in patients with gastric cancer (GC).METHODS: We retrospectively evaluated 1320 patients with GC undergoing curative resection. The PNS score was constructed based on four objective and easily measurable criteria: prognostic nutritional index (PNI) score 1, serum albumin <35 g/L, body mass index (BMI) <18.5 kg/m2, or preoperative weight loss ≥5% of body weight. The PNS score was 2 for patients who met three or four criteria, 1 for those who met one or two criteria, and 0 for those who didn't meet all of these criteria.RESULTS: The overall survival (OS) rates in patients with PNS scores 0, 1, and 2 were 59.1%, 42.4%, and 23.4%, respectively (P < 0.001). Multivariate analyses revealed the PNS was an independent predictor for OS (HR for PNS 1 and PNS 2: 1.497, 95 % CI: 1.230-1.820 and 2.434, 95 % CI: 1.773-3.340, respectively; p < 0.001). Furthermore, 5-year OS ranged from 92% (stage I) to 37% (stage III), while the combination of TNM and PNS stratified 5-year OS from 95% (TNM I, PNS 0) to 19% (TNM III, PNS 3). Of note, the prognostic significance of PNS was still maintained when stratified by TNM stage, age, sex, tumor size, anemia and adjuvant chemotherapy (All P < 0.05).CONCLUSIONS: The PNS, a novel nutritional-based prognostic score, is independently associated with OS in GC. Prospective studies are needed to validate its clinical utility.

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“…The correlation of the indicators reflecting nutritional status with survival in patients with various types of cancer has received much attention in recent years [14][15][16] . Cancer-related malnutrition is frequently caused by activation of systemic inflammation due to cancer progression, resulting in impaired immunity and reduced survival 8,11,17 .…”

Section: Discussionmentioning

confidence: 99%

The Preoperative Prognostic Nutritional Index for the Prediction of Outcomes in Patients with Early-Stage Ovarian Clear Cell Carcinoma

Yoshikawa

Yoshida

Tamauchi

et al. 2020

Sci Rep

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The prognostic nutritional index (PNI), which reflects preoperative malnutrition, is useful for predicting the incidence of postoperative complications and has been reported in recent years to predict the longterm prognosis of various malignancies. The purpose of this study was to clarify the significance of PNI as a prognostic factor for early-stage clear cell ovarian carcinoma. A total of 82 patients with stage I-II (FIGO 2014) ovarian clear cell carcinoma undergoing primary surgery at our hospital from January 2005 to December 2017 were enrolled. PNI was calculated using the formula: 10 × serum albumin (g/ dL) + 0.005 × peripheral blood lymphocyte count (/mm 3 ). preoperative pni exhibited relatively high area under the curve value (0.709) for 5 year survival, and the optimal cutoff value was 46.5. The overall survival was significantly shorter in the PNI-low group than in the PNI-high group. Multivariate analysis showed that high PNI was a significant independent prognostic factor for favorable prognosis (hazard ratio = 0.102, p = 0.010). There was no significant difference in recurrence-free survival between the two groups (p = 0.220), but the postrecurrence survival was significantly longer in the PNI-high group than in the pni-low group (p = 0.0383). The preoperative PNI was a useful predictor of prognosis, even in early-stage ovarian clear cell carcinoma.Ovarian clear cell carcinoma (OCCC) is one of the common histologic subtypes of epithelial ovarian cancer (EOC), accounting for approximately 20% of all EOC in Asian countries but only for 6% of all EOC in Western countries 1-3 . As with the other histologic types of EOC, OCCC frequently presents with various symptoms, including abdominal pain or swelling. In particular, OCCC had been generally associated with ovarian endometriosis, which is characterized by severe dysmenorrhea and chronic pelvic inflammation 4 . Although the majority of OCCC cases are diagnosed in the early-stage and patients with stage IA OCCC have a favorable prognosis, stage IC OCCC with positive peritoneal cytology can lead to poor prognosis due to its high recurrence rate and resistance to conventional platinum-based chemotherapy 5 . Therefore, identification of the clinical indicators that predict long-term outcomes is needed to improve the management of patients with early-stage OCCC.Malnutrition has been reported to make patients more susceptible to infection, increase the risk of postoperative complications, and promote tumor recurrence through suppression of tumor immunity 6-8 . The prognostic nutritional index (PNI), which is calculated using serum albumin level and lymphocyte count as indicators of nutritional status, has been reported to be correlated with survival and perioperative complications in various types of cancer [8][9][10][11] . Even in gynecologic malignancies, low PNI was recently reported to be associated with poor prognosis in HGSOC and cervical cancer 12,13 . Although several reports have shown a correlation between malnutrition and poor prognosis in advanced...

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Malnutrition Identified by the Nutritional Risk Index and Poor Prognosis in Advanced Epithelial Ovarian Carcinoma

Cited by 55 publications

References 36 publications

The prognostic value of the preoperative c-reactive protein/albumin ratio in ovarian cancer

The prognostic value of the preoperative c-reactive protein/albumin ratio in ovarian cancer

A Novel Prognostic Score, Based on Preoperative Nutritional Status, Predicts Outcomes of Patients after Curative Resection for Gastric Cancer

The Preoperative Prognostic Nutritional Index for the Prediction of Outcomes in Patients with Early-Stage Ovarian Clear Cell Carcinoma

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