Relationship of prognostic nutritional index with prognosis of gastrointestinal stromal tumors

Sun, Jinhua; Mei, Ying; Zhu, Qiutao; Shou, Chunhui; Tjhoi, Welda E H; Yang, Weili; Yu, Hang; Zhang, Qing; Liu, Xiaosun; Yu, Jiren

doi:10.7150/jca.32299

Cited by 34 publications

(55 citation statements)

References 33 publications

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“…NLR, PLR, and PNI constitute the frequently used indicators for serum systemic inflammatory response (SIR) and nutritional status. The results of several studies show that NLR, PLR, and PNI are independent prognostic factors in GIST patients ( 32 – 35 ). In the present study, consistent with the findings of these studies, our univariate analysis results revealed that PNI, NLR, and PLR are significant predictors of RFS.…”

Section: Discussionmentioning

confidence: 99%

Fibrinogen/Albumin Ratio Index Is an Independent Prognosis Predictor of Recurrence-Free Survival in Patients After Surgical Resection of Gastrointestinal Stromal Tumors

Cao

Cui

et al. 2020

Front. Oncol.

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Background: Nutritional status, systemic inflammation, and coagulation mechanism are closely related to tumor progression. Herein, we examined the role of fibrinogen-to-albumin ratio index (FARI) in the prognosis of gastrointestinal stromal tumors (GISTs) and developed a novel nomogram predicting recurrence-free survival (RFS). Methods: We retrospectively analyzed data from 357 GIST patients admitted at the gastrointestinal surgery of the Beijing Hospital from January 2008 to January 2018 and underwent curative resection. FARI was calculated as fibrinogen level (g/L) /albumin level (g/L). The cutoff point of FARI was set using the point with the largest Youden index on the receiver operating characteristic curve with the 5-years recurrence-free survival as an endpoint. We used the Kaplan-Meier approach and multivariable Cox regression model to study the impact of FARI on recurrence-free survival. Finally, we developed a nomogram based on tumor size, location, mitotic index, and FARI to predict RFS. The nomogram was assessed by calculating concordance probabilities and testing calibration of predicted RFS with observed RFS. Concordance probabilities were also compared with the National Institute of Health (NIH) risk classification system. Results: The ROC curve revealed that the best cutoff point of the FARI was set as 0.08. The patients were classified into the FARI-high (≥0.08) and FARI-low (<0.08) groups. FARI was significantly associated with age, size of the tumor, NIH risk category, and Mitotic Index (all P < 0.05). FARI was weakly associated with NLR and PLR. FARI and PNI had a weak negative association. Multivariate analysis showed that the NIH risk category and FARI were independent prognostic predictors for worse outcomes concerning RFS in GIST patients. In the high-risk subgroup, patients with low FARI also had a more prolonged RFS than patients with high FARI (P <0.05). The nomogram had a concordance probability of 0.802 (SE 0.025). Nomogram predictions were well-calibrated. Concordance probabilities of the nomogram were better than NIH risk classification system [0.802 [0.025] vs. 0.737 [0.024], p < 0.01].

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Section: Discussionmentioning

confidence: 99%

Fibrinogen/Albumin Ratio Index Is an Independent Prognosis Predictor of Recurrence-Free Survival in Patients After Surgical Resection of Gastrointestinal Stromal Tumors

Cao

Cui

et al. 2020

Front. Oncol.

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“…hypothesised PNI to be a useful marker for predicting the prognosis in high-risk GIST. 11 Lu et al. suggested that elevated fibrinogen levels may serve as independent prognostic factor for poorer clinical outcomes in GIST 9 .…”

Section: Discussionmentioning

confidence: 99%

“… [5] , [6] , [7] , [8] Some pre-operative blood indices, especially inflammatory marks, have also proved to be valuable prognostic indicators. [9] , [10] , [11] , [12] Further, the nomogram serves as a disease-specific and clinically relevant prognostic model for predicting disease outcomes, and the first prognostic nomogram developed by Gold et al. showed a good calibration of predictive recurrence in all GISTs.…”

Section: Introductionmentioning

confidence: 99%

Development and validation of a prognostic nomogram to predict recurrence in high-risk gastrointestinal stromal tumour: A retrospective analysis of two independent cohorts

et al. 2020

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Background The risk of recurrence in localised, primary gastrointestinal stromal tumour (GIST) classified as high-risk after complete resection varies significantly. Thus, we aimed to develop a nomogram to predict the recurrence of high-risk GIST after surgery to aid patient selection. Methods We retrospectively evaluated patients ( n = 424) with high-risk GIST who underwent curative resection as the initial treatment at two high-volume medical centres, between January 2005 and September 2019. The least absolute shrinkage and selection operator (LASSO) regression model was utilised to select potentially relevant features. Multivariate Cox proportional hazards analysis was used to develop a novel nomogram. Findings The nomogram comprised age, fibrinogen levels, prognostic nutritional index (PNI), platelet-lymphocyte ratio (PLR), mitotic counts and tumour size, which provided favourable calibration and discrimination in the training dataset with an AUC of 0•749 and a C-index of 0•742 (95%CI:0•689–0•804). Further, it showed acceptable discrimination in the validation cohort, with an AUC of 0•778 and C-index of 0•735 (95%CI:0•634–0•846). The time-dependant receiver operating characteristic (ROC) curves performed well throughout the observation period. Additionally, the nomogram could classify high-risk GISTs into ‘very high-risk’ and ‘general high-risk’ groups with a hazard ratio (HR) of 5•190 (95%CI: 3•202–8•414) and 5•438 (95%CI: 2•236–13•229) for the training and validation datasets, respectively. Interpretation The nomogram independently predicted post-operative recurrence-free survival (RFS) in high-risk GIST and showed favourable discrimination and calibration values. It may be a useful clinical tool for identifying ‘very high-risk’ GIST, by allowing treatment strategy optimisation in these patients. Funding National Natural Science Foundation of China (No. 81702386 and 81874184)

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“…In this study, according to recent investigations of Sun JY's team that showed OPNI was an independent predictive factor of RFS in GIST patients with no TKIs treatment [23]. we initially base our analysis on the 349 patients who received no TKIs therapy, and get the cut-off points of NLR, PLR, OPNI and Ki-67 index.…”

Section: Discussionmentioning

confidence: 99%

“…According to the recent study, OPNI is a prognostic marker to GIST [23]. We used the continuous variable NLR, The Hosmer-Lemeshow test and the value of c-statistic (0.71) showed fairly excellent calibration (p = 0.08) and discrimination, respectively, between the 2 groups.…”

Section: Roc Analysismentioning

confidence: 99%

Prognostic value of Onodera’s Nutritional Index for intermediate and high risk gastrointestinal stromal tumors treated with or without TKIs

Wang

Tao

et al. 2020

Preprint

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Background Immunoinflammatory and nutritional markers such as peripheral blood neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and onodera’s prognostic nutritional index (OPNI) have gained considerable attention and revealed preliminaryly as prognostic markers in gastrointestinal stromal tumor (GIST). Methods In this study, we firstly investigated the prognostic value of OPNI in GIST treated with or without TKIs based on the propensity score matching (PSM) method. All of the patients had received surgical resection for primary GIST, The data from 2010 to 2018 were initially and retrospectively identified from our gastrointestinal center. Recurrence-free survival (RFS) was calculated by the Kaplan-Meier method and compared by the log-rank test. Results These patients who were treated with TKIs and those who did not were divided into two groups, and we used propensity score matching method to make them have more unified baseline data. Multivariate Cox proportional hazard regression models were applied to identify associations with outcome variables.A total of 563 GISTs were initially chosen and 280 of them were included for analysis under an inclusion criteria. After PSM, there were 200 patients included. Multivariate analyses identified OPNI was an independent prognostic marker, and was associated with primary site, tumor size, mitotic index, tumor rupture, necrosis, and modified NIH risk classification. Low OPNI (< 44.05; HR 0.433; 95% CI 0.236–0.794; P = 0.007) were associated with worse RFS. Conclusions Preoperative OPNI is a novel and useful prognostic marker for GISTs both treated with or without TKIs.

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Relationship of prognostic nutritional index with prognosis of gastrointestinal stromal tumors

Cited by 34 publications

References 33 publications

Fibrinogen/Albumin Ratio Index Is an Independent Prognosis Predictor of Recurrence-Free Survival in Patients After Surgical Resection of Gastrointestinal Stromal Tumors

Fibrinogen/Albumin Ratio Index Is an Independent Prognosis Predictor of Recurrence-Free Survival in Patients After Surgical Resection of Gastrointestinal Stromal Tumors

Development and validation of a prognostic nomogram to predict recurrence in high-risk gastrointestinal stromal tumour: A retrospective analysis of two independent cohorts

Prognostic value of Onodera’s Nutritional Index for intermediate and high risk gastrointestinal stromal tumors treated with or without TKIs

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