The Prognostic Nutritional Index Predicts Long-term Outcomes of Gastric Cancer Patients Independent of Tumor Stage

PurposeThe impact of postoperative complications on survival after radical surgery for esophageal, gastric, and colorectal cancers remains controversial. We conducted a systematic review of recent publications to examine the effect of postoperative complications on oncological outcome.MethodsA literature search of PubMed/MEDLINE was performed using the keywords “esophageal cancer,” “gastric cancer,” and “colorectal cancer,” obtaining 27 reports published online up until the end of April 2016. Articles focusing on (i) postoperative morbidity and oncological outcome; and (ii) body mass index (BMI), postoperative morbidity, and oncological outcome, were selected. Univariate and multivariate analyses (Cox proportional hazards model) were performed.ResultsPatients with postoperative complications had significantly poorer long‐term survival than those without complications. Complications were associated with impaired oncological outcomes. The hazard ratios for overall survival were 1.67 (95% confidence interval [CI], 1.31‐2.12), 1.59 (95% CI, 1.13‐2.24), and 1.55 (95% CI, 1.28‐1.87) in esophageal, gastric, and colorectal cancers, respectively. High BMI was associated with postoperative morbidity rate but not with poor oncological outcome. Low BMI was significantly associated with inferior oncological outcome.ConclusionsComplications after radical surgery for esophageal, gastric, and colorectal cancers are associated with patient prognosis. Avoiding such complications might improve the outcomes.

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“…However, some studies have found that postoperative complications do not always have a negative impact on prognosis 40, 41, 42. Migita et al .…”

Section: Resultsmentioning

confidence: 99%

Does postoperative morbidity worsen the oncological outcome after radical surgery for gastrointestinal cancers? A systematic review of the literature

Shimada

Fukagawa

Haga

et al. 2017

Annals of Gastroent Surgery

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“…En el cáncer gástrico, el conocimiento de los riesgos de la cirugía y sus posibles complicaciones así como la identificación de los casos con mayores probabilidades de presentarlas son muy importantes para el paciente y para el cirujano en el proceso de toma de decisiones terapéuticas 25 . En la literatura asiática, se ha propuesto al IO como un parámetro que pudiera predecir pre-operatoriamente la frecuencia de presentación de complicaciones [5][6][7][8][9][10][11][12][13] . El IO es el producto de los valores de la albuminemia y de los linfocitos circulantes en sangre periférica.…”

Section: Resultsunclassified

“…Por todo ello, el IO se ha considerado como un marcador del estado nutricional y de la respuesta inmune del organismo frente al tumor 8,10 . El punto de corte para considerar patológico o no el valor del IO en el estudio de las complicaciones post-cirugía del carcinoma gástrico sigue en discusión 9 , oscilando entre 40 y 49 en los diferentes trabajos 5,[8][9][10][11]28 . Al igual que otros autores 29,30 , hemos empleado como punto de corte el valor de la mediana de nuestra serie.…”

Section: Resultsunclassified

“…Al igual que otros autores 29,30 , hemos empleado como punto de corte el valor de la mediana de nuestra serie. La cifra obtenida: 45, es muy similar a la de la ma-yoría de las publicaciones 6,8,9,11,12,28,30 y coincide con el valor establecido como límite entre la desnutrición leve y la moderada 28 . Como en otros trabajos 7,8 , en nuestra serie los casos con IO bajo son más frecuentes en los pacientes de más edad y con mayor co-morbilidad.…”

Section: Resultsunclassified

“…En la literatura asiática, fundamentalmente en Japón, se han publicado varios trabajos que determinan el IO previo a la gastrectomía y estudian la posible relación entre un IO disminuido y la morbi-mortalidad post-operatoria [5][6][7][8][9][10][11][12][13] . Aunque los resultados obtenidos no han sido concluyentes, en el carcinoma gástrico se ha postulado que la presencia de un IO bajo podría tener un valor predictivo sobre la frecuencia de complicaciones que conlleva la resección R0 [5][6][7][8][9][10][11] , careciendo de datos acerca de su posible relación con su gravedad. Los paí-ses orientales, donde se realizaron dichos estudios, presentan una mayor incidencia de cáncer gástrico, habiendo establecido programas de cribado para el diagnóstico del tumor 14 .…”

Section: Introductionunclassified

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Relation between preoperative prognostic Onodera’s Index and postsurgery complications in the R0 gastric carcinoma resection

Borda

Miranda

Borda

et al. 2017

An Sist Sanit Navar

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Fundamento. En publicaciones asiáticas se postula que un Índice de Onodera (IO) bajo puede asociarse con una mayor frecuencia de complicaciones post-resección radical del cáncer gástrico, careciendo de resultados en áreas occidentales. En el presente trabajo se analiza la relación entre un IO pre-operatorio bajo con la frecuencia y la gravedad de las complicaciones post-cirugía R0 en el cáncer gástrico.Pacientes y métodos. Se revisaron 124 tumores gástricos con resección R0. Considerando patológicamente bajo un IO <45, estudiamos la frecuencia de complicaciones entre los grupos con IO menor y ≥45. En el análisis multivariante incluimos como variables de ajuste la edad mayor de 68 años, puntuación ASA, hemoglobina pre-operatoria menor de 12 g/dL, estadio pTNM, administración o no de tratamiento neoadyuvante y tipo de gastrectomía realizada. Determinamos la relación entre IO <45 y la frecuencia y gravedad de las complicaciones, según la clasificación de Clavien-Dindo modificada.resultados. Se registraron complicaciones leves en un 11,3%; graves 9,7% y exitus 2,4%. Los pacientes con IO <45 presentaron mayor frecuencia de complicaciones: 37,7% versus 12,7% [ odds ratio ( conclusiones. También en un país occidental, los pacientes con IO pre-operatorio bajo (<45) muestran un mayor riesgo independiente de presentar complicaciones tras la resección R0 del carcinoma gástrico. Adicionalmente, las complicaciones registradas en los casos con IO <45, muestran una significativa mayor gravedad. aBstractBackground. It has been postulated in the Asian literature that a low prognostic nutritional index (OI) could be associated with a higher rate of complications following radical gastric cancer surgery, but there is a lack of data concerning western countries. The aim is to analyze the relationship between a low preoperative OI and the frequency and severity of surgical complications in R0 gastric cancer resection. Patients and methods.In the present article, 124 cases of gastric cancer with R0 resection were reviewed. An OI <45 was considered pathologically low. The complication rate was compared between both groups: OI <45 vs OI ≥45. A multivariate analysis was performed adjusting for: age > 68 years, ASA score, preoperative hemoglobin level <12 g/dL, pTNM stage, administration of neoadyuvant therapy and type of gastrectomy. The relationship between a PNI<45 and the severity of complications graded according to the Clavien-Dindo classification was determined.results. We registered mild complications in 11.3% of cases, severe complications in 9.7% and a mortality rate of 2.4%. Patients with a OI <45 showed a higher complication rate: 37.7% versus 12. conclusions. We confirmed that patients with a low preoperative OI show a higher independent risk of complications after a R0 gastric cancer resection in a western country as well. Complications, in these cases with OI <45, registered a significantly higher severity grade.

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Survival outcomes of elderly patients with pathological stages II and III gastric cancer following curative gastrectomy

Takahashi

Nunobe

Makuuchi

et al. 2020

Annals of Gastroent Surgery

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Aim Survival outcomes in elderly patients with pathological stages (pStages) II and III gastric cancer remain inadequately elucidated. We retrospectively analyzed outcomes of elderly and nonelderly patients who underwent curative gastrectomy for this cancer and considered clinical results of the Estimation of Physiologic Ability and Surgical Stress (E‐PASS) scoring system for prediction. Methods Among 1041 patients who underwent gastrectomy for pStages II and III gastric cancer between 2008 and 2013 consecutively, 898 patients were enrolled. Of these, 158 patients (17.6%) were elderly and 740 patients (82.4%) were nonelderly. Results Disease‐specific survival (DSS) in the elderly group with pStage III cancer was significantly worse than that in the same stage nonelderly group ( P = .001), while there was no difference in DSS for pStage II cancer between the groups ( P = .45). Overall survival (OS) was significantly worse in elderly patients for both pStages II and III. Elderly patients with pStage II cancer had larger survival gaps between OS and DSS compared with those with pStage III cancer. OS for elderly patients with comprehensive risk score (CRS) > 0.159 was significantly worse than that for elderly patients with CRS ≤ 0.159 in pStage II cancer. Conclusions Compared with nonelderly patients, different characteristics were observed in the survival outcomes of elderly patients between pStages II and III gastric cancer. The survival gap between OS and DSS of elderly patients was larger in pStage II cancer than in pStage III cancer. The E‐PASS scoring system could be a relatively useful predictor in elderly patients.

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The Prognostic Nutritional Index Predicts Long-term Outcomes of Gastric Cancer Patients Independent of Tumor Stage

Abstract: The PNI is a simple and useful marker for predicting the long-term outcomes of gastric cancer patients independent of the tumor stage. Based on our results, we suggest that the PNI should be included in the routine assessment of gastric cancer patients.

Cited by 290 publications

References 28 publications

Does postoperative morbidity worsen the oncological outcome after radical surgery for gastrointestinal cancers? A systematic review of the literature

Does postoperative morbidity worsen the oncological outcome after radical surgery for gastrointestinal cancers? A systematic review of the literature

Relation between preoperative prognostic Onodera’s Index and postsurgery complications in the R0 gastric carcinoma resection

Survival outcomes of elderly patients with pathological stages II and III gastric cancer following curative gastrectomy

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