Prognostic impact of preoperative prognostic nutritional index in resected advanced gastric cancer: A multicenter propensity score analysis |
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| Affiliation: | 1. Department of General Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China;2. Department of General Surgery, General Hospital of Guangzhou Military Command of PLA, China;3. Department of General Surgery, Guangdong No. 2 Provincial People''s Hospital, Guangzhou, Guangdong Province, China;1. University of Groningen, University Medical Center Groningen, Department of Medical Oncology, Hanzeplein 1, 9713, GZ, Groningen, the Netherlands;2. Netherlands Cancer Institute, Antoni van Leeuwenhoek, Department of Medical Oncology, Plesmanlaan 121, 1066, CX, Amsterdam, the Netherlands;3. Netherlands Cancer Institute, Antoni van Leeuwenhoek, Department of Surgical Oncology, Plesmanlaan 121, 1066, CX, Amsterdam, the Netherlands;4. Leiden University Medical Center, Department of Medical Oncology, P.O. Box 9600, 2300, RC, Leiden, the Netherlands;5. Erasmus MC – Cancer Institute, Department of Surgical Oncology, s Gravendijkwal 230, 3015, CE, Rotterdam, the Netherlands;6. Radboud University Medical Center, Department of Medical Oncology, P.O. Box 9101, 6500, HB, Nijmegen, the Netherlands;7. Radboud University Medical Center, Department of Surgical Oncology, P.O. Box 9101, 6500, HB, Nijmegen, the Netherlands;8. University of Groningen, University Medical Center Groningen, Department of Surgical Oncology, Hanzeplein 1, 9713, GZ, Groningen, the Netherlands;1. Division of Thoracic and Hyperbaric Surgery, Department of Surgery, Medical University of Graz, Austria;2. Institute of Medical Informatics, Statistics and Documentation, Medical University of Graz, Austria;3. Division of Oncology, Department of Internal Medicine, Medical University of Graz, Austria;4. Department of Cell Stress Biology, Photodynamic Therapy Center at the Roswell Park Cancer Institute, University at Buffalo-State University of New York, Buffalo, USA;1. Klinik und Poliklinik für Chirurgie, Klinikum Rechts der Isar der Technischen Universität München, Germany;2. Visceral- und Thoraxchirurgie, Kreisklinikum Erding, Germany;1. Department of Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands;2. Department of Radiation Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands |
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| Abstract: | BackgroundAdvanced gastric cancer (AGC) causes debilitating malnutrition and leads to deterioration of the immune response. However, the concept of the prognostic nutritional index (PNI) is controversial when applied to patients with AGC. The aim of the present study was to evaluate the effect of the PNI after gastrectomy in patients with AGC.Materials and methodsA multicenter retrospective study was conducted using propensity score matching (PSM) in gastric adenocarcinoma patients who underwent resection via laparoscopic or open surgery between 2014 and 2017. To overcome selection bias, we performed 1:1 matching using 5 covariates.ResultsThe resection margins (P < 0.001) and LNM (P = 0.004) were significantly different between the two groups. In univariate analysis, poor tumor differentiation (P = 0.038) (R1+R2, P = 0.004), vascular and neural invasion (P < 0.001), and a PNI<50 (P < 0.001) were associated with poor recurrence-free survival (RFS). In multivariate analysis, a PNI<50 (hazard ratio (HR), 12.993; P < 0.001) was a risk factor for RFS. Univariate analysis for overall survival (OS) revealed that a PNI<50 (P < 0.001) (R1+R2,P = 0.006) and vascular and neural invasion (P < 0.001) were risk factors. In subsequent multivariate analysis, a PNI<50 (HR, 24.501; P < 0.001) was a significant risk factor for OS. Clinical assessments performed during a 12.34 (±5.050) month follow-up revealed that OS (P < 0.001) and RFS (P < 0.001) were worse in patients with a low PNI (<50) than in matched patients with a high PNI.ConclusionA low PNI is a strong predictor of unfavorable RFS and OS in patients with AGC. |
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| Keywords: | Advanced gastric cancer Prognostic nutritional index Prognosis Inflammation Propensity score matching |
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