Abstract
BackgroundTo investigate the relationship between prognostic nutritional index (PNI) and the survival of patients with colorectal cancer (CRC) undergoing surgical treatment.MethodsIn total 1,014 CRC patients who underwent surgical treatment were enrolled. Logistic regression analysis was used to identify the features that influenced postoperative complications in CRC patients. Restricted cubic spline was used to assess the dose-response relationship between PNI and survival in CRC patients. Kaplan-Meier method and log-rank test were used to compare survival differences between groups of CRC patients. Cox proportional risk regression models was used to assess independent risk factors for progression-free survival (PFS) and overall survival (OS) of CRC patients.ResultsLow PNI was associated with high tumor burden, invasive pathological features, and poor host status. Compared with patients with high PNI, patients with low PNI have a higher incidence of complications and longer hospital stay. Low PNI was an independent risk factor for postoperative complications in CRC patients. for every SD increased in PNI, the risk of poor prognosis for CRC patients was reduced by 2.3% (HR = 0.977, 95%CI = 0.962–0.993, p = 0.004) in PFS, and 2.3% (HR = 0.977, 95%CI = 0.962–0.993, p = 0.004) in OS. PNI was an independent prognostic factor affecting the PFS and OS of CRC patients. Finally, we constructed the PNI-based nomograms to predict postoperative complications, 1–5 years PFS and OS in CRC patients. Concordance index and calibration curve indicated that the PNI-based nomograms have moderate prediction accuracy.ConclusionPNI is an independent risk factor affecting postoperative complications, PFS and OS of CRC patients, and is a useful supplement to the TNM stage.
Highlights
Colorectal cancer (CRC) is one of the most common gastrointestinal malignancy in the world, ranking third in incidence and second in cancer-related death, according to the latest data
Low prognostic nutritional index (PNI) was an independent risk factor for postoperative complications in CRC patients. for every SD increased in PNI, the risk of poor prognosis for CRC patients was reduced by 2.3% (HR = 0.977, 95%CI = 0.962–0.993, p = 0.004) in progression-free survival (PFS), and 2.3% (HR = 0.977, 95%CI = 0.962–0.993, p = 0.004) in overall survival (OS)
The results showed that the independent prognostic factors affecting PFS in CRC patients were age (≥60 years) (HR = 1.297, 95%CI = 1.072–1.568, p = 0.007), PNI (HR = 1.359, 95%CI = 1.115–1.656, p = 0.002), pathological tumor infiltration depth (pT) stage (HR = 1.561, 95% CI = 1.184–2.059, p = 0.002), pN stage (p < 0.001), Distant metastasis (HR = 3.113, 95%CI = 2.420–4.005, p < 0.001), vascular invasion (HR = 1.363, 95%CI = 1.062– 1.750, p = 0.015) and CEA (HR = 1.463, 95%CI = 1.203–1.780, p < 0.001) (Table 2)
Summary
Colorectal cancer (CRC) is one of the most common gastrointestinal malignancy in the world, ranking third in incidence and second in cancer-related death, according to the latest data. It is estimated that more than 1.93 million new CRC cases and 935,000 death occur globally in 2020, accounting for ∼10% of new cancer cases and cancer-related death worldwide [1]. In China, CRC is the fourth most common malignancy (∼388,000 cases) and the fifth most common cause of cancerrelated death (∼187,000 cases) [2]. Have been reported as prognostic factors for CRC patients. There is an urgent need to find effective prognostic indicators to help clinicians adopt optimal prevention and treatment strategies to reduce CRC-related mortality. To investigate the relationship between prognostic nutritional index (PNI) and the survival of patients with colorectal cancer (CRC) undergoing surgical treatment
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