Abstract
The purpose of this article is to evaluate the relationship between the nutrition-based microenvironment and clinicopathological information for gastric cancer patients and to investigate the prognostic value of nutrition index for gastric cancer patients undergoing total gastrectomy. We retrospectively collected clinical information of 245 gastric cancer patients who underwent total gastrectomy in our hospital between January 1st 2005 and December 30th 2015. According to the prognostic nutritional index (PNI) level, they were divided into low PNI (< 43) group and high PNI (≥ 43) group. The relationship between PNI and the disease-free survival (DFS) and overall survival (OS) were analyzed by statistical analysis. Univariate analyses demonstrated that TNM stage (p = 0.025), patients age (p = 0.042), lymph node metastasis (p = 0.028), tumor differentiation (p = 0.037) and a low PNI (p = 0.033) were closely correlated with a poor prognosis. In multivariate analysis, TNM stage (p = 0.027) and a low PNI (p = 0.041) were found to be independently associated with poor survival. Additionally, when age was considered as a stratified factor, univariate analyses demonstrated that low PNI correlated with shorter DFS in non-elderly (< 65) patients (p = 0.022) and shorter DFS (p = 0.036) and OS (p = 0.047) in elderly (≥ 65) patients. The low prognostic nutritional index is an independent risk factor associated with poor gastric cancer survival which represents the nutritional microenvironment. Patients with low pre-operative prognostic nutritional index levels should be observed more closely after surgery to prevent the occurrence of post-operative complications in the near future.
Highlights
The purpose of this article is to evaluate the relationship between the nutrition-based microenvironment and clinicopathological information for gastric cancer patients and to investigate the prognostic value of nutrition index for gastric cancer patients undergoing total gastrectomy
Albumin represents the nutritional condition of the human body and peripheral blood lymphocyte is an important immune index, the unbalance of albumin and lymphocyte is closely correlated with poor post-operative complications and cancer outcomes which have already demonstrated by multiple cancer types such as liver cancer[6], non-small cell lung cancer[7], bladder cancer[4], pancreatic cancer[8,9], colorectal cancer[10], esophageal cancer[11,12,13], ovarian cancer[14], and renal cell carcinoma[15]
Univariate statistical analyses demonstrated that TNM stage, patients age (HR 2.116; 95% CI 0.493– 4.739; p = 0.042), lymph node metastasis (HR 2.392; 95% CI 0.469–4.315; p = 0.028), tumor differentiation (HR 3.542; 95% CI 0.764–6.320; p = 0.037) and a low prognostic nutritional index (PNI) (HR 2.573; 95% CI 0.692–4.454; p = 0.033) were significant risk factors for a poor prognosis (Table 1)
Summary
The purpose of this article is to evaluate the relationship between the nutrition-based microenvironment and clinicopathological information for gastric cancer patients and to investigate the prognostic value of nutrition index for gastric cancer patients undergoing total gastrectomy. The low prognostic nutritional index is an independent risk factor associated with poor gastric cancer survival which represents the nutritional microenvironment. Albumin represents the nutritional condition of the human body and peripheral blood lymphocyte is an important immune index, the unbalance of albumin and lymphocyte is closely correlated with poor post-operative complications and cancer outcomes which have already demonstrated by multiple cancer types such as liver cancer[6], non-small cell lung cancer[7], bladder cancer[4], pancreatic cancer[8,9], colorectal cancer[10], esophageal cancer[11,12,13], ovarian cancer[14], and renal cell carcinoma[15]. Gastric cancer is a group of heterogeneous tumors based on distinctive morphological and molecular genetic features which closely correlates with the nutritional conditions, peripheral blood cells might reflect the inflammatory and immune response of patients to malignant tumors and are critical for determining the treatment response and clinical outcomes of patients[16,17]. These results may reveal the important role of nutrition-based factors in gastric cancer after radical gastrectomy and may help to evaluate patient prognosis
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