Prognostic Impact Of Preoperative Prognostic Nutritional Index In Resected Advanced Gastric Cancer

BackgroundGastric cancer(GC)is one of the most common malignant tumors in the world.According to the National Cancer Center and the National Cancer Clinical Medical Research Center,the analysis of the national registration data of China's malignant txunors in 2015 is estimated.The number of cases was estimated to be 403,000 cases,which was only behind lung cancer.The number of deaths caused by gastric cancer was estimated to be 291,000,which was only after lung cancer and liver cancer.Because gastric malignant tumors seldom have early symptoms and specific symptoms which can only help to diagnose advanced gastric cancer,it is difficult to find and diagnose early gastric cancer patients,which is an important cause of relatively poor prognosis.Therefore,in the clinical medical work,the establishment of a comprehensive long-term prognosis evaluation system for gastric cancer surgery has long-term significance for the development and timely correction of the treatment plans for patients with gastric cancer.In clinical practice,factors such as TNM staging of tumors,molecular markers of gastric malignant tumors,and clinicopathological features of malignant tumors are often used to predict and evaluate the long-term prognosis of patients with gastric cancer.However,most of the current prognostic assessment and prediction indicators focus on the tumor burden itself,but the immunity and nutritional status often lack a systematic evaluation standard.Recently,prognostic nutritional index(PNI),which can be easily and conveniently measured by laboratory blood test,has received attention,and the current prognostic nutritional index(PNI)has important predictions in many other malignant tumors.Besides,the potential for predictive assessment of long-term prognosis after gastric malignancy is affirmed.Chapter 1 Prognostic impact of preoperative prognostic nutritional index in resected advanced gastric cancer:A multicenter propensity score analysisObjectiveThe aim of this study was to assess the relationship between prognostic nutritional index and long-term prognosis after gastrectomy in patients with advanced gastric cancer.MethodsData of 260 patients undergoing radical gastrectomy for gastric cancer were collected and analyzed from 2014 to 2017,in the General Surgery of one of a top hospitals in Haizhu District,Guangzhou,General Surgery of one of a top hospitals in Liwan District,Guangzhou,and General Surgery of one of a top hospitals in Haizhu District,Guangzhou.The result were recorded in various laboratory tests such as blood routines,and detailed medical history review,endoscopic ultrasonography(EUS)and chest and abdomen CT scans were performed.The study collected standard demographic and clinical pathology data including gender,age,body mass index(BMI),symptoms,tumor location and size,and pathologic outcomes.At the same time,we collect and analyze the surgical details,including the operation time,and postoperative follow-up,including tumor recurrence and death.In order to reduce bias,we used a propensity score matching method and performed matched pairing analysis on patients.The Kaplan-Meier method was used to analyze the survival curve and the three-year overall survival rate.The Cox proportional hazards model was used for univariate analysis and multivariate analysis.ResultsA total of 230 patients with advanced gastric cancer were enrolled in the study.Among them,64 patients had a prognostic nutritional score<50,and 64 patients with prognostic nutritional index>50 were matched and analyzed.In this 128 cases,according to pathological analysis after the surgery,a total of 41 cases of stage ? of TNM stage,a total of 71 cases of stage ?,and a total of 16 cases of IV.A total of 90 patients with partial gastric resection,46 patients with low prognosis nutrition scores,and 44 patients with high prognosis nutrition scores.Meanwhile,38 patients were performed total gastrectomy,18 patients with low prognosis nutrition scores,and 20 patients with high prognostic nutrional scores.There were 113 cases of continued chemotherapy after surgery,while 57 cases of continued chemotherapy in the low prognosis nutrition score group and 56 cases in the high prognosis nutrition score group.The average follow-up time of all patients after gastric cancer resection was 12.34(±5.050)months.The results of univariate analysis showed that the factors like tumor differentiated into poorly differentiated adenocarcinoma,low prognostic nutritional index,invasive vascular nerve,and negative margin were related with poor recurrence-free survival.Cox multivariate analysis showed that only a low prognostic nutritional score was an independent predictor of poor recurrence-free survival(p-value less than 0.001).Univariate analysis of overall survival showed that low prognostic nutritional index,positive margin(ie,R1 or R2 resection),and neurological and vascular invasion were associated with a reduction in overall survival.At the same time,Cox multivariate analysis showed that only low prognostic nutritional scores were independent prognostic factors for postoperative survival in patients with gastric cancer(p value less than 0.001).ConclusionPrognostic nutritional index was associated with postoperative overall survival and tumor-free survival in patients with advanced gastric cancer.Therefore.preoperative nutritional status assessment may provide a better strategy for long-term follow-up,and may prompt adjustment of adjuvant chemotherapy to improve the health management of patients with advanced gastric cancer.Chapter 2 Progress in research on correlation between long-term prognosis of gastric malignant tumor and prognosis nutritional indexGastric cancer is one of the most common malignant tumors in the world and an important cause of death among Chinese residents.Because the curative effect of gastric cancer is still unsatisfactory even after radical surgery,people are striving to seek reliable long-term prognosis prediction and evaluation indicators for gastric cancer,aiming to guide the rationally formulation of clinical work and correct treatment plans.Based on the research status of prognostic nutritional index on the prognosis and evaluation of long-term prognosis and postoperative complications of gastric cancer,this chapter comprehensively reviews the evaluation effect of prognostic nutritional index on the patient's immunity and nutritional status,and the current progess of recent research.We also analyzed the current limitations of the prognostic nutritional index and looked forward to the development of the prognostic nutritional index and its prospects for clinical application.