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. 2021 Aug 3;19(1):227.
doi: 10.1186/s12957-021-02345-9.

Prognostic value of Onodera's nutritional index for intermediate- and high-risk gastrointestinal stromal tumors treated with or without tyrosine kinase inhibitors

Feng Wang #  1 , Tingting Tao #  2 , Heng Yu #  1 , Yingying Xu #  3 , Zhi Yang  1 , Xuefeng Xia  2 , Meng Wang  4 , Liang Zong  5 , Wenxian Guan  6
Affiliations

Prognostic value of Onodera's nutritional index for intermediate- and high-risk gastrointestinal stromal tumors treated with or without tyrosine kinase inhibitors

Feng Wang et al. World J Surg Oncol. .

Abstract

Background: Immunoinflammatory and nutritional markers, such as the peripheral blood neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and Onodera's prognostic nutritional index (OPNI), have gained considerable attention and have been preliminarily revealed as prognostic markers of gastrointestinal stromal tumors (GISTs).

Methods: In this study, we first investigated the prognostic value of OPNI in GISTs treated with or without TKIs based on the propensity score matching (PSM) method. All of the patients had received surgical resection for primary GIST, and data from 2010 to 2018 were initially and retrospectively identified from our gastrointestinal center. Recurrence-free survival (RFS) was calculated by the Kaplan-Meier method and compared by the log-rank test.

Results: The patients were divided into groups treated and not treated with TKIs, and we used the propensity score matching method to homogenize their baseline data. Multivariate Cox proportional hazard regression models were applied to identify associations with outcome variables. A total of 563 GISTs were initially chosen, and 280 of them were included for analysis under the inclusion criteria. After PSM, there were 200 patients included. Multivariate analyses identified OPNI as an independent prognostic marker that was associated with primary site, tumor size, mitotic index, tumor rupture, necrosis, and modified NIH risk classification. Low OPNI (< 42.6; HR 0.409; P < 0.001) was associated with worse RFS.

Conclusions: Preoperative OPNI is a novel and useful prognostic marker for GISTs both treated and not treated with TKIs. Higher NLR and PLR have negative effects on RFS.

Keywords: Gastrointestinal stromal tumor; Neutrophil-to-lymphocyte ratio; Onodera’s prognostic nutritional index; Platelet-to-lymphocyte ratio; Prognostic marker; Propensity score matching.

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Conflict of interest statement

The authors declare that they have no competing of interests.

Figures

Fig. 1
Fig. 1
ROC analysis of NLR (a), PLR (b) and OPNI (c) in TKIs-unused patients. The PLR, NLR, and OPNI cut-off value was determined by R 3.6.3 which was performed based on the recurrence state at 9-year follow-up. And the cut-off point of OPNI is 42.1 (P < 0.001), NLR is 5.1(P < 0.001) and PLR is 98.6 (P = 0.008)
Fig. 2
Fig. 2
Correlation between tumor size and NLR (a), PLR (b), OPNI (c), and Ki-67 index (d). The correlation of continuous variables was calculated by Pearson correlation coefficient, while discrete variables by Spearman’s correlation coefficient. Higher OPNI was associated with primary tumor site of stomach (P < 0.01), smaller tumor size (P < 0.017), lower mitotic index (P < 0.001), lower modified NIH risk classification (P < 0.001), less gastrointestinal bleeding rate (P < 0.01) and tumor rupture (P < 0.01), and much lower tumor relapse rate (P < 0.01)
Fig. 3
Fig. 3
Recurrence-free survival analysis of 200 patients after PSM. Kaplan–Meier curve analysis demonstrated a worse relapse-free survival for patients presenting with a higher NLR, b higher PLR, and c lower OPNI. Patients treated with TKIs had better prognosis in our study and low NLR, low PLR, and high OPNI also indicated better prognosis
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