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. 2022 Mar 11:9:794489.
doi: 10.3389/fnut.2022.794489. eCollection 2022.

Prognostic Value of Prognostic Nutritional Index in Patients With Colorectal Cancer Undergoing Surgical Treatment

Hailun Xie  1 , Lishuang Wei  2 , Guanghui Yuan  1 , Mingxiang Liu  1 , Shuangyi Tang  3 , Jialiang Gan  1   4
Affiliations

Prognostic Value of Prognostic Nutritional Index in Patients With Colorectal Cancer Undergoing Surgical Treatment

Hailun Xie et al. Front Nutr. .

Abstract

Background: To investigate the relationship between prognostic nutritional index (PNI) and the survival of patients with colorectal cancer (CRC) undergoing surgical treatment.

Methods: In 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.

Results: Low 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.

Conclusion: PNI is an independent risk factor affecting postoperative complications, PFS and OS of CRC patients, and is a useful supplement to the TNM stage.

Keywords: colorectal cancer; complication; nutrition; prognosis; prognostic nutritional index.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
The dose-response relationship between PNI and survival in CRC patients. (A) Unadjusted RCS of PFS; (B) unadjusted RCS of OS; (C) adjusted RCS of PFS; (D) adjusted RCS of OS; The model adjusted for gender, age, BMI, hypertension, diabetes, pT stage, pN stage, clinical distant metastasis, tumor location, tumor size, perineural invasion, vascular invasion, macroscopic type, and histological type.
Figure 2
Figure 2
Kaplan-Meier curves of different PNI groups in CRC patients. (A) PFS of PNI; (B) OS of PNI; (C) PFS of PNI based on TNM I-II stage; (D) OS of PNI based on TNM I-II stage; (E) PFS of PNI based on TNM III-IV stage; (F) OS of PNI based on TNM III-IV stage.
Figure 3
Figure 3
Construction a novel complication nomogram model. (A) Complication nomogram; (B) calibration curve of complication nomogram.
Figure 4
Figure 4
Construction the novel prognostic nomograms in CRC patients. (A) PFS nomogram; (B) OS nomogram.
See this image and copyright information in PMC

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