Clinical value of prognostic nutritional index combined with C-reactive protein and albumin in early prediction of anastomotic leakage after radical gastric cancer surgery

Abstract

Objective: To evaluate the predictive value of the Prognostic Nutritional Index (PNI) combined with C-reactive protein (CRP) and albumin (ALB) for anastomotic leakage following radical gastric cancer surgery.

Methods: A retrospective case-control study was conducted with 275 gastric cancer patients at the Second People's Hospital of Lanzhou City from September 2019 to October 2022. Patients were categorized into an anastomotic leakage group (n=31) or a non-leakage group. Clinical, surgical, and pathological data were analyzed using logistic regression to develop two risk models: a combined clinical-laboratory index (RISK1) and a separate laboratory index (RISK2). Model effectiveness was compared using Receiver Operating Characteristic (ROC) curves.

Results: Anastomotic leakage occurred in 11.27% of patients, predominantly in those with advanced TNM stages (P=0.006). Notably, higher operative times (P=0.049) and increased intraoperative bleeding (P=0.027) were associated with the leakage group. Significant differences in ALB, PNI, and CRP levels were observed between the groups. Both RISK1 and RISK2 identified ALB, CRP, PNI, operative time, and intraoperative bleeding as independent predictors of leakage, demonstrating high predictive accuracy (RISK1 AUC=0.937, RISK2 AUC=0.911), with no significant difference in performance between the models (P=0.245).

Conclusion: The combination of ALB, CRP, and PNI effectively predicts the risk of anastomotic leakage in patients undergoing gastric cancer surgery. These biomarkers can significantly enhance postoperative management and improve patient outcomes.

Keywords: ALB; CRP; Prognostic nutritional index; postoperative anastomotic leakage; radical gastric cancer surgery.

Figure 1

Study flowchart. NSAIDs, Nonsteroidal anti-inflammatory drugs.

Figure 2

Comparison of the predictive efficacy of the two models. A. Comparison of the scores of patients with and without anastomotic leakage in the two models. B. ROC curves of the two models in predicting patients with anastomotic leakage. Note: RISK1 is the ROC curve of clinical data combined with laboratory indicators, and RISK2 is the ROC curve of laboratory indicators-subjects’ ROC. RISK1, a combined clinical-laboratory index; RISK2, a separate laboratory index; ROC, receiver operating characteristic.