Prognostic value of prognostic nutritional index in colorectal cancer patients with simultaneous liver metastasis

doi:10.3877/cma.j.issn.1674-0793.2021.04.007

Abstract

Abstract:

Objective

To investigate the relationship between preoperative prognostic nutritional index (PNI) and prognosis of colorectal cancer (CRC) patients with simultaneous liver metastasis.

Methods

This retrospective cohort study included 83 patients of newly diagnosed CRC with simultaneous liver metastasis in Shenzhen People’s Hospital from January 2015 to January 2017. According to 5-year follow-up survival outcomes, the receiver operating characteristic curve (ROC) was used to determine the cut-off value of PNI, and the patients were divided into high PNI group and low PNI group. Kaplan-Meier method was used to analyze the related factors and survival. Cox proportional hazards model was used to screen the prognostic factors.

Results

The median follow-up time was 13 months (9 to 25 months), and 44 cases died. The Youden index was 1.31 and the PNI value was 50.4. According to PNI, 44 cases (53.01%) were divided into low PNI group and 39 cases (46.99%) into high PNI group. The overall survival (OS) and progression free survival (PFS) of low PNI group were significantly shorter than those of high PNI group (P=0.005, 0.018, respectively). PNI<50.4, without radical operation, multiple liver metastase, and age≥60 years old were independent prognostic factors of OS. PNI<50.4 and without radical operation were independent prognostic factors of PFS (both P<0.05).

Conclusion

Preoperative PNI is an independent predictor of OS and PFS in CRC patients with simultaneous liver metastasis.

Key words: Colorectal neoplasms, Liver metastasis, Prognostic nutritional index, Prognosis

Yuxiang Fu, Kai Pan, Ligang Xia, Keli Zhong, Guixiang Liao, Chang Zhu, Fang Li. Prognostic value of prognostic nutritional index in colorectal cancer patients with simultaneous liver metastasis[J]. Chinese Archives of General Surgery(Electronic Edition), 2021, 15(04): 273-277.

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Figures/Tables 5

References 14

[1]	杨星朋，李松岩，胡时栋, 等. 术前红细胞分布宽度联合乳酸脱氢酶对结直肠癌肝转移术后患者预后的预测价值[J]. 解放军医学院学报, 2020, 41(9): 853-856.
[2]	朱德祥，任黎，许剑民. 中国结直肠癌肝转移诊断和综合治疗指南（2020版）[J]. 中国实用外科杂志, 2021, 41(1): 1-11.
[3]	Hata T, Mise Y, Ono Y, et al. Multidisciplinary treatment for colorectal liver metastases in elderly patients[J]. World J Surg Oncol, 2020, 18(1): 173.
[4]	Liao G, Zhao Z, Yang H, et al. Can prognostic nutritional index be a prediction factor in esophageal cancer? A Meta-analysis[J]. Nutr Cancer, 2020, 72(2): 187-193.
[5]	Engstrand J, Nilsson H, Stromberg C, et al. Colorectal cancer liver metastases - a population-based study on incidence, management and survival[J]. BMC Cancer, 2018, 18(1): 78.
[6]	Manfredi S, Lepage C, Hatem C, et al. Epidemiology and management of liver metastases from colorectal cancer[J]. Ann Surg, 2006, 244(2): 254-259.
[7]	Martin J, Petrillo A, Smyth E C, et al. Colorectal liver metastases: current management and future perspectives[J]. World J Clin Oncol, 2020, 11(10): 761-808.
[8]	Gelsomino F, Spallanzani A, Garajova I. The treatment of rectal cancer with synchronous liver metastases: A matter of strategy[J]. Crit Rev Oncol Hematol, 2019, 139: 91-95.
[9]	Zhao Y, Deng Y, Peng J, et al. Does the preoperative prognostic nutritional index predict survival in patients with liver metastases from colorectal cancer who underwent curative resection?[J]. J Cancer, 2018, 9(12): 2167-2174.
[10]	Hirashima K, Watanabe M, Shigaki H, et al. Prognostic significance of the modified Glasgow prognostic score in elderly patients with gastric cancer[J]. J Gastroenterol, 2014, 49(6): 1040-1046.
[11]	Kwag SJ, Kim JG, Kang WK, et al. The nutritional risk is an independent factor for postoperative morbidity in surgery for colorectal cancer[J]. Ann Surg Treat Res, 2014, 86(4): 206-211.
[12]	Onodera T, Goseki N, Kosaki G. Prognostic nutritional index in gastrointestinal surgery of malnourished cancer patients[J]. Nihon Geka Gakkai Zasshi, 1984, 85(9): 1001-1005.
[13]	陈天文，温贺新，刘牧林. 术前预后营养指数对结直肠癌根治术后生存的预测价值研究[J/CD]. 中华普通外科学文献（电子版）, 2020, 14(4): 261-265.
[14]	Abreu P, Ferreira R, Bussyguin DS, et al. Liver resections for metastasis: surgical outcomes of a single center academic institution[J]. BMC Surg, 2020, 20(1): 254.

特征		总数(83例)	低PNI组(44例)	高PNI组(39例)	统计值	P值
年龄(岁)^a		62.54 ±14.50	66.75 ±13.36	58.00 ±14.49	8.750	0.005
性别
	男	55(66.26)	25(56.82)	30(76.92)	2.893	0.089
	女	28(33.73)	19(43.18)	9(23.08)
体质指数(kg/m²) ^a		21.45±1.85	20.18±1.06	22.89±1.44	-2.712	<0.001
吸烟					1.757	0.185
	是	29(34.94)	12(27.27)	17(43.59)
	否	54(65.06)	32(72.72)	22(56.41)
饮酒					1.274	0.259
	是	14(16.87)	5(11.36)	9(23.08)
	否	69(83.13)	39(88.64)	30(76.92)
合并疾病					1.315	0.251
	是	47(56.63)	28(63.64)	19(48.72)
	否	36(43.37)	16(36.36)	20(51.28)
分化程度					0.677	0.410
	高/中	64(77.11)	36(81.82)	28(71.79)
	低	19(22.89)	8(18.18)	11(28.21)
肿瘤位置					1.744	0.187
	直肠	27(32.53)	11(25.00)	16(41.03)
	结肠	56(67.47)	33(75.00)	23(58.97)
肝转移					2.450	0.118
	单发	32(38.55)	13(29.55)	19(48.72)
	多发	51(61.45)	31(70.45)	20(51.28)
肝外转移					0.008	0.931
	是	12(14.45)	7(15.91)	5(12.82)
	否	71(85.55)	37(84.09)	34(87.18)
肿瘤T分期					0.044	0.834
	1~3	51(61.45)	28(63.64)	23(58.97)
	4	32(38.55)	16(36.36)	16(41.03)
肿瘤N分期					0.808	0.369
	0	9(10.84)	3(6.81)	6(15.38)
	1~2	74(89.16)	41(93.19)	33(84.62)
癌胚抗原(U/ml)					1.169	0.280
	<5	20(24.09)	8(18.18)	12(30.77)
	≥5	63(75.91)	36(81.82)	27(69.23)
CA19-9(U/ml)					<0.001	1.000
	<37	43(51.81)	23(53.49)	20(51.28)
	≥37	40(48.19)	21(46.51)	19(48.72)
根治手术					2.956	0.086
	是	46(55.42)	20(45.45)	26(66.67)
	否	37(44.58)	24(54.55)	13(33.33)
转化后根治手术					0.026	0.872
	是	6(42.86)	2(40.00)	4(44.44)
	否	8(57.14)	3(60.00)	5(55.56)

特征		总数(83例)	低PNI组(44例)	高PNI组(39例)	统计值	P值
年龄(岁)^a		62.54 ±14.50	66.75 ±13.36	58.00 ±14.49	8.750	0.005
性别
	男	55(66.26)	25(56.82)	30(76.92)	2.893	0.089
	女	28(33.73)	19(43.18)	9(23.08)
体质指数(kg/m²) ^a		21.45±1.85	20.18±1.06	22.89±1.44	-2.712	<0.001
吸烟					1.757	0.185
	是	29(34.94)	12(27.27)	17(43.59)
	否	54(65.06)	32(72.72)	22(56.41)
饮酒					1.274	0.259
	是	14(16.87)	5(11.36)	9(23.08)
	否	69(83.13)	39(88.64)	30(76.92)
合并疾病					1.315	0.251
	是	47(56.63)	28(63.64)	19(48.72)
	否	36(43.37)	16(36.36)	20(51.28)
分化程度					0.677	0.410
	高/中	64(77.11)	36(81.82)	28(71.79)
	低	19(22.89)	8(18.18)	11(28.21)
肿瘤位置					1.744	0.187
	直肠	27(32.53)	11(25.00)	16(41.03)
	结肠	56(67.47)	33(75.00)	23(58.97)
肝转移					2.450	0.118
	单发	32(38.55)	13(29.55)	19(48.72)
	多发	51(61.45)	31(70.45)	20(51.28)
肝外转移					0.008	0.931
	是	12(14.45)	7(15.91)	5(12.82)
	否	71(85.55)	37(84.09)	34(87.18)
肿瘤T分期					0.044	0.834
	1~3	51(61.45)	28(63.64)	23(58.97)
	4	32(38.55)	16(36.36)	16(41.03)
肿瘤N分期					0.808	0.369
	0	9(10.84)	3(6.81)	6(15.38)
	1~2	74(89.16)	41(93.19)	33(84.62)
癌胚抗原(U/ml)					1.169	0.280
	<5	20(24.09)	8(18.18)	12(30.77)
	≥5	63(75.91)	36(81.82)	27(69.23)
CA19-9(U/ml)					<0.001	1.000
	<37	43(51.81)	23(53.49)	20(51.28)
	≥37	40(48.19)	21(46.51)	19(48.72)
根治手术					2.956	0.086
	是	46(55.42)	20(45.45)	26(66.67)
	否	37(44.58)	24(54.55)	13(33.33)
转化后根治手术					0.026	0.872
	是	6(42.86)	2(40.00)	4(44.44)
	否	8(57.14)	3(60.00)	5(55.56)

临床特征	OS单因素分析		OS多因素分析		PFS单因素分析		PFS多因素分析
临床特征	HR	P值	HR	P值	HR	P值	HR	P值
PNI(≥50.4 vs <50.4)	0.425(0.224~0.791)	0.007	0.452(0.235~0.868)	0.017	0.457(0.265~0.789)	0.005	0.526(0.287~0.966)	0.038
年龄(≥60岁vs <60岁)	2.236(1.148~4.355)	0.015	2.933(1.468~5.853)	0.002	1.120(0.652~1.925)	0.681
性别(女vs男)	0.845(0.440~1.626)	0.614			1.028(0.593~1.782)	0.922
吸烟(是vs否)	1.371(0.756~2.486)	0.297			1.038(0.609~1.768)	0.892
饮酒(是vs否)	1.320(0.662~2.631)	0.429			0.986(0.494~1.971)	0.986
合并症(是vs否)	1.596(0.861~2.957)	0.134			1.637(0.968~2.768)	0.064
体质指数(≥21 kg/m² vs <21 kg/m²)	0.630(0.336~1.179)	0.145			0.639(0.38~1.108)	0.120
治疗(根治手术vs姑息治疗)	0.503(0.262~0.965)	0.034	1.540(1.060~2.220)	0.031	0.085(0.03	0.000	0.098(0.040~0.238)	<0.001
分化程度(高/中vs低)	1.222(0.823~1.812)	0.321			1.094(0.795~1.515)	0.593
肝转移(多发vs单发)	2.421(1.253~4.677)	0.007	2.565(1.301~5.054)	0.007	0.911(0.539~1.538)	0.727
T分期(1~3 vs 4)	0.850(0.452~1.597)	0.613			1.081(0.631~1.852)	0.776
N分期(0 vs 1~2)	0.442(0.183~1.065)	0.061			0.508(0.213~1.208)	0.118
原发部位(直肠vs结肠)	0.870(0.474~1.599)	0.654			1.097(0.626~1.923)	0.746
癌胚抗原(<5 U/ml vs ≥5 U/ml )	0.802(0.400~1.609)	0.533			1.417(0.760~2.644)	0.271
CA19-9(<37 U/ml vs ≥37 U/ml)	0.806(0.445~1.462)	0.477			0.805(0.479~1.350)	0.410
肝外转移(是vs否)	1.071(0.706~1.626)	0.746			1.636(1.078~2.484)	0.018	1.232(0.776~1.957)	0.376

临床特征	OS单因素分析		OS多因素分析		PFS单因素分析		PFS多因素分析
临床特征	HR	P值	HR	P值	HR	P值	HR	P值
PNI(≥50.4 vs <50.4)	0.425(0.224~0.791)	0.007	0.452(0.235~0.868)	0.017	0.457(0.265~0.789)	0.005	0.526(0.287~0.966)	0.038
年龄(≥60岁vs <60岁)	2.236(1.148~4.355)	0.015	2.933(1.468~5.853)	0.002	1.120(0.652~1.925)	0.681
性别(女vs男)	0.845(0.440~1.626)	0.614			1.028(0.593~1.782)	0.922
吸烟(是vs否)	1.371(0.756~2.486)	0.297			1.038(0.609~1.768)	0.892
饮酒(是vs否)	1.320(0.662~2.631)	0.429			0.986(0.494~1.971)	0.986
合并症(是vs否)	1.596(0.861~2.957)	0.134			1.637(0.968~2.768)	0.064
体质指数(≥21 kg/m² vs <21 kg/m²)	0.630(0.336~1.179)	0.145			0.639(0.38~1.108)	0.120
治疗(根治手术vs姑息治疗)	0.503(0.262~0.965)	0.034	1.540(1.060~2.220)	0.031	0.085(0.03	0.000	0.098(0.040~0.238)	<0.001
分化程度(高/中vs低)	1.222(0.823~1.812)	0.321			1.094(0.795~1.515)	0.593
肝转移(多发vs单发)	2.421(1.253~4.677)	0.007	2.565(1.301~5.054)	0.007	0.911(0.539~1.538)	0.727
T分期(1~3 vs 4)	0.850(0.452~1.597)	0.613			1.081(0.631~1.852)	0.776
N分期(0 vs 1~2)	0.442(0.183~1.065)	0.061			0.508(0.213~1.208)	0.118
原发部位(直肠vs结肠)	0.870(0.474~1.599)	0.654			1.097(0.626~1.923)	0.746
癌胚抗原(<5 U/ml vs ≥5 U/ml )	0.802(0.400~1.609)	0.533			1.417(0.760~2.644)	0.271
CA19-9(<37 U/ml vs ≥37 U/ml)	0.806(0.445~1.462)	0.477			0.805(0.479~1.350)	0.410
肝外转移(是vs否)	1.071(0.706~1.626)	0.746			1.636(1.078~2.484)	0.018	1.232(0.776~1.957)	0.376

[1]	Yuezhou Li, Kongxi Zhang, Xiaohong Li, Zhonghua Shang. Prognostic significance of PUM in gastric carcinoma based on bioinformatics analysis [J]. Chinese Archives of General Surgery(Electronic Edition), 2023, 17(06): 426-432.
[2]	Jun Zhang, Zai Luo, Mingyu Duan, Zhengjun Qiu, Chen Huang. Research progress of prognostic prediction models for gastric cancer [J]. Chinese Archives of General Surgery(Electronic Edition), 2023, 17(06): 456-461.
[3]	Dechen Wang, Kang Yang, Zijie Yang, Mingbin Gui, Lianping Qu, Xiaofeng Zhang, Feng Gao. Progress of microsatellite stability state and PD-1/PD-L1/IDO in colorectal carcinoma [J]. Chinese Archives of General Surgery(Electronic Edition), 2023, 17(06): 462-465.
[4]	Xu Tang, Bing Han, Wei Liu, Ruxing Chen. Analysis of risk factors for metachronous liver metastases after radical colorectal cancer surgery and construction of a predictive model [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2024, 18(01): 16-20.
[5]	Shengjun Zhang, Ajing Zhao, Shoubo Li, Xianghong Hao, Minli Liu. An experimental study on the promotion of colorectal cancer invasion and migration by high glucose through HGF/c-met pathway [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2024, 18(01): 21-24.
[6]	Qian Yang, Cuifang Li, Wanqiu Zhang. Analysis of short-term and long-term prognosis and influencing factors of primary liver cancer with spontaneous ruptured hemorrhage after emergency TACE surgery [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2024, 18(01): 33-36.
[7]	Yansong Li, Huimin Feng, Mingchao Liu, Zepeng Liu, Qiuxia Jiang. Expression and clinical significance of STIP1 in triple negative breast cancer [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2024, 18(01): 52-56.
[8]	Zhenjian Jiang, Ming Jiang, Dali Huang. The expression and prognostic value of TK1 and Ki67 proteins in differentiated thyroid carcinoma [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2023, 17(06): 623-626.
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[11]	Ting Li, Lin Zhang. Relationship between serum fatty acid metabolites and vitamin D levels and colorectal cancer [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2023, 17(06): 661-665.
[12]	Ming Jiang, Rui Luo, Chengchao Long. Diagnosis and treatment of obturator hernia: An experience of 73 cases over 10 years [J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2023, 17(06): 706-710.
[13]	Yongsheng Li, Jiahe Sun, Shuwei Guo, Yikang Lu, Hongzhou Liu. Short-term postoperative complications and their influencing factors in elderly patients with colorectal cancer [J]. Chinese Journal of Clinicians(Electronic Edition), 2023, 17(9): 962-967.
[14]	Jun Wang, Kunpeng Liu, Lan Yao, Hua Zhang, Yue Wei, Libin Suo, Jun Chen, chengli Miao, Chenghua Luo. Retrospective analysis of anesthesia management of massive transfusion patients undergoing retroperitoneal tumor resection [J]. Chinese Journal of Clinicians(Electronic Edition), 2023, 17(08): 844-849.
[15]	Libin Suo, Kunpeng Liu, Lan Yao, Hua Zhang, Yue Wei, Jun Wang, Jun Chen, Chengli Miao, Chenghua Luo. Key points of anesthesia management and prognostic factors in patients undergoing primary retroperitoneal paraganglioma resection [J]. Chinese Journal of Clinicians(Electronic Edition), 2023, 17(07): 771-776.

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