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, 18 (1), 285

Prognostic Nutritional Index as a Predictor of Survival in Resectable Gastric Cancer Patients With Normal Preoperative Serum Carcinoembryonic Antigen Levels: A Propensity Score Matching Analysis

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Prognostic Nutritional Index as a Predictor of Survival in Resectable Gastric Cancer Patients With Normal Preoperative Serum Carcinoembryonic Antigen Levels: A Propensity Score Matching Analysis

Noriyuki Hirahara et al. BMC Cancer.

Abstract

Background: An ideal tumor marker should be capable of being detected at any stage of the disease. However, gastric cancer patients do not always have elevated serum carcinoembryonic antigen (CEA) levels, even in advanced cases. Recently, several studies have investigated the associations between preoperative PNI and postoperative long-term outcomes. In this study, we focused on the significance of the prognostic nutritional index (PNI) as a potential predictor of survival in resectable gastric cancer patients with normal preoperative serum CEA levels.

Methods: We retrospectively conducted cohort study to evaluate the PNI as a predictor of survival in 368 resectable gastric cancer patients who underwent potentially curative gastrectomy at our institute between January 2010 and December 2016. We selected 218 patients by propensity score matching to reduce biases due to the different distributions of co-variables among the comparable groups.

Results: In the multivariate analysis, pStage (hazard ratio [HR]: 14.003, 95% confidence interval [CI]: 5.033-44.487; p < 0.001), PNI (HR: 2.794, 95% CI: 1.352-6.039; p < 0.001) were identified as independent prognostic factors of CSS in 218 propensity matched gastric cancer patients. The Kaplan-Meier analysis demonstrated that low PNI patients had a significantly poorer cancer specific survival (CSS) than high PNI patients (p = 0.008). Among 166 propensity matched gastric cancer patients with normal preoperative serum CEA levels, multivariate analysis demonstrated that pStage (HR: 7.803, 95% CI: 3.015-24.041; p < 0.001) and PNI (HR: 3.078, 95% CI: 1.232-8.707; p = 0.016) were identified as independent prognostic factors of CSS. And Kaplan-Meier analysis demonstrated that low PNI had a significantly poorer CSS than high PNI value (p = 0.011).

Conclusions: This study demonstrates that a low preoperative PNI value is a potential independent risk factor for poorer CSS in patients with gastric cancer, even in those with normal serum CEA levels.

Keywords: Gastric cancer; Normal CEA; Prognostic factor; Prognostic nutritional index.

Conflict of interest statement

Ethics approval and consent to participate

This retrospective study was approved with the ethical board of Shimane University Faculty of Medicine, and was conducted in accordance with the Declaration of Helsinki. Informed consent was obtained from all individual participants included in the study.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Receiver operating curves for post-operative survival were plotted to verify the optimum cut-off value of PNI for cancer-specific survival
Fig. 2
Fig. 2
PNI values in propensity score matched 218 gastric cancer patients according to the serum level of carcinoembryonic antigen. Kruskal-Wallis test: p = 0.367. In each box plot, the lower and upper ends of the box represent the 25th and 75th percentiles, respectively. Capped bars indicate the minimum and maximum values, respectively, and the line inside the box represents the median PNI value
Fig. 3
Fig. 3
Kaplan-Meier curves of postoperative cancer-specific survival based on PNI in propensity score matched 218 gastric cancer patients
Fig. 4
Fig. 4
Kaplan-Meier curves of postoperative cancer-specific survival based on serum CEA levels in propensity score matched 218 gastric cancer patients
Fig. 5
Fig. 5
Kaplan-Meier curves of postoperative cancer-specific survival based on PNI in propensity score matched 166 gastric cancer patients with normal serum CEA levels

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References

    1. Hirahara N, Matsubara T, Mizota Y, Ishibashi S, Tajima Y. Prognostic value of preoperative inflammatory response biomarkers in patients with esophageal cancer who undergo a curative thoracoscopic esophagectomy. BMC Surg. 2016;20(16(1)):66. doi: 10.1186/s12893-016-0179-5. - DOI - PMC - PubMed
    1. Mimatsu K, Fukino N, Ogasawara Y, Saino Y, Oida T. Utility of Inflammatory Marker- and Nutritional Status-based Prognostic Factors for Predicting the Prognosis of Stage IV Gastric Cancer Patients Undergoing Non-curative Surgery. Anticancer Res. 2017;37(8):4215–4222. - PubMed
    1. Lin YH, Chang KP, Lin YS, Chang TS. Pretreatment combination of platelet counts and neutrophil-lymphocyte ratio predicts survival of nasopharyngeal cancer patients receiving intensity-modulated radiotherapy. Onco Targets Ther. 2017;10:2751–2760. doi: 10.2147/OTT.S137000. - DOI - PMC - PubMed
    1. Kim A, Im M, Ma JY. Sosiho-tang ameliorates cachexia-related symptoms in mice bearing colon 26 adenocarcinoma by reducing systemic inflammation and muscle loss. Oncol Rep. 2016;35(3):1841–1850. doi: 10.3892/or.2015.4527. - DOI - PubMed
    1. Dev R, Wong A, Hui D, Bruera E. The Evolving Approach to Management of Cancer Cachexia. Oncology (Williston Park) 2017;31(1):23–32. - PubMed

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