Clinical Significance of the Preoperative Prognostic Nutritional Index on Age/comorbidity Burdens in Patients with Resectable Non-small Cell Lung Cancer

Overview

Journal Surg Today

Specialty General Surgery

Date 2023 Jan 31

PMID 36720742

Authors

Mamoru Takahashi

Hironobu Tokumasu

Sachiko Ota

Harutaro Okada

Akihiro Aoyama

Affiliations

Soon will be listed here.

Abstract

Purpose: Objective nutritional scoring systems using preoperative blood samples have shown the potential to predict the postoperative outcomes of patients with non-small cell lung cancer (NSCLC). However, it remains unclear whether the prognostic impact depends on age and comorbid burdens. We conducted this study to validate the impact of preoperative nutritional status, stratified with age and comorbidity.

Methods: We reviewed the preoperative prognostic nutritional index (PNI) and postoperative outcomes of 713 consecutive patients with completely resected NSCLC.

Results: We identified the optimal cutoff values of the PNI as 46. Significantly higher postoperative complication rates and worse survival rates were observed in the low PNI (≤ 46) group, regardless of age/comorbidity burdens. Multivariate analysis showed that a low PNI (≤ 46) was an independent prognostic factor for poor overall survival (hazard ratio: 2.5). A matched-pair analysis gave consistent results, showing that a low PNI (≤ 46) was an independent prognostic factor for poor overall survival (OS; hazard ratio: 1.8) and recurrence-free survival (RFS; hazard ratio: 1.6).

Conclusion: Nutritional status, indexed by the PNI, is a strong prognostic factor for the postoperative outcomes of patients undergoing curative resection for NSCL, regardless of age/comorbidity burdens.

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References

Arends J, Bachmann P, Baracos V, Barthelemy N, Bertz H, Bozzetti F . ESPEN guidelines on nutrition in cancer patients. Clin Nutr. 2016; 36(1):11-48. DOI: 10.1016/j.clnu.2016.07.015. View

Marshall K, Loeliger J, Nolte L, Kelaart A, Kiss N . Prevalence of malnutrition and impact on clinical outcomes in cancer services: A comparison of two time points. Clin Nutr. 2018; 38(2):644-651. DOI: 10.1016/j.clnu.2018.04.007. View

Batchelor T, Rasburn N, Abdelnour-Berchtold E, Brunelli A, Cerfolio R, Gonzalez M . Guidelines for enhanced recovery after lung surgery: recommendations of the Enhanced Recovery After Surgery (ERAS®) Society and the European Society of Thoracic Surgeons (ESTS). Eur J Cardiothorac Surg. 2018; 55(1):91-115. DOI: 10.1093/ejcts/ezy301. View

Pallis A, Gridelli C, Wedding U, Faivre-Finn C, Veronesi G, Jaklitsch M . Management of elderly patients with NSCLC; updated expert's opinion paper: EORTC Elderly Task Force, Lung Cancer Group and International Society for Geriatric Oncology. Ann Oncol. 2014; 25(7):1270-1283. DOI: 10.1093/annonc/mdu022. View

McKenna N, Bews K, Al-Refaie W, Colibaseanu D, Pemberton J, Cima R . Assessing Malnutrition Before Major Oncologic Surgery: One Size Does Not Fit All. J Am Coll Surg. 2020; 230(4):451-460. DOI: 10.1016/j.jamcollsurg.2019.12.034. View

Mori S, Usami N, Fukumoto K, Mizuno T, Kuroda H, Sakakura N . The Significance of the Prognostic Nutritional Index in Patients with Completely Resected Non-Small Cell Lung Cancer. PLoS One. 2015; 10(9):e0136897. PMC: 4565697. DOI: 10.1371/journal.pone.0136897. View

Okada S, Shimada J, Kato D, Tsunezuka H, Teramukai S, Inoue M . Clinical Significance of Prognostic Nutritional Index After Surgical Treatment in Lung Cancer. Ann Thorac Surg. 2017; 104(1):296-302. DOI: 10.1016/j.athoracsur.2017.01.085. View

Takahashi M, Sowa T, Tokumasu H, Gomyoda T, Okada H, Ota S . Comparison of three nutritional scoring systems for outcomes after complete resection of non-small cell lung cancer. J Thorac Cardiovasc Surg. 2020; 162(4):1257-1268.e3. DOI: 10.1016/j.jtcvs.2020.06.030. View

Soto-Perez-de-Celis E, Li D, Yuan Y, Lau Y, Hurria A . Functional versus chronological age: geriatric assessments to guide decision making in older patients with cancer. Lancet Oncol. 2018; 19(6):e305-e316. DOI: 10.1016/S1470-2045(18)30348-6. View

10.

Edwards B, Noone A, Mariotto A, Simard E, Boscoe F, Henley S . Annual Report to the Nation on the status of cancer, 1975-2010, featuring prevalence of comorbidity and impact on survival among persons with lung, colorectal, breast, or prostate cancer. Cancer. 2013; 120(9):1290-314. PMC: 3999205. DOI: 10.1002/cncr.28509. View

11.

Mohile S, Dale W, Somerfield M, Schonberg M, Boyd C, Burhenn P . Practical Assessment and Management of Vulnerabilities in Older Patients Receiving Chemotherapy: ASCO Guideline for Geriatric Oncology. J Clin Oncol. 2018; 36(22):2326-2347. PMC: 6063790. DOI: 10.1200/JCO.2018.78.8687. View

12.

Park S, Ahn H, Yang M, Kim J, Kim J, Park S . The prognostic nutritional index and postoperative complications after curative lung cancer resection: A retrospective cohort study. J Thorac Cardiovasc Surg. 2019; 160(1):276-285.e1. DOI: 10.1016/j.jtcvs.2019.10.105. View

13.

Sudarshan M, Murthy S . Commentary: Using nutritional scoring systems to predict outcomes after lung cancer surgery: Food for thought. J Thorac Cardiovasc Surg. 2020; 162(4):1270-1271. DOI: 10.1016/j.jtcvs.2020.06.107. View

14.

Charlson M, Szatrowski T, Peterson J, Gold J . Validation of a combined comorbidity index. J Clin Epidemiol. 1994; 47(11):1245-51. DOI: 10.1016/0895-4356(94)90129-5. View

15.

Wang S, Wong M, Hamilton N, Davoren J, Jahan T, Walter L . Impact of age and comorbidity on non-small-cell lung cancer treatment in older veterans. J Clin Oncol. 2012; 30(13):1447-55. PMC: 3383118. DOI: 10.1200/JCO.2011.39.5269. View

16.

Dindo D, Demartines N, Clavien P . Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004; 240(2):205-13. PMC: 1360123. DOI: 10.1097/01.sla.0000133083.54934.ae. View

17.

Yang H, Woo K, Sima C, Bains M, Adusumilli P, Huang J . Long-term Survival Based on the Surgical Approach to Lobectomy For Clinical Stage I Nonsmall Cell Lung Cancer: Comparison of Robotic, Video-assisted Thoracic Surgery, and Thoracotomy Lobectomy. Ann Surg. 2017; 265(2):431-437. PMC: 5033685. DOI: 10.1097/SLA.0000000000001708. View

18.

Kanda Y . Investigation of the freely available easy-to-use software 'EZR' for medical statistics. Bone Marrow Transplant. 2012; 48(3):452-8. PMC: 3590441. DOI: 10.1038/bmt.2012.244. View

19.

Koppie T, Serio A, Vickers A, Vora K, Dalbagni G, Donat S . Age-adjusted Charlson comorbidity score is associated with treatment decisions and clinical outcomes for patients undergoing radical cystectomy for bladder cancer. Cancer. 2008; 112(11):2384-92. DOI: 10.1002/cncr.23462. View

20.

Yang C, Fong Y, Lin L, Que J, Ting W, Chang C . The age-adjusted Charlson comorbidity index is a better predictor of survival in operated lung cancer patients than the Charlson and Elixhauser comorbidity indices. Eur J Cardiothorac Surg. 2017; 53(1):235-240. DOI: 10.1093/ejcts/ezx215. View