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Clinical nutrition

Association among the prognostic nutritional index, completion of adjuvant chemotherapy, and cancer-specific survival after curative resection of stage II/III gastric cancer

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Abstract

Background/objective

To investigate the impact of preoperative immunological and nutritional status, using the prognostic nutritional index (PNI), on completion of planned adjuvant chemotherapy (AC), and the potential additive effects of low PNI and incomplete AC on gastric cancer-specific survival (CSS) after curative resection of stage II/III gastric cancer (GC).

Methods

Medical records of 1288 consecutive stage II/III GC patients who underwent curative resection and planned to receive AC between November 2010 and December 2017 were retrospectively reviewed. The optimal cut-off value of PNI for CSS was determined by X-tile. The independent predictive factors for incomplete AC were identified using univariate and multivariate analyses. Cox regression analyses assessed the association of low PNI, incomplete AC and CSS.

Results

Of the 1288 patients, 406 (31.5%) completed at least six cycles of AC within 6 months following initial of AC (complete AC). Low PNI (<43.9, n = 386) was identified to be an independent risk factor for incomplete AC (<6 cycles). Both low PNI and incomplete AC independently predicted poor CSS (hazard ratio (HR): 1.287, 95% confidence interval (CI): 1.058–1.565; HR: 1.667, 95% CI: 1.342–2.071). Further analyses confirmed an additive effect with those with both low PNI and incomplete AC having an even worse CSS.

Conclusions

Low preoperative PNI significantly affects completion of AC. Low PNI and incomplete AC has an additive effect and is associated with even worse outcomes. Further prospective studies are needed to clarify whether perioperative nutrition intervention could improve completion of AC and improve prognosis of GC patients.

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Acknowledgements

The authors gratefully thank all of the participants in this study and Hunan Cancer Hospital for supporting this study.

Funding

This study was supported by grants from the Natural Science Foundation of Hunan Province (no. 2018JJ6108) and the 2017 Annual Research Project of Health and Family Planning Commission of Hunan Province (no. B2017101).

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Authors and Affiliations

  1. Department of Gastroduodenal and Pancreatic Surgery, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China

    Hua Xiao, Hu Quan, Bin Yin, Gang Huang & Yongzhong Ouyang

  2. Department of Gastroenterology and Urology, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China

    Huijun Zhou, Rongrong Li & Xianli Yin

  3. Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China

    Peng Zhang

  4. Department of Cancer Prevention and Control, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China

    Haifan Xiao

  5. Department of Lamphoma and Abdominal Radiotherapy, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China

    Ke Liu

  6. Department of Pathology, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China

    Xiaoyan Chen

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  1. Hua Xiao
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Contributions

HX, XLY, and YZOY contributed to the conception and the design of the study; HX, HJZ, PZ, HFX, KL, XYC, HQ, BY, RRL, and GH collected, analyzed, and interpreted the data; HX grafted the manuscript. XLY and YZOY critically revised the manuscript. All authors agree to be fully accountable for ensuring the integrity and accuracy of the work, and read and approve the final manuscript.

Corresponding authors

Correspondence to Xianli Yin or Yongzhong Ouyang.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Xiao, H., Zhou, H., Zhang, P. et al. Association among the prognostic nutritional index, completion of adjuvant chemotherapy, and cancer-specific survival after curative resection of stage II/III gastric cancer. Eur J Clin Nutr 74, 555–564 (2020). https://doi.org/10.1038/s41430-019-0502-1

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