Published online Feb 27, 2023. doi: 10.4240/wjgs.v15.i2.211
Peer-review started: September 15, 2022
First decision: December 12, 2022
Revised: December 14, 2022
Accepted: December 31, 2022
Article in press: December 31, 2022
Published online: February 27, 2023
The mechanism of the occurrence and development of remnant gastric cancer (RGC) remains unclear. Systematically evaluating the preoperative immune and nutritional status of patients and analyzing its prognostic impact on postoperative RGC patients are crucial.
In RGC, the clinical data of immune-nutritional scoring systems are still lacking; particularly, no relevant literature is available for the prediction of postoperative overall survival (OS). Prognostic nutritional index (PNI), controlled nutritional status (CONUT), and Naples prognostic score system (NPS) are comprehensive predictive evaluation methods that are easy to obtain. They represent the entire systemic inflammation and nutritional status of patients with RGC from many aspects.
This retrospective cohort study aimed to determine the prognostic value of three preoperative immune-nutritional score systems, namely, PNI, CONUT, and NPS, in patients with RGC, and to examine their relationship with other clinicopathological features.
The curves of the three immune-nutritional scores for predicting postoperative survival were plotted. Kaplan–Meier analysis was used to analyze the relationship between PNI, CONUT, and NPS scores and prognosis.
NPS was found to have the largest area under the curve [AUC = 0.707; 95% confidence interval (CI): 0.566–0.848; P = 0.009]. The AUC values of PNI and CONUT were 0.611 (95%CI: 0.460–0.763; P = 0.161) and 0.635 (95%CI: 0.485–0.784; P = 0.090), respectively. The three immune-nutritional scoring systems, PNI (P = 0.002), CONUT (P = 0.039), and NPS (P < 0.001), were significantly correlated with OS. Median OS of patients with a low immune-nutritional risk was significantly higher than that of patients with a high immune-nutritional risk (PNI: 75 mo vs 42 mo, P = 0.001; CONUT: 69 mo vs 48 mo, P = 0.033; NPS: 77 mo vs 40 mo, P < 0.001).
Poor immune-nutritional scores are associated with a poor OS. Among the three immune-nutritional scoring systems, the NPS scoring system can more accurately evaluate the prognosis of patients with RGC.
The finding shows that the three immune-nutritional systems can significantly predict the prognosis of patients. Of note, the NPS system demonstrates the best prediction capability.