Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Feb 27, 2023; 15(2): 211-221
Published online Feb 27, 2023. doi: 10.4240/wjgs.v15.i2.211
Prognostic value of preoperative immune-nutritional scoring systems in remnant gastric cancer patients undergoing surgery
Yan Zhang, Lin-Jun Wang, Qin-Ya Li, Zhen Yuan, Dian-Cai Zhang, Hao Xu, Li Yang, Xin-Hua Gu, Ze-Kuan Xu
Yan Zhang, Zhen Yuan, Xin-Hua Gu, Department of Gastrointestinal Surgery, Suzhou Municipal Hospital, Affiliated Suzhou Hospital of Nanjing Medical University, Gusu School of Nanjing Medical University, Suzhou 215000, Jiangsu Province, China
Lin-Jun Wang, Qin-Ya Li, Dian-Cai Zhang, Hao Xu, Li Yang, Ze-Kuan Xu, Department of General Surgery, Jiangsu Province Hospital, First Affiliated Hospital of Nanjing Medical University, Nanjing 210003, Jiangsu Province, China
Author contributions: Zhang Y, Wang LJ, and Xu ZK contributed equally to this work; Gu XH and Xu ZK designed the research study; Zhang Y and Wang LJ performed the research; Li QY contributed analytic tools; Yuan Z, Zhang DC, Xu H, and Yang L analyzed the data and wrote the manuscript; all authors have read and approved the final manuscript.
Supported by National Natural Science Foundation of China, No. 81871946 and No. 82072708; Suzhou Medical Key Discipline, No. SZXK202109; Suzhou Clinical Key Diseases Project, No. LCZX202111; Project of Gusu School of Nanjing Medical University, No. GSKY20210233.
Institutional review board statement: This study was approved by the medical ethics committee of Nanjing Medical University.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xin-Hua Gu, Doctor, Department of Gastrointestinal Surgery, Suzhou Municipal Hospital, Affiliated Suzhou Hospital of Nanjing Medical University, Gusu School of Nanjing Medical University, No. 26 Daoqianjie, Gusu District, Suzhou 215000, Jiangsu Province, China. 1173421755@qq.com
Received: September 15, 2022
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
Processing time: 164 Days and 19.9 Hours
ARTICLE HIGHLIGHTS
Research background

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.

Research motivation

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.

Research objectives

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.

Research methods

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.

Research results

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).

Research conclusions

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.

Research perspectives

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.