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, nā=ā386) 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): 1.058ā1.565; HR: 1.667, 95% CI: 1.342ā2.071). 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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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.
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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, 555ā564 (2020). https://doi.org/10.1038/s41430-019-0502-1
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DOI: https://doi.org/10.1038/s41430-019-0502-1
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