Preoperative nutritional index may predict postoperative outcome in elderly with CRC
Onodera's prognostic nutritional index (PNI) indicates the patient's nutritional and immunological status and is used to predict the risk of several kinds of complications after surgery. A study published in the Indian Journal of Surgery suggests, Preoperative Prognostic Nutritional Index (PNI) < 45 in patients aged ≥ 85 years with Colorectal Cancer (CRC) is both predictive and prognostic for short- and long-term outcomes.
Incidence of CRC has increased in recent years; CRC is the third most common cause of cancer-related death worldwide. Despite improved treatments, CRC recurrences arise at a steady rate. Long-term survival and local recurrence in CRC patients are affected by postoperative complications (PCs). Therefore it is important to identifying predictors for PCs from preoperative data to improve patients overall quality of life especially in elders. Prognostic nutritional index (PNI) is calculated from serum albumin concentration and peripheral blood lymphocyte (PBL) count and is used to predict the risk of several kinds of complications after surgery. They have also been proposed to be causally related to overall survival (OS) in some cancers. However, there are only a few reports available addressing the relationship between preoperative PNI and PCs in very elderly (≥ 85 years old) patients with CRC. For this purpose, researchers of Kawasaki Medical School, Japan conducted a study to assess the PNI as a predictor of postoperative outcome in elderly patients over 85 years old with colorectal cancer.
It was a retrospective study in 45 patients over 85 years old who underwent colorectal tumor resection at our hospital from April 2013 to March 2018. Researchers examined the correlations between preoperative PNI and postoperative complications. All preoperative demographic data and blood samples were collected within 14 days before surgery and Onodera's PNI (10 × serum albumin as g/dl) + (0.005 × PBL per mm3) was measured within 7 days before surgery. They determined that complications occurred within 30 days after surgery as PCs and were graded using Clavien–Dindo classification.
Key findings of the study were:
♦The incidence rate of postoperative complications was 31.1% (14/45) and they were improved conservatively.
♦The median preoperative PNI was 43.20 (range 24.05–57.05) in the validation study and the PNI cutoff value was set at 45.
♦Upon multivariate analysis, researchers found PNI was an independent predictive factor of postoperative complications.
♦They also found 3-year overall survival rates of patients in the PNI ≧ 45 and PNI < 45 were 100% and 63.8%
The authors concluded, "preoperative PNI < 45 in patients aged ≥ 85 years with CRC is both predictive and prognostic for short- and long-term outcomes".
They further added, "To our knowledge, this is the first report that PNI is relevant to PCs and long-term prognosis in patients aged ≥ 85 years with CRC. However, a prospective large-scale study is needed to clarify the value of PNI for very elderly patients with CRC".
For further information:
https://link.springer.com/article/10.1007/s12262-020-02164-4
