The clinical significance of prognostic nutritional index combined with neutrophil to lymphocyte ratio in early prediction of anastomotic leakage after radical gastrectomy for gastric cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 SONG Yingzhou ¹ , WU Xinjun ²

1. Department of General Surgery, The Third People’s Hospital of Shangqiu City, Shangqiu, Henan 476000, P. R. China;
2. Department of General Surgery, The First Affiliated Hospital of Xinxiang Medical College, Xinxiang, Henan 453000, P. R. China;

Corresponding?author：

SONG Yingzhou, Email: songyingzhou123@163.com

Keywords：

anastomotic leakage; prognostic nutritional index; neutrophil to lymphocyte ratio; radical gastrectomy for gastric cancer; risk factor

DOI：

10.7507/1007-9424.202010074

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Objective To study the clinical significance of prognostic nutritional index (PNI) combined with neutrophil to lymphocyte ratio (NLR) in predicting the occurrence of anastomotic leakage after radical gastrectomy for gastric cancer.Methods To retrospectively analyze and collect the clinical data of 517 patients with gastric cancer who were diagnosed at the Third People’s Hospital of Shangqiu City from January 2016 to May 2020, all of the patients received radical gastrectomy. We explored the risk factors that affect the occurrence of postoperative anastomotic leakage, and explored the clinical significance of PNI combined with NLR on the third day after operation in predicting the occurrence of anastomotic leakage.Results Among 517 patients undergoing radical gastrectomy, 61 had anastomotic leakage, and the incidence of anastomotic leakage was 11.8%. The results of multivariate logistic regression analysis showed that patients with preoperative diabetes and intraoperative blood loss ≥400 mL had a higher incidence of anastomotic leakage, and with the increase of NLR value on the 3rd and 5th day after operation, and the decrease of PNI value on the 3rd and 5th day after operation, the incidence of anastomotic leakage increased (P<0.05). The area under the curve of NLR, PNI, and NLR combined with PNI on the 3rd day after operation in predicting the occurrence of anastomotic leakage were 0.849, 0.581, and 0.949, respectively, and the differences were statistically significant (P<0.05), the sensitivity and specificity of NLR combined with PNI were higher than the individual indicator.Conclusion PNI combined with NLR on the 3rd day after operation has important clinical significance in predicting the occurrence of anastomotic leakage after radical gastrectomy for gastric cancer.

Citation： SONG Yingzhou, WU Xinjun. The clinical significance of prognostic nutritional index combined with neutrophil to lymphocyte ratio in early prediction of anastomotic leakage after radical gastrectomy for gastric cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2021, 28(7): 915-919. doi: 10.7507/1007-9424.202010074 Copy

1.	Carboni F, Valle M, Federici O, et al. Esophagojejunal anastomosis leakage after total gastrectomy for esophagogastric junction adenocarcinoma: options of treatment. J Gastrointest Oncol, 2016, 7(4): 515-522.
2.	Kim SH, Son SY, Park YS, et al. Risk factors for anastomotic leakage: A retrospective cohort study in a single gastric surgical unit. J Gastric Cancer, 2015, 15(3): 167-175.
3.	Yamana I, Takeno S, Yamada T, et al. The risk factors for refractory fistula after esophagectomy with gastric tube reconstruction in patients with esophageal cancer. Dig Surg, 2017, 34(1): 18-24.
4.	Radulescu D, Baleanu VD, Padureanu V, et al. Neutrophil/lymphocyte ratio as predictor of anastomotic leak after gastric cancer surgery. Diagnostics (Basel), 2020, 10(10): 799.
5.	Katipo?lu Z, Mirza E, Oltulu R, et al. May monocyte/HDL cholesterol ratio (MHR) and neutrophil/lymphocyte ratio (NLR) be an indicator of inflammation and oxidative stress in patients with keratoconus? Ocul Immunol Inflamm, 2020, 28(4): 632-636.
6.	Mirili C, Y?lmaz A, Demirkan S, et al. Clinical significance of prognostic nutritional index (PNI) in malignant melanoma. Int J Clin Oncol, 2019, 24(10): 1301-1310.
7.	Karimi P, Islami F, Anandasabapathy S, et al. Gastric cancer: descriptive epidemiology, risk factors, screening, and prevention. Cancer Epidemiol Biomarkers Prev, 2014, 23(5): 700-713.
8.	闞永豐, 鄭毅, 李世擁, 等. 1 142例胃癌切除術圍手術期死亡因素分析. 中華胃腸外科雜志, 2005, 8(5): 422-424.
9.	Tsou CC, Lo SS, Fang WL, et al. Risk factors and management of anastomotic leakage after radical gastrectomy for gastric cancer. Hepatogastroenterology, 2011, 58(105): 218-223.
10.	Yasuda T, Sugimura K, Yamasaki M, et al. Ten cases of gastro-tracheobronchial fistula: a serious complication after esophagectomy and reconstruction using posterior mediastinal gastric tube. Dis Esophagus, 2012, 25(8): 687-693.
11.	Nelen SD, Bosscha K, Lemmens VEPP, et al. Morbidity and mortality according to age following gastrectomy for gastric cancer. Br J Surg, 2018, 105(9): 1163-1170.
12.	Smith SR, Pockney P, Holmes R, et al. Biomarkers and anastomotic leakage in colorectal surgery: C-reactive protein trajectory is the gold standard. ANZ J Surg, 2018, 88(5): 440-444.
13.	Bennis M, Parc Y, Lefevre JH, et al. Morbidity risk factors after low anterior resection with total mesorectal excision and coloanal anastomosis: a retrospective series of 483 patients. Ann Surg, 2012, 255(3): 504-510.
14.	Platt JJ, Ramanathan ML, Crosbie RA, et al. C-reactive protein as a predictor of postoperative infective complications after curative resection in patients with colorectal cancer. Ann Surg Oncol, 2012, 19(13): 4168-4177.
15.	Mik M, Dziki L, Berut M, et al. Neutrophil to lymphocyte ratio and C-reactive protein as two predictive tools of anastomotic leak in colorectal cancer open surgery. Dig Surg, 2018, 35(1): 77-84.
16.	劉英俊, 高重慶, 王剛成, 等. 中性粒細胞與淋巴細胞比值早期預測直腸癌術后吻合口瘺的價值. 中華腫瘤雜志, 2020, 42(1): 70-73.
17.	?etin DA, Günde? E, ?iyiltepe H, et al. Risk factors and laboratory markers used to predict leakage in esophagojejunal anastomotic leakage after total gastrectomy. Turk J Surg, 2018, 35(1): 6-12.
18.	Cadwell JB, Afonso AM, Shahrokni A. Prognostic nutritional index (PNI), independent of frailty is associated with six-month postoperative mortality. J Geriatr Oncol, 2020, 11(5): 880-884.
19.	Hua X, Long ZQ, Huang X, et al. The value of prognostic nutritional index (PNI) in predicting survival and guiding radiotherapy of patients with T1-2N1 breast cancer. Front Oncol, 2020, 9: 1562.

1. Carboni F, Valle M, Federici O, et al. Esophagojejunal anastomosis leakage after total gastrectomy for esophagogastric junction adenocarcinoma: options of treatment. J Gastrointest Oncol, 2016, 7(4): 515-522.
2. Kim SH, Son SY, Park YS, et al. Risk factors for anastomotic leakage: A retrospective cohort study in a single gastric surgical unit. J Gastric Cancer, 2015, 15(3): 167-175.
3. Yamana I, Takeno S, Yamada T, et al. The risk factors for refractory fistula after esophagectomy with gastric tube reconstruction in patients with esophageal cancer. Dig Surg, 2017, 34(1): 18-24.
4. Radulescu D, Baleanu VD, Padureanu V, et al. Neutrophil/lymphocyte ratio as predictor of anastomotic leak after gastric cancer surgery. Diagnostics (Basel), 2020, 10(10): 799.
5. Katipo?lu Z, Mirza E, Oltulu R, et al. May monocyte/HDL cholesterol ratio (MHR) and neutrophil/lymphocyte ratio (NLR) be an indicator of inflammation and oxidative stress in patients with keratoconus? Ocul Immunol Inflamm, 2020, 28(4): 632-636.
6. Mirili C, Y?lmaz A, Demirkan S, et al. Clinical significance of prognostic nutritional index (PNI) in malignant melanoma. Int J Clin Oncol, 2019, 24(10): 1301-1310.
7. Karimi P, Islami F, Anandasabapathy S, et al. Gastric cancer: descriptive epidemiology, risk factors, screening, and prevention. Cancer Epidemiol Biomarkers Prev, 2014, 23(5): 700-713.
8. 闞永豐, 鄭毅, 李世擁, 等. 1 142例胃癌切除術圍手術期死亡因素分析. 中華胃腸外科雜志, 2005, 8(5): 422-424.
9. Tsou CC, Lo SS, Fang WL, et al. Risk factors and management of anastomotic leakage after radical gastrectomy for gastric cancer. Hepatogastroenterology, 2011, 58(105): 218-223.
10. Yasuda T, Sugimura K, Yamasaki M, et al. Ten cases of gastro-tracheobronchial fistula: a serious complication after esophagectomy and reconstruction using posterior mediastinal gastric tube. Dis Esophagus, 2012, 25(8): 687-693.
11. Nelen SD, Bosscha K, Lemmens VEPP, et al. Morbidity and mortality according to age following gastrectomy for gastric cancer. Br J Surg, 2018, 105(9): 1163-1170.
12. Smith SR, Pockney P, Holmes R, et al. Biomarkers and anastomotic leakage in colorectal surgery: C-reactive protein trajectory is the gold standard. ANZ J Surg, 2018, 88(5): 440-444.
13. Bennis M, Parc Y, Lefevre JH, et al. Morbidity risk factors after low anterior resection with total mesorectal excision and coloanal anastomosis: a retrospective series of 483 patients. Ann Surg, 2012, 255(3): 504-510.
14. Platt JJ, Ramanathan ML, Crosbie RA, et al. C-reactive protein as a predictor of postoperative infective complications after curative resection in patients with colorectal cancer. Ann Surg Oncol, 2012, 19(13): 4168-4177.
15. Mik M, Dziki L, Berut M, et al. Neutrophil to lymphocyte ratio and C-reactive protein as two predictive tools of anastomotic leak in colorectal cancer open surgery. Dig Surg, 2018, 35(1): 77-84.
16. 劉英俊, 高重慶, 王剛成, 等. 中性粒細胞與淋巴細胞比值早期預測直腸癌術后吻合口瘺的價值. 中華腫瘤雜志, 2020, 42(1): 70-73.
17. ?etin DA, Günde? E, ?iyiltepe H, et al. Risk factors and laboratory markers used to predict leakage in esophagojejunal anastomotic leakage after total gastrectomy. Turk J Surg, 2018, 35(1): 6-12.
18. Cadwell JB, Afonso AM, Shahrokni A. Prognostic nutritional index (PNI), independent of frailty is associated with six-month postoperative mortality. J Geriatr Oncol, 2020, 11(5): 880-884.
19. Hua X, Long ZQ, Huang X, et al. The value of prognostic nutritional index (PNI) in predicting survival and guiding radiotherapy of patients with T1-2N1 breast cancer. Front Oncol, 2020, 9: 1562.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

The clinical significance of prognostic nutritional index combined with neutrophil to lymphocyte ratio in early prediction of anastomotic leakage after radical gastrectomy for gastric cancer

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