Value of a nomogram based on nutritional risk and sarcopenia on predicting postoperative complications in elderly patients with gastric cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZHANG Caihua ¹ , LIU Pengpeng ² ,  GONG Longbo ¹ , LIN Hao ¹

1. Department of Gastrointestinal Surgery, Xuzhou Central Hospital, Xuzhou, Jiangsu 221009, P. R. China;
2. Department of Hepatobiliary Surgery, Xuzhou Central Hospital, Xuzhou, Jiangsu 221009, P. R. China;

Corresponding?author：

GONG Longbo, Email: glbdoc2000@163.com

Keywords：

gastric cancer; geriatric nutritional risk index; sarcopenia; complications; nomogram

DOI：

10.7507/1007-9424.202212009

Video：

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Objective To explore the value of geriatric nutritional risk index (GNRI) and sarcopenia on predicting postoperative complications in elderly patients with gastric cancer. Methods According to the inclusion and exclusion criteria, the elderly (aged ≥60 years) patients with gastric cancer underwent radical gastrectomy in the Department of Gastrointestinal Surgery of Xuzhou Central Hospital from January 1, 2017 to December 31, 2021 were retrospectively gathered. The occurrence of postoperative complications (grade 2 or beyond by the Clavien-Dindo classification) was analyzed. The risk factors affecting postoperative complications were analyzed by univariate and multivariate logistic regression analyses to construct the prediction model, then was visualized by drawing a nomogram. The differentiation of the nomogram between the patients with postoperative complications and without postoperative complications was evaluated by the receiver operating characteristic (ROC) curve. The accuracy of the nomogram was evaluated by the calibration curve. Further, the clinical net benefit rate was analyzed by the decision curve analysis (DCA) to evaluate the clinical practicability. Results A total of 236 patients were gathered, 97 (41.1%) of whom had postoperative complications during hospitalization. The results of multivariate logistic regression analysis showed that the age, gender, GNRI, sarcopenia, surgical mode, and American Society of Aneshesiologists classification were the factors influencing the postoperative complications (P<0.05). The differentiation of nomogram based on the influencing factors was well, the area under the ROC curve was 0.732. The calibration curve showed that the model prediction curve was close to the ideal curve. The clinical net benefit rate by the DCA was higher when the probability of postoperative complications was 0.18 to 0.72. Conclusions The efficiency of nomogram based on GNRI and sarcopenia is well for predicting the occurrence of postoperative complications in elderly patients with gastric cancer. However, the nomogram needs to be further validated by prospective studies and external data.

Citation： ZHANG Caihua, LIU Pengpeng, GONG Longbo, LIN Hao. Value of a nomogram based on nutritional risk and sarcopenia on predicting postoperative complications in elderly patients with gastric cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2023, 30(4): 431-436. doi: 10.7507/1007-9424.202212009 Copy

1.	Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
2.	Lidoriki I, Schizas D, Mylonas KS, et al. Postoperative changes in nutritional and functional status of gastroesophageal cancer patients. J Am Nutr Assoc, 2022, 41(3): 301-309.
3.	李文成, 張帆, 牛勵, 等. GLIM在胃癌病人營養不良診斷和預后評估中的價值研究及生存預測列線圖模型的構建. 腸外與腸內營養, 2021, 28(6): 324-331.
4.	Zhang L, Wang S, Gao X, et al. Poor pre-operative nutritional status is a risk factor of post-operative infections in patients with gastrointestinal cancer—A multicenter prospective cohort study. Front Nutr, 2022, 9: 850063. doi: 10.3389/fnut.2022.850063.
5.	韓東, 賀軍, 黃秋林. 三種術前營養評價方法對消化道惡性腫瘤患者術后并發癥預測價值比較. 中華胃腸外科雜志, 2013, 16(11): 1067-1072.
6.	張丹, 景文江, 張淑蓮, 等. GNRI對老年消化道腫瘤患者術后并發癥和生存的預測價值研究. 河北醫科大學學報, 2022, 43(10): 1142-1146, 1152.
7.	吳寒寒, 蔣建華, 程靖, 等. 老年營養風險指數與老年胃癌患者圍手術期康復的關系. 安徽醫科大學學報, 2022, 57(11): 1816-1820.
8.	Rosenberg IH. Summary comments. Am J Clin Nutr, 1989, 50(5): 1231-1233.
9.	陶平, 潘超. 肌少癥對老年胃癌病人術前評估與術后并發癥的影響. 實用老年醫學, 2021, 35(1): 49-51, 56.
10.	肖海燕, 劉婷, 李岱, 等. 胃癌合并肌少癥的研究進展. 中國普通外科雜志, 2022, 31(8): 1121-1128.
11.	鄭志芳. 一個全新的基于術前肌少癥的預后評分系統預測胃癌R0切除術后的遠期療效. 福州: 福建醫科大學, 2019.
12.	Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6 336 patients and results of a survey. Ann Surg, 2004, 240(2): 205-213.
13.	Hirahara N, Tajima Y, Fujii Y, et al. Prediction of postoperative complications and survival after laparoscopic gastrectomy using preoperative Geriatric Nutritional Risk Index in elderly gastric cancer patients. Surg Endosc, 2021, 35(3): 1202-1209.
14.	Teigen LM, Kuchnia AJ, Nagel E, et al. Impact of software selection and image J tutorial corrigendum on skeletal muscle measures at the third lumbar vertebra on computed tomography scans in clinical populations. JPEN J Parenter Enteral Nutr, 2018, 42(5): 933-941.
15.	Su H, Ruan J, Chen T, et al. CT-assessed sarcopenia is a predictive factor for both long-term and short-term outcomes in gastrointestinal oncology patients: a systematic review and meta-analysis. Cancer Imaging, 2019, 19(1): 82. doi: 10.1186/s40644-019-0270-0.
16.	Marcoulides KM, Raykov T. Evaluation of variance inflation factors in regression models using latent variable modeling methods. Educ Psychol Meas, 2019, 79(5): 874-882.
17.	Kobayashi D, Ishigure K, Mochizuki Y, et al. Multi-institutional prospective feasibility study to explore tolerability and efficacy of oral nutritional supplements for patients with gastric cancer undergoing gastrectomy (CCOG1301). Gastric Cancer, 2017, 20(4): 718-727.
18.	張星霞, 胡艷杰, 李卡. 腸內聯合腸外與單純腸內營養支持在胃癌術后患者中應用效果的Meta分析. 中國循證醫學雜志, 2022, 22(1): 60-66.
19.	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.
20.	Shibata C, Ogawa H, Nakano T, et al. Influence of age on postoperative complications especially pneumonia after gastrectomy for gastric cancer. BMC Surg, 2019, 19(1): 106. doi: 10.1186/s12893-019-0573-x.
21.	趙建剛. 80歲及以上高齡胃癌外科手術治療分析. 杭州: 浙江大學, 2016.
22.	Nishibeppu K, Sakuramoto S, Matsui K, et al. Dismal prognosis of elderly gastric cancer patients who underwent gastrectomy with American Society of Anesthesiologists (ASA) 3. Langenbecks Arch Surg, 2022, 407(8): 3413-3421.
23.	李新星, 胡志前. 腹腔鏡和機器人在胃癌微創手術中的發展. 外科研究與新技術, 2021, 10(3): 157-161.
24.	方振. 術前骨骼肌狀態對胃癌術后并發癥的影響. 濟南: 山東大學, 2020.
25.	吳國豪, 談善軍. 胃腸外科病人圍手術期全程營養管理中國專家共識(2021版). 中國實用外科雜志, 2021, 41(10): 1111-1125.
26.	李向陽, 李凡, 張樹澤, 等. 腫瘤相關性肌少癥研究進展. 解放軍醫學雜志, 2022, 47(7): 739-744.
27.	Yang Z, Zhou X, Ma B, et al. Predictive value of preoperative sarcopenia in patients with gastric cancer: a meta-analysis and systematic review. J Gastrointest Surg, 2018, 22(11): 1890-1902.
28.	鄒紅波, 余鼎業, 嚴夏霖, 等. 基于CT的肌肉質量對伴有營養風險的老年胃癌病人臨床預后的影響. 腸外與腸內營養, 2021, 28(3): 129-134.
29.	Cruz-Jentoft AJ, Bahat G, Bauer J, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing, 2019, 48(1): 16-31.
30.	Chen LK, Woo J, Assantachai P, et al. Asian Working Group for sarcopenia: 2019 consensus update on sarcopenia diagnosis and treatment. J Am Med Dir Assoc, 2020, 21(3): 300-307.
31.	International Working Group on Sarcopenia. Sarcopenia: an undiagnosed condition in older adults. Current consensus definition: prevalence, etiology, and consequences. J Am Med Dir Assoc, 2011, 12(4): 249-256.

1. Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
2. Lidoriki I, Schizas D, Mylonas KS, et al. Postoperative changes in nutritional and functional status of gastroesophageal cancer patients. J Am Nutr Assoc, 2022, 41(3): 301-309.
3. 李文成, 張帆, 牛勵, 等. GLIM在胃癌病人營養不良診斷和預后評估中的價值研究及生存預測列線圖模型的構建. 腸外與腸內營養, 2021, 28(6): 324-331.
4. Zhang L, Wang S, Gao X, et al. Poor pre-operative nutritional status is a risk factor of post-operative infections in patients with gastrointestinal cancer—A multicenter prospective cohort study. Front Nutr, 2022, 9: 850063. doi: 10.3389/fnut.2022.850063.
5. 韓東, 賀軍, 黃秋林. 三種術前營養評價方法對消化道惡性腫瘤患者術后并發癥預測價值比較. 中華胃腸外科雜志, 2013, 16(11): 1067-1072.
6. 張丹, 景文江, 張淑蓮, 等. GNRI對老年消化道腫瘤患者術后并發癥和生存的預測價值研究. 河北醫科大學學報, 2022, 43(10): 1142-1146, 1152.
7. 吳寒寒, 蔣建華, 程靖, 等. 老年營養風險指數與老年胃癌患者圍手術期康復的關系. 安徽醫科大學學報, 2022, 57(11): 1816-1820.
8. Rosenberg IH. Summary comments. Am J Clin Nutr, 1989, 50(5): 1231-1233.
9. 陶平, 潘超. 肌少癥對老年胃癌病人術前評估與術后并發癥的影響. 實用老年醫學, 2021, 35(1): 49-51, 56.
10. 肖海燕, 劉婷, 李岱, 等. 胃癌合并肌少癥的研究進展. 中國普通外科雜志, 2022, 31(8): 1121-1128.
11. 鄭志芳. 一個全新的基于術前肌少癥的預后評分系統預測胃癌R0切除術后的遠期療效. 福州: 福建醫科大學, 2019.
12. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6 336 patients and results of a survey. Ann Surg, 2004, 240(2): 205-213.
13. Hirahara N, Tajima Y, Fujii Y, et al. Prediction of postoperative complications and survival after laparoscopic gastrectomy using preoperative Geriatric Nutritional Risk Index in elderly gastric cancer patients. Surg Endosc, 2021, 35(3): 1202-1209.
14. Teigen LM, Kuchnia AJ, Nagel E, et al. Impact of software selection and image J tutorial corrigendum on skeletal muscle measures at the third lumbar vertebra on computed tomography scans in clinical populations. JPEN J Parenter Enteral Nutr, 2018, 42(5): 933-941.
15. Su H, Ruan J, Chen T, et al. CT-assessed sarcopenia is a predictive factor for both long-term and short-term outcomes in gastrointestinal oncology patients: a systematic review and meta-analysis. Cancer Imaging, 2019, 19(1): 82. doi: 10.1186/s40644-019-0270-0.
16. Marcoulides KM, Raykov T. Evaluation of variance inflation factors in regression models using latent variable modeling methods. Educ Psychol Meas, 2019, 79(5): 874-882.
17. Kobayashi D, Ishigure K, Mochizuki Y, et al. Multi-institutional prospective feasibility study to explore tolerability and efficacy of oral nutritional supplements for patients with gastric cancer undergoing gastrectomy (CCOG1301). Gastric Cancer, 2017, 20(4): 718-727.
18. 張星霞, 胡艷杰, 李卡. 腸內聯合腸外與單純腸內營養支持在胃癌術后患者中應用效果的Meta分析. 中國循證醫學雜志, 2022, 22(1): 60-66.
19. 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.
20. Shibata C, Ogawa H, Nakano T, et al. Influence of age on postoperative complications especially pneumonia after gastrectomy for gastric cancer. BMC Surg, 2019, 19(1): 106. doi: 10.1186/s12893-019-0573-x.
21. 趙建剛. 80歲及以上高齡胃癌外科手術治療分析. 杭州: 浙江大學, 2016.
22. Nishibeppu K, Sakuramoto S, Matsui K, et al. Dismal prognosis of elderly gastric cancer patients who underwent gastrectomy with American Society of Anesthesiologists (ASA) 3. Langenbecks Arch Surg, 2022, 407(8): 3413-3421.
23. 李新星, 胡志前. 腹腔鏡和機器人在胃癌微創手術中的發展. 外科研究與新技術, 2021, 10(3): 157-161.
24. 方振. 術前骨骼肌狀態對胃癌術后并發癥的影響. 濟南: 山東大學, 2020.
25. 吳國豪, 談善軍. 胃腸外科病人圍手術期全程營養管理中國專家共識(2021版). 中國實用外科雜志, 2021, 41(10): 1111-1125.
26. 李向陽, 李凡, 張樹澤, 等. 腫瘤相關性肌少癥研究進展. 解放軍醫學雜志, 2022, 47(7): 739-744.
27. Yang Z, Zhou X, Ma B, et al. Predictive value of preoperative sarcopenia in patients with gastric cancer: a meta-analysis and systematic review. J Gastrointest Surg, 2018, 22(11): 1890-1902.
28. 鄒紅波, 余鼎業, 嚴夏霖, 等. 基于CT的肌肉質量對伴有營養風險的老年胃癌病人臨床預后的影響. 腸外與腸內營養, 2021, 28(3): 129-134.
29. Cruz-Jentoft AJ, Bahat G, Bauer J, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing, 2019, 48(1): 16-31.
30. Chen LK, Woo J, Assantachai P, et al. Asian Working Group for sarcopenia: 2019 consensus update on sarcopenia diagnosis and treatment. J Am Med Dir Assoc, 2020, 21(3): 300-307.
31. International Working Group on Sarcopenia. Sarcopenia: an undiagnosed condition in older adults. Current consensus definition: prevalence, etiology, and consequences. J Am Med Dir Assoc, 2011, 12(4): 249-256.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Value of a nomogram based on nutritional risk and sarcopenia on predicting postoperative complications in elderly patients with gastric cancer

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