Comparative study of prognostic nutritional index and patient-generated subjective global assessment in perioperative nutritional prediction in patients with esophageal cancer_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHOU Hong , XIE Qin , DENG Mingzhen , MIAO Yan ,  HAN Yongtao

Division of Thoracic Surgery, Sichuan Cancer Hospital & Institute, Cancer Hospital Affiliated to School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610041, P.R.China;

Corresponding?author：

HAN Yongtao, Email: hanyongt@aliyun.com

Keywords：

Esophageal cancer; perioperative period; prognosis nutritional index; patient-generated subjective global assessment; nutritional status

DOI：

10.7507/1007-4848.201905056

Video：

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Objective To investigate the prognostic value and consistency of prognostic nutritional index (PNI) and patient-generated subjective global assessment (PG-SGA) in perioperative nutritional status of patients with esophageal cancer.Methods Clinical data of 224 patients, including 186 males and 38 females with an average age of 63.08±8.42 years, who underwent esophageal cancer surgery in our hospital from November 2017 to August 2018 were retrospectively reviewed. The PNI was calculated according to the results of the first time blood and biochemical tests, and the PG-SGA assessment was also performed. According to the PNI value, the patients were divided into a good nutrition group (PNI≥45, 60 patients) and a malnutrition group (PNI<45, 164 patients). According to the PG-SGA score, the patients were divided into a good nutrition group (PG-SGA<4, 75 patients) and a malnutrition group (PG-SGA≥4, 149 patients). Nutrition-related haematological indexes and body mass index (BMI) were compared between the two groups, and the consistency of PNI and PG-SGA for nutritional assessment was analyzed.Results The nutrition-related haematological indexes in different PNI groups were statistically different in the perioperative period (P<0.01). The longitudinal changes of prealbumin in patients of different PG-SGA groups were statistically different (P<0.05); the BMI of patients in different PG-SGA groups was statistically different in the perioperative period (P<0.01). The Kappa coefficient of the two indicators was 0.589 (P<0.001).Conclusion Both PNI and PG-SGA can predict the nutritional risk of patients with esophageal cancer to some extent. PNI is an objective monitoring indicator, and PG-SGA is a subjective evaluation indicator, the combined use of which can more comprehensively reflect and predict the nutritional status of patients, and provide an important reference to the development of individualized nutrition support programs.

Citation： ZHOU Hong, XIE Qin, DENG Mingzhen, MIAO Yan, HAN Yongtao. Comparative study of prognostic nutritional index and patient-generated subjective global assessment in perioperative nutritional prediction in patients with esophageal cancer. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(4): 436-440. doi: 10.7507/1007-4848.201905056 Copy

1.	王耀鵬, 徐林浩, 王清, 等. 食管癌患者術后早期腸內營養的臨床研究. 中國胸心血管外科臨床雜志, 2006, 13(2): 94-96.
2.	余帥, 王志剛, 黃敏乾, 等. 食管癌手術后腸內營養與腸外營養對肝、腎功能及胃腸功能影響的對比研究. 中國胸心血管外科臨床雜志, 2014, 21(4): 498-502.
3.	孫志勇, 曹子昂, 葉清, 等. 術前運用 NRS2002 評估食管癌患者營養風險及臨床結局的研究. 中國胸心血管外科臨床雜志, 2015, 22(4): 323-326.
4.	黎介壽. 腫瘤營養學的興起及臨床應用. 腸外與腸內營養, 2004, 11(1): 1-2.
5.	Zhang L, Lu Y, Fang Y. Nutritional status and related factors of patients with advanced gastrointestinal cancer. Br J Nutr, 2014, 111(7): 1239-1244.
6.	中國營養學會. 國民營養計劃(2017-2030 年). 營養學報, 2017, 39(4): 315-320, 312.
7.	Huhmann MB, August DA. Review of American Society for Parenteral and Enteral Nutrition (ASPEN) clinical guidelines for nutrition support in cancer patients: nutrition screening and assessment. Nutr Clin Pract, 2008, 23(2): 182-188.
8.	Bauer J, Capra S, Ferguson M. Use of the scored Patient-Generated Subjective Global Assessment (PG-SGA) as a nutrition assessment tool in patients with cancer. Eur J Clin Nutr, 2002, 56(8): 779-785.
9.	CSCO 腫瘤營養治療專家委員會. 惡性腫瘤患者的營養治療專家共識. 臨床腫瘤學雜志, 2012, 17(1): 59-73.
10.	Buzby GP, Mullen JL, Matthews DC, et al. Prognostic nutritional index in gastrointestinal surgery. Am J Surg, 1980, 139(1): 160-167.
11.	Onodera T, Goseki N, Kosaki G. Prognostic nutritional index in gastrointestinal surgery of malnourished cancer patients. Nihon Geka Gakkai Zasshi, 1984, 85(9): 1001-1005.
12.	Borda F, Miranda C, Borda A, et al. Relation between preoperative prognostic Onodera's Index and postsurgery complications in the R0 gastric carcinoma resection. An Sist Sanit Navar, 2017, 40(1): 67-75.
13.	Ottery FD. Rethinking nutritional support of the cancer patient: the new field of nutritional oncology. Semin Oncol, 1994, 21(6): 770-778.
14.	Gabrielson DK, Scaffidi D, Leung E, et al. Use of an abridged scored Patient-Generated Subjective Global Assessment (abPG-SGA) as a nutritional screening tool for cancer patients in an outpatient setting. Nutr Cancer, 2013, 65(2): 234-239.
15.	侯雷, 呂曉峰, 趙恩宏. 早期腸內營養在腹腔鏡低位直腸癌術后患者中的應用效果及吻合口漏的影響因素分析. 解放軍預防醫學雜志, 2019, 37(3): 87-89.
16.	劉明勛, 朱青山. 食管癌 TNM 分期以外的預后因素分析. 實用醫藥雜志, 2014, 31(10): 897-900.
17.	d'Engremont C, Vernerey D, Pointet AL, et al. Additive value of pre-operative and one-month post-operative lymphocyte count for death-risk stratification in patients with resectable pancreatic cancer: a multicentric study. BMC Cancer, 2016, 16(1): 823.
18.	徐世斌, 徐美青, 孫效輝, 等. 預后營養指數與食管鱗癌患者術后并發癥和遠期預后的相關性研究. 中國腫瘤臨床, 2018, 45(15): 789-794.
19.	李美端, 張娟, 楊勝生, 等. 營養預后指數評估術前營養狀態對食管癌術后并發癥的預測價值. 臨床與病理雜志, 2018, 38(6): 1267-1273.
20.	方炎鑫, 張仁泉, 黃云龍, 等. 中性粒/淋巴細胞的比值和預后營養指數在食管鱗癌患者預后評估的應用. 安徽醫科大學學報, 2018, 53(8): 1294-1298.
21.	Matsumoto H, Okamoto Y, Kawai A, et al. Prognosis prediction for postoperative esophageal cancer patients using Onodera's prognostic nutritional index. Nutr Cancer, 2017, 69(6): 849-854.
22.	Okadome K, Baba Y, Yagi T, et al. Prognostic nutritional index, tumor-infiltrating lymphocytes, and prognosis in patients with esophageal cancer [published online ahead of print, 2018 Oct 10]. Ann Surg, 2018. doi:10.1097/SLA.0000000000002985.
23.	Gu WS, Fang WZ, Liu CY, et al. Prognostic significance of combined pretreatment body mass index (BMI) and BMI loss in patients with esophageal cancer. Cancer Manag Res, 2019, 11: 3029-3041.
24.	孫方園, 張蓓蕾, 張燕忠. 進展期胃癌患者前白蛋白水平與 PG-SGA 評分相關性分析. 腫瘤代謝與營養電子雜志, 2016, 3(3): 170-173.
25.	徐東平, 齊玉梅, 張明, 等. 胃癌患者術前 PG-SGA 評分與人體成分的相關性. 海南醫學, 2017, 28(16): 2622-2624.
26.	翟澤民. 消化道腫瘤患者術前 PG-SGA 評分與人體成分的相關性研究. 腫瘤代謝與營養電子雜志, 2016, 3(2): 114-117.
27.	黃道來, 吳向華, 陳俊強, 等. NRS 2002、PG-SGA、BMI、TF 在胃癌營養篩查與評估中的作用. 腫瘤代謝與營養電子雜志, 2017, 4(3): 317-321.

1. 王耀鵬, 徐林浩, 王清, 等. 食管癌患者術后早期腸內營養的臨床研究. 中國胸心血管外科臨床雜志, 2006, 13(2): 94-96.
2. 余帥, 王志剛, 黃敏乾, 等. 食管癌手術后腸內營養與腸外營養對肝、腎功能及胃腸功能影響的對比研究. 中國胸心血管外科臨床雜志, 2014, 21(4): 498-502.
3. 孫志勇, 曹子昂, 葉清, 等. 術前運用 NRS2002 評估食管癌患者營養風險及臨床結局的研究. 中國胸心血管外科臨床雜志, 2015, 22(4): 323-326.
4. 黎介壽. 腫瘤營養學的興起及臨床應用. 腸外與腸內營養, 2004, 11(1): 1-2.
5. Zhang L, Lu Y, Fang Y. Nutritional status and related factors of patients with advanced gastrointestinal cancer. Br J Nutr, 2014, 111(7): 1239-1244.
6. 中國營養學會. 國民營養計劃(2017-2030 年). 營養學報, 2017, 39(4): 315-320, 312.
7. Huhmann MB, August DA. Review of American Society for Parenteral and Enteral Nutrition (ASPEN) clinical guidelines for nutrition support in cancer patients: nutrition screening and assessment. Nutr Clin Pract, 2008, 23(2): 182-188.
8. Bauer J, Capra S, Ferguson M. Use of the scored Patient-Generated Subjective Global Assessment (PG-SGA) as a nutrition assessment tool in patients with cancer. Eur J Clin Nutr, 2002, 56(8): 779-785.
9. CSCO 腫瘤營養治療專家委員會. 惡性腫瘤患者的營養治療專家共識. 臨床腫瘤學雜志, 2012, 17(1): 59-73.
10. Buzby GP, Mullen JL, Matthews DC, et al. Prognostic nutritional index in gastrointestinal surgery. Am J Surg, 1980, 139(1): 160-167.
11. Onodera T, Goseki N, Kosaki G. Prognostic nutritional index in gastrointestinal surgery of malnourished cancer patients. Nihon Geka Gakkai Zasshi, 1984, 85(9): 1001-1005.
12. Borda F, Miranda C, Borda A, et al. Relation between preoperative prognostic Onodera's Index and postsurgery complications in the R0 gastric carcinoma resection. An Sist Sanit Navar, 2017, 40(1): 67-75.
13. Ottery FD. Rethinking nutritional support of the cancer patient: the new field of nutritional oncology. Semin Oncol, 1994, 21(6): 770-778.
14. Gabrielson DK, Scaffidi D, Leung E, et al. Use of an abridged scored Patient-Generated Subjective Global Assessment (abPG-SGA) as a nutritional screening tool for cancer patients in an outpatient setting. Nutr Cancer, 2013, 65(2): 234-239.
15. 侯雷, 呂曉峰, 趙恩宏. 早期腸內營養在腹腔鏡低位直腸癌術后患者中的應用效果及吻合口漏的影響因素分析. 解放軍預防醫學雜志, 2019, 37(3): 87-89.
16. 劉明勛, 朱青山. 食管癌 TNM 分期以外的預后因素分析. 實用醫藥雜志, 2014, 31(10): 897-900.
17. d'Engremont C, Vernerey D, Pointet AL, et al. Additive value of pre-operative and one-month post-operative lymphocyte count for death-risk stratification in patients with resectable pancreatic cancer: a multicentric study. BMC Cancer, 2016, 16(1): 823.
18. 徐世斌, 徐美青, 孫效輝, 等. 預后營養指數與食管鱗癌患者術后并發癥和遠期預后的相關性研究. 中國腫瘤臨床, 2018, 45(15): 789-794.
19. 李美端, 張娟, 楊勝生, 等. 營養預后指數評估術前營養狀態對食管癌術后并發癥的預測價值. 臨床與病理雜志, 2018, 38(6): 1267-1273.
20. 方炎鑫, 張仁泉, 黃云龍, 等. 中性粒/淋巴細胞的比值和預后營養指數在食管鱗癌患者預后評估的應用. 安徽醫科大學學報, 2018, 53(8): 1294-1298.
21. Matsumoto H, Okamoto Y, Kawai A, et al. Prognosis prediction for postoperative esophageal cancer patients using Onodera's prognostic nutritional index. Nutr Cancer, 2017, 69(6): 849-854.
22. Okadome K, Baba Y, Yagi T, et al. Prognostic nutritional index, tumor-infiltrating lymphocytes, and prognosis in patients with esophageal cancer [published online ahead of print, 2018 Oct 10]. Ann Surg, 2018. doi:10.1097/SLA.0000000000002985.
23. Gu WS, Fang WZ, Liu CY, et al. Prognostic significance of combined pretreatment body mass index (BMI) and BMI loss in patients with esophageal cancer. Cancer Manag Res, 2019, 11: 3029-3041.
24. 孫方園, 張蓓蕾, 張燕忠. 進展期胃癌患者前白蛋白水平與 PG-SGA 評分相關性分析. 腫瘤代謝與營養電子雜志, 2016, 3(3): 170-173.
25. 徐東平, 齊玉梅, 張明, 等. 胃癌患者術前 PG-SGA 評分與人體成分的相關性. 海南醫學, 2017, 28(16): 2622-2624.
26. 翟澤民. 消化道腫瘤患者術前 PG-SGA 評分與人體成分的相關性研究. 腫瘤代謝與營養電子雜志, 2016, 3(2): 114-117.
27. 黃道來, 吳向華, 陳俊強, 等. NRS 2002、PG-SGA、BMI、TF 在胃癌營養篩查與評估中的作用. 腫瘤代謝與營養電子雜志, 2017, 4(3): 317-321.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Comparative study of prognostic nutritional index and patient-generated subjective global assessment in perioperative nutritional prediction in patients with esophageal cancer

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