Low Prognostic Nutritional Index Is Common and Associated with Poor Outcomes following Curative-Intent Resection for Gastro-Entero-Pancreatic Neuroendocrine Tumors.

IF 2.8 2区医学 Q2 ENDOCRINOLOGY & METABOLISM

Neuroendocrinology Pub Date : 2024-01-01 Epub Date: 2023-09-13 DOI:10.1159/000534075

Jun-Xi Xiang, Ye-Rong Qian, Jin He, Alexandra G Lopez-Aguiar, George Poultsides, Flavio Rocha, Sharon Weber, Ryan Fields, Kamran Idrees, Cliff Cho, Shishir K Maithel, Yi Lv, Xu-Feng Zhang, Timothy M Pawlik

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引用次数: 0

Abstract

Introduction: To investigate the impact of prognostic nutritional index (PNI) on short- and long-term outcomes of patients who underwent curative-intent resection for gastro-entero-pancreatic neuroendocrine tumors (GEP-NETs).

Methods: Patients with GET-NETs who underwent curative-intent resection were identified from a multi-center database. The prognostic impact of clinicopathological factors including PNI on post-operative outcomes were evaluated. A novel nomogram was developed and externally validated.

Results: A total of 2,099 patients with GEP-NETs were included in the training cohort; 255 patients were in the external validation cohort. Median PNI (n = 973) was 47.4 (IQR 43.1-52.4). At the time of presentation, 1,299 (61.9%) patients presented with some type of clinical symptom. Low-PNI (≤42.2) was associated with gastrointestinal symptoms, as well as nodal metastasis and distant metastasis (all p < 0.05). Patients with a low PNI had a higher incidence of severe (≥Clavien-Dindo grade IIIa: low PNI 24.9% vs. high PNI 15.4%, p = 0.001) and multiple (≥3 types of complications: low PNI 14.5% vs. high PNI 9.2%, p = 0.024) complications, as well as a worse overall survival (OS)(5-year OS, low PNI 73.7% vs. high PNI 88.5%, p < 0.001), and RFS (5-year RFS, low PNI 68.5% vs. high PNI 79.8%, p = 0.008) versus patients with high PNI (>42.2). A nomogram based on PNI, tumor grade and metastatic disease demonstrated excellent discrimination and calibration to predict OS in both the training (C-index 0.748) and two external validation (C-index 0.827, 0.745) cohorts.

Conclusions: Low PNI was common and associated with worse short- and long-term outcomes among patients with GEP-NETs.

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低预后营养指数是胃肠胰神经内分泌肿瘤根治性切除术后常见的不良预后因素。

简介研究预后营养指数（PNI）对接受胃肠胰神经内分泌肿瘤（GEP-NETs）根治性切除术患者短期和长期预后的影响：方法：从多中心数据库中筛选出接受根治性切除术的GET-NET患者。评估了包括 PNI 在内的临床病理因素对术后预后的影响。结果显示，共有 2,099 名患者接受了治疗：共有 2,099 名 GEP-NET 患者被纳入训练队列；255 名患者被纳入外部验证队列。中位 PNI（n = 973）为 47.4（IQR 43.1-52.4）。发病时，1299 名患者（61.9%）出现了某种临床症状。低 PNI（≤42.2）与胃肠道症状以及结节转移和远处转移有关（所有 p < 0.05）。低 PNI 患者出现严重（≥Clavien-Dindo IIIa 级：低 PNI 24.9% vs. 高 PNI 15.4%，p = 0.001）和多种（≥3 种并发症：低 PNI 14.5% vs. 高 PNI 9.2%，p = 0.024）并发症，以及总生存期（OS）（5 年 OS，低 PNI 73.7% vs. 高 PNI 88.5%，p <0.001）和 RFS（5 年 RFS，低 PNI 68.5% vs. 高 PNI 79.8%，p = 0.008）较高 PNI（>42.2）患者差。基于PNI、肿瘤分级和转移性疾病的提名图在训练队列（C-index 0.748）和两个外部验证队列（C-index 0.827，0.745）中都显示出预测OS的极佳区分度和校准性：结论：低PNI在GEP-NET患者中很常见，并与较差的短期和长期预后相关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Neuroendocrinology 医学-内分泌学与代谢

CiteScore

8.30

自引率

2.40%

发文量

审稿时长

6-12 weeks

期刊介绍： ''Neuroendocrinology'' publishes papers reporting original research in basic and clinical neuroendocrinology. The journal explores the complex interactions between neuronal networks and endocrine glands (in some instances also immunecells) in both central and peripheral nervous systems. Original contributions cover all aspects of the field, from molecular and cellular neuroendocrinology, physiology, pharmacology, and the neuroanatomy of neuroendocrine systems to neuroendocrine correlates of behaviour, clinical neuroendocrinology and neuroendocrine cancers. Readers also benefit from reviews by noted experts, which highlight especially active areas of current research, and special focus editions of topical interest.