Prognostic immune nutritional index-based nutritional stratification enhances recovery and survival in gastric cancer: A randomized controlled trial.

IF 3.2 Q3 ONCOLOGY

World journal of clinical oncology Pub Date : 2025-09-24 DOI:10.5306/wjco.v16.i9.110068

Gang Wang, Sheng-Jie Pan

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Abstract

Background: Postoperative malnutrition, systemic inflammation, and immune dysfunction significantly impair recovery and survival in gastric cancer patients undergoing radical gastrectomy. The Prognostic Immune Nutritional Index (PINI) enables immune-nutritional risk stratification; however, its utility in guiding perioperative nutritional support remains underexplored.

Aim: To evaluate whether risk-stratified perioperative nutritional support based on PINI scores improves postoperative recovery, quality of life, and long-term outcomes in gastric cancer patients.

Methods: In this prospective, randomized controlled trial, 195 patients undergoing radical gastrectomy were stratified into low- (PINI ≤ 1.5), moderate- (1.5 < PINI ≤ 3), and high-risk (PINI > 3) groups. Patients received standard, intensive, or immune-enhancing nutritional support, respectively. Outcomes were assessed at 1 week, 1 month, and 1 year postoperatively and included body mass index (BMI), serum albumin, PINI scores, Pittsburgh Sleep Quality Index (PSQI), Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS), Visual Analog Scale (VAS) for pain, EORTC QLQ-C30 for quality of life, complication rates, hospital stay, and survival.

Results: At 1 year, the high-risk group receiving immune-enhancing nutrition demonstrated the greatest improvements, with higher serum albumin (47.5 ± 3.8 g/L) and stabilized BMI (+0.1 ± 0.2 kg/m² vs -0.2 ± 0.2 kg/m² in the low-risk group, P < 0.01). Sleep quality (ΔPSQI: -8.5 ± 2.7), anxiety (ΔSAS: -12.9 ± 3.1), and depression (ΔSDS: -12.6 ± 4.2) improved significantly (all P < 0.01). Pain scores were lowest (VAS: 2.1 ± 1.3), and quality of life was highest (78.2 ± 8.0, P < 0.01). The high-risk group also had the lowest complication rate (3.3%), shortest hospital stay (9.8 ± 2.4 days), and highest 1-year survival (98.5%, P < 0.05).

Conclusion: PINI-based graded nutritional support significantly enhances postoperative recovery, reduces complications, and improves long-term outcomes following radical gastrectomy. These findings support its integration into precision perioperative care strategies for gastric cancer.

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基于预后免疫营养指数的营养分层提高胃癌的恢复和生存：一项随机对照试验。

背景：胃癌根治术患者术后营养不良、全身炎症和免疫功能障碍显著影响恢复和生存。预后免疫营养指数（PINI）使免疫营养风险分层；然而，它在指导围手术期营养支持方面的应用仍未得到充分探讨。目的：评估基于PINI评分的风险分层围手术期营养支持是否能改善胃癌患者的术后恢复、生活质量和长期预后。方法：在这项前瞻性、随机对照试验中，195例接受根治性胃切除术的患者被分为低（PINI≤1.5）、中（1.5 < PINI≤3）和高风险（PINI bb0 3）组。患者分别接受标准、强化或增强免疫的营养支持。在术后1周、1个月和1年评估结果，包括体重指数（BMI）、血清白蛋白、PINI评分、匹兹堡睡眠质量指数（PSQI）、焦虑自评量表（SAS）、抑郁自评量表（SDS）、疼痛视觉模拟量表（VAS）、生活质量EORTC QLQ-C30、并发症发生率、住院时间和生存率。结果：1年时，接受免疫增强营养的高危组改善最大，血清白蛋白升高（47.5±3.8 g/L）， BMI稳定（低危组+0.1±0.2 kg/m2 vs -0.2±0.2 kg/m2, P < 0.01）。睡眠质量（ΔPSQI: -8.5±2.7）、焦虑（ΔSAS: -12.9±3.1）、抑郁（ΔSDS: -12.6±4.2）均显著改善（P均< 0.01）。疼痛评分最低（VAS: 2.1±1.3），生活质量评分最高（78.2±8.0,P < 0.01）。高危组并发症发生率最低（3.3%），住院时间最短（9.8±2.4 d）， 1年生存率最高（98.5%,P < 0.05）。结论：基于pinii的分级营养支持可显著提高胃癌根治术术后恢复，减少并发症，改善远期预后。这些发现支持将其整合到胃癌的精确围手术期护理策略中。

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

World journal of clinical oncology ONCOLOGY-

自引率

0.00%

发文量

585

期刊介绍： The WJCO is a high-quality, peer reviewed, open-access journal. The primary task of WJCO is to rapidly publish high-quality original articles, reviews, editorials, and case reports in the field of oncology. In order to promote productive academic communication, the peer review process for the WJCO is transparent; to this end, all published manuscripts are accompanied by the anonymized reviewers’ comments as well as the authors’ responses. The primary aims of the WJCO are to improve diagnostic, therapeutic and preventive modalities and the skills of clinicians and to guide clinical practice in oncology. Scope: Art of Oncology, Biology of Neoplasia, Breast Cancer, Cancer Prevention and Control, Cancer-Related Complications, Diagnosis in Oncology, Gastrointestinal Cancer, Genetic Testing For Cancer, Gynecologic Cancer, Head and Neck Cancer, Hematologic Malignancy, Lung Cancer, Melanoma, Molecular Oncology, Neurooncology, Palliative and Supportive Care, Pediatric Oncology, Surgical Oncology, Translational Oncology, and Urologic Oncology.