title: Prognostic Nutritional Index Predicts Severe Complications, Recurrence, and Poor Prognosis in Patients With Colorectal Cancer Undergoing Primary Tumor Resection.
abstract: BACKGROUND
  The prognostic nutritional index is reportedly related to postoperative outcomes.
  
  
  OBJECTIVE
  The aim of this study was to elucidate the clinical importance of the prognostic nutritional index in patients with colorectal cancer who were undergoing primary tumor resection.
  
  
  METHODS
  This is a retrospective study from a single institution.
  
  
  METHODS
  This study was conducted at a colorectal surgery service in an academic teaching hospital.
  
  
  METHODS
  The 556 patients with colorectal cancer who were undergoing surgery between March 2005 and August 2014 were eligible for this study.
  
  
  METHODS
  The preoperative prognostic nutritional index was calculated. Classification and regression tree analysis was performed to determine the prognostic nutritional index cutoff value. The associations of the prognostic nutritional index status with clinicopathological factors and postoperative outcomes were examined using univariate and multivariate analyses.
  
  
  RESULTS
  Classification and regression tree analysis demonstrated that 45.5 was the optimal cutoff value. The low status (≤45.5) was correlated with older age, low BMI, low estimated glomerular filtration rate, CEA positivity, carbohydrate antigen 19-9 positivity, preoperative chemotherapy, tumors invading muscular or deeper layers, distant metastasis, poor differentiation, severe postoperative complications, tumor recurrence, and poor survival. In multivariate analysis, the low status was an independent risk factor for severe postoperative complications (OR = 2.06 [95% CI, 1.22-3.50]; p = 0.007) and low overall survival (HR =3.98 [95% CI, 2.38-6.89]; p < 0.001).
  
  
  CONCLUSIONS
  Our data set was collected retrospectively from a single institution. In addition, our study was only for preoperative prognostic nutritional index status, not considering the postoperative host status.
  
  
  CONCLUSIONS
  The preoperative prognostic nutritional index predicts severe complications, recurrence, and poor prognosis in patients with colorectal cancer who are undergoing primary tumor resection. Investigation of the nutritional and immunologic statuses using the prognostic nutritional index could be a useful clinical approach.
authors.affiliation: 1 Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan 2 Department of Surgery and Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan 3 Department of Gastroenterological Surgery, Japanese Foundation for Cancer Research, Tokyo, Japan.
authors.forename: Ryuma
authors.initials: R
authors.lastname: Tokunaga
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Sakamoto
authors.forename: Shigeki
authors.initials: S
authors.lastname: Nakagawa
authors.forename: Yuji
authors.initials: Y
authors.lastname: Miyamoto
authors.forename: Naoya
authors.initials: N
authors.lastname: Yoshida
authors.forename: Eiji
authors.initials: E
authors.lastname: Oki
authors.forename: Masayuki
authors.initials: M
authors.lastname: Watanabe
authors.forename: Hideo
authors.initials: H
authors.lastname: Baba
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D018395:CA-19-9 Antigen / Q000097:blood; D002272:Carcinoembryonic Antigen / Q000097:blood; D015331:Cohort Studies; D003082:Colectomy; D015179:Colorectal Neoplasms / Q000097:blood / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D005260:Female; D005919:Glomerular Filtration Rate; D006784:Hospitals, Teaching; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D044342:Malnutrition / Q000453:epidemiology*; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D015596:Nutrition Assessment; D011183:Postoperative Complications / Q000453:epidemiology*; D011379:Prognosis; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D012709:Serum Albumin; D012720:Severity of Illness Index; D013851:Thinness / Q000453:epidemiology; D055815:Young Adult
chemical_list: D018395:CA-19-9 Antigen; D002272:Carcinoembryonic Antigen; D012709:Serum Albumin