Top

Journal of Gastrointestinal Surgery

Published in:

01-10-2017 | Original Article

Postoperative Prognostic Nutritional Index Predicts Survival of Patients with Hepatocellular Carcinoma within Milan Criteria and Hypersplenism

Authors: Xiaoyun Zhang, Chuan Li, Tianfu Wen, Wei Peng, Lunan Yan, Jiayin Yang

Published in: Journal of Gastrointestinal Surgery | Issue 10/2017

Abstract

Background

To investigate the predictable value of postprognostic nutritional index (PNI) for patients who are suffering hepatocellular carcinoma (HCC) within Milan criteria and hypersplenism with well-preserved liver function after curative resection.

Methods

Patients were divided into two groups: group A (postoperative PNI < 53.05, n = 280) and group B (postoperative PNI ≥ 53.05, n = 109), according to cutoff value of receiver-operating characteristic curve. Clinical data, overall survival (OS), and disease-free survival (DFS) were statistically compared between the two groups, and a multivariate analysis was used to identify prognostic factors.

Results

The 1-, 3-, 5-, 7-, and 9-year OS of patients in group A were 93.3, 74.2, 53.6, 39.6, and 33.0%, respectively, and 98.9, 89.5, 79.7, 63.9, and 63.9%, respectively, for patients in group B (P = 0.001). The corresponding 1-, 3-, 5-, 7-, and 9-year DFS was 74.1, 51.1, 41.5, 30.1, 24.0, and 83.8, 64.6, 79.7, 54.0, and 49.9% for patients in the two groups, respectively (P = 0.009). Multivariable analysis revealed postoperative PNI as independent predictors of OS (P = 0.004) and DFS (P = 0.007) in patients with HCC within Milan criteria and hypersplenism after liver resection.

Conclusions

Postoperative PNI, not preoperative PNI, could predict survival of patients with HCC within Milan criteria and hypersplenism after surgical resection.

Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA: a cancer journal for clinicians. 2011;61(2):69–90. doi:10.3322/caac.20107.

Sugawara Y, Yamamoto J, Shimada K, Yamasaki S, Kosuge T, Takayama T et al. Splenectomy in patients with hepatocellular carcinoma and hypersplenism. Journal of the American College of Surgeons. 2000;190(4):446–50.CrossRefPubMed

Lau WY. Management of hepatocellular carcinoma. Journal of the Royal College of Surgeons of Edinburgh. 2002;47(1):389–99.PubMed

(2012) EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma. Journal of hepatology, 56(4):908–43. doi:10.1016/j.jhep.2011.12.001

Bruix J, Sherman M. Management of hepatocellular carcinoma: an update. Hepatology. 2011;53(3):1020–2. doi:10.1002/hep.24199.CrossRefPubMedPubMedCentral

Ishizawa T, Hasegawa K, Aoki T, Takahashi M, Inoue Y, Sano K et al. Neither multiple tumors nor portal hypertension are surgical contraindications for hepatocellular carcinoma. Gastroenterology. 2008;134(6):1908–16. doi:10.1053/j.gastro.2008.02.091.CrossRefPubMed

Wu CC, Cheng SB, Ho WM, Chen JT, Liu TJ, P’Eng F K. Liver resection for hepatocellular carcinoma in patients with cirrhosis. The British journal of surgery. 2005;92(3):348–55. doi:10.1002/bjs.4838.CrossRefPubMed

Chen XP, Wu ZD, Huang ZY, Qiu FZ. Use of hepatectomy and splenectomy to treat hepatocellular carcinoma with cirrhotic hypersplenism. The British journal of surgery. 2005;92(3):334–9. doi:10.1002/bjs.4776.CrossRefPubMed

Belli A, Cioffi L, Russo G, Belli G. Liver resection for hepatocellular carcinoma in patients with portal hypertension: the role of laparoscopy. Hepatobiliary surgery and nutrition. 2015;4(6):417–21. doi:10.3978/j.issn.2304-3881.2015.12.02.PubMedPubMedCentral

10.

Llovet JM, Fuster J, Bruix J. Intention-to-treat analysis of surgical treatment for early hepatocellular carcinoma: resection versus transplantation. Hepatology. 1999;30(6):1434–40. doi:10.1002/hep.510300629.CrossRefPubMed

11.

Onodera T, Goseki N, Kosaki G. [Prognostic nutritional index in gastrointestinal surgery of malnourished cancer patients]. Nihon Geka Gakkai zasshi. 1984;85(9):1001–5.PubMed

12.

Migita K, Takayama T, Saeki K, Matsumoto S, Wakatsuki K, Enomoto K et al. The prognostic nutritional index predicts long-term outcomes of gastric cancer patients independent of tumor stage. Annals of surgical oncology. 2013;20(8):2647–54. doi:10.1245/s10434-013-2926-5.CrossRefPubMed

13.

Feng JF, Chen QX. Significance of the prognostic nutritional index in patients with esophageal squamous cell carcinoma. Therapeutics and clinical risk management. 2014;10:1–7. doi:10.2147/TCRM.S56159.PubMed

14.

Nozoe T, Kohno M, Iguchi T, Mori E, Maeda T, Matsukuma A et al. The prognostic nutritional index can be a prognostic indicator in colorectal carcinoma. Surgery today. 2012;42(6):532–5. doi:10.1007/s00595-011-0061-0.CrossRefPubMed

15.

Kanda M, Fujii T, Kodera Y, Nagai S, Takeda S, Nakao A. Nutritional predictors of postoperative outcome in pancreatic cancer. The British journal of surgery. 2011;98(2):268–74. doi:10.1002/bjs.7305.CrossRefPubMed

16.

Pinato DJ, North BV, Sharma R. A novel, externally validated inflammation-based prognostic algorithm in hepatocellular carcinoma: the prognostic nutritional index (PNI). British journal of cancer. 2012;106(8):1439–45. doi:10.1038/bjc.2012.92.CrossRefPubMedPubMedCentral

17.

Kinoshita A, Onoda H, Imai N, Iwaku A, Oishi M, Fushiya N et al. Comparison of the prognostic value of inflammation-based prognostic scores in patients with hepatocellular carcinoma. British journal of cancer. 2012;107(6):988–93. doi:10.1038/bjc.2012.354.CrossRefPubMedPubMedCentral

18.

Nozoe T, Ninomiya M, Maeda T, Matsukuma A, Nakashima H, Ezaki T. Prognostic nutritional index: a tool to predict the biological aggressiveness of gastric carcinoma. Surgery today. 2010;40(5):440–3. doi:10.1007/s00595-009-4065-y.CrossRefPubMed

19.

Esper DH, Harb WA. The cancer cachexia syndrome: a review of metabolic and clinical manifestations. Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition. 2005;20(4):369–76.CrossRef

20.

McMillan DC (2008) An inflammation-based prognostic score and its role in the nutrition-based management of patients with cancer. The Proceedings of the Nutrition Society, 67(3):257–62. doi:10.1017/S0029665108007131 CrossRefPubMed

21.

Forrest LM, McMillan DC, McArdle CS, Angerson WJ, Dunlop DJ. Evaluation of cumulative prognostic scores based on the systemic inflammatory response in patients with inoperable non-small-cell lung cancer. British journal of cancer. 2003;89(6):1028–30. doi:10.1038/sj.bjc.6601242.CrossRefPubMedPubMedCentral

22.

Ishizuka M, Kubota K, Kita J, Shimoda M, Kato M, Sawada T. Impact of an inflammation-based prognostic system on patients undergoing surgery for hepatocellular carcinoma: a retrospective study of 398 Japanese patients. Am J Surg. 2012;203(1):101–6. doi:10.1016/j.amjsurg.2010.09.030.CrossRefPubMed

23.

Shankaran V, Ikeda H, Bruce AT, White JM, Swanson PE, Old LJ et al. IFNgamma and lymphocytes prevent primary tumour development and shape tumour immunogenicity. Nature. 2001;410(6832):1107–11. doi:10.1038/35074122.CrossRefPubMed

24.

Dunn GP, Old LJ, Schreiber RD. The immunobiology of cancer immunosurveillance and immunoediting. Immunity. 2004;21(2):137–48. doi:10.1016/j.immuni.2004.07.017.CrossRefPubMed

25.

Yamamura K, Sugimoto H, Kanda M, Yamada S, Nomoto S, Nakayama G et al. Comparison of inflammation-based prognostic scores as predictors of tumor recurrence in patients with hepatocellular carcinoma after curative resection. Journal of hepato-biliary-pancreatic sciences. 2014;21(9):682–8. doi:10.1002/jhbp.114.CrossRefPubMed

26.

Chen TM, Lin CC, Huang PT, Wen CF. Neutrophil-to-lymphocyte ratio associated with mortality in early hepatocellular carcinoma patients after radiofrequency ablation. Journal of gastroenterology and hepatology. 2012;27(3):553–61. doi:10.1111/j.1440-1746.2011.06910.x.CrossRefPubMed

27.

Dan J, Zhang Y, Peng Z, Huang J, Gao H, Xu L et al. Postoperative neutrophil-to-lymphocyte ratio change predicts survival of patients with small hepatocellular carcinoma undergoing radiofrequency ablation. Plos One. 2013;8(3):e58184. doi:10.1371/journal.pone.0058184.CrossRefPubMedPubMedCentral

28.

Peng W, Li C, Wen TF, Yan LN, Li B, Wang WT et al. Neutrophil to lymphocyte ratio changes predict small hepatocellular carcinoma survival. The Journal of surgical research. 2014;192(2):402–8. doi:10.1016/j.jss.2014.05.078.CrossRefPubMed

29.

Jasnis MA, Eljan AM, Oisgold-Daga S. Regulation of tumor growth by soluble spleen factors: effect of tumor resection. Journal of surgical oncology. 1987;35(2):139–45.CrossRefPubMed

30.

Poon RT, Fan ST, Lo CM, Ng IO, Liu CL, Lam CM et al. Improving survival results after resection of hepatocellular carcinoma: a prospective study of 377 patients over 10 years. Ann Surg. 2001;234(1):63–70.CrossRefPubMedPubMedCentral

31.

Dimick JB, Cowan JA, Jr., Knol JA, Upchurch GR, Jr. Hepatic resection in the United States: indications, outcomes, and hospital procedural volumes from a nationally representative database. Arch Surg. 2003;138(2):185–91.CrossRefPubMed

32.

Zhang XY, Li C, Wen TF, Yan LN, Li B, Yang JY et al. Synchronous splenectomy and hepatectomy for patients with hepatocellular carcinoma and hypersplenism: A case-control study. World journal of gastroenterology. 2015;21(8):2358–66. doi:10.3748/wjg.v21.i8.2358.CrossRefPubMedPubMedCentral

Title: Postoperative Prognostic Nutritional Index Predicts Survival of Patients with Hepatocellular Carcinoma within Milan Criteria and Hypersplenism
Authors: Xiaoyun Zhang
Chuan Li
Tianfu Wen
Wei Peng
Lunan Yan
Jiayin Yang
Publication date: 01-10-2017
Publisher: Springer US
Published in: Journal of Gastrointestinal Surgery / Issue 10/2017
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-017-3414-1

At a glance: The STEP trials

Springer Medicine

Postoperative Prognostic Nutritional Index Predicts Survival of Patients with Hepatocellular Carcinoma within Milan Criteria and Hypersplenism

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 10/2017

A Twist in the Tale

The Primary Result of Prospective Randomized Multicenter Trial of New Spray-Type Bio-absorbable Adhesion Barrier System (TCD-11091) Against Postoperative Adhesion Formation

Acute Cholangitis After Bilioenteric Anastomosis for Bile Duct Injuries

Delayed Gastric Emptying in Side-to-Side Gastrojejunostomy in Pancreaticoduodenectomy: Result of a Propensity Score Matching

Chemoradiation and Local Excision for T2N0 Rectal Cancer Offers Equivalent Overall Survival Compared to Standard Resection: a National Cancer Database Analysis

Multiple Bile Duct Hamartomas