Value of a nomogram based on nutritional risk and sarcopenia on predicting postoperative complications in elderly patients with gastric cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZHANG Caihua ¹ , LIU Pengpeng ² ,  GONG Longbo ¹ , LIN Hao ¹

1. Department of Gastrointestinal Surgery, Xuzhou Central Hospital, Xuzhou, Jiangsu 221009, P. R. China;
2. Department of Hepatobiliary Surgery, Xuzhou Central Hospital, Xuzhou, Jiangsu 221009, P. R. China;

Corresponding author：

GONG Longbo, Email: glbdoc2000@163.com

Keywords：

gastric cancer; geriatric nutritional risk index; sarcopenia; complications; nomogram

DOI：

10.7507/1007-9424.202212009

Video：

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Objective To explore the value of geriatric nutritional risk index (GNRI) and sarcopenia on predicting postoperative complications in elderly patients with gastric cancer. Methods According to the inclusion and exclusion criteria, the elderly (aged ≥60 years) patients with gastric cancer underwent radical gastrectomy in the Department of Gastrointestinal Surgery of Xuzhou Central Hospital from January 1, 2017 to December 31, 2021 were retrospectively gathered. The occurrence of postoperative complications (grade 2 or beyond by the Clavien-Dindo classification) was analyzed. The risk factors affecting postoperative complications were analyzed by univariate and multivariate logistic regression analyses to construct the prediction model, then was visualized by drawing a nomogram. The differentiation of the nomogram between the patients with postoperative complications and without postoperative complications was evaluated by the receiver operating characteristic (ROC) curve. The accuracy of the nomogram was evaluated by the calibration curve. Further, the clinical net benefit rate was analyzed by the decision curve analysis (DCA) to evaluate the clinical practicability. Results A total of 236 patients were gathered, 97 (41.1%) of whom had postoperative complications during hospitalization. The results of multivariate logistic regression analysis showed that the age, gender, GNRI, sarcopenia, surgical mode, and American Society of Aneshesiologists classification were the factors influencing the postoperative complications (P<0.05). The differentiation of nomogram based on the influencing factors was well, the area under the ROC curve was 0.732. The calibration curve showed that the model prediction curve was close to the ideal curve. The clinical net benefit rate by the DCA was higher when the probability of postoperative complications was 0.18 to 0.72. Conclusions The efficiency of nomogram based on GNRI and sarcopenia is well for predicting the occurrence of postoperative complications in elderly patients with gastric cancer. However, the nomogram needs to be further validated by prospective studies and external data.

Citation： ZHANG Caihua, LIU Pengpeng, GONG Longbo, LIN Hao. Value of a nomogram based on nutritional risk and sarcopenia on predicting postoperative complications in elderly patients with gastric cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2023, 30(4): 431-436. doi: 10.7507/1007-9424.202212009 Copy

1.	Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
2.	Lidoriki I, Schizas D, Mylonas KS, et al. Postoperative changes in nutritional and functional status of gastroesophageal cancer patients. J Am Nutr Assoc, 2022, 41(3): 301-309.
3.	李文成, 张帆, 牛励, 等. GLIM在胃癌病人营养不良诊断和预后评估中的价值研究及生存预测列线图模型的构建. 肠外与肠内营养, 2021, 28(6): 324-331.
4.	Zhang L, Wang S, Gao X, et al. Poor pre-operative nutritional status is a risk factor of post-operative infections in patients with gastrointestinal cancer—A multicenter prospective cohort study. Front Nutr, 2022, 9: 850063. doi: 10.3389/fnut.2022.850063.
5.	韩东, 贺军, 黄秋林. 三种术前营养评价方法对消化道恶性肿瘤患者术后并发症预测价值比较. 中华胃肠外科杂志, 2013, 16(11): 1067-1072.
6.	张丹, 景文江, 张淑莲, 等. GNRI对老年消化道肿瘤患者术后并发症和生存的预测价值研究. 河北医科大学学报, 2022, 43(10): 1142-1146, 1152.
7.	吴寒寒, 蒋建华, 程靖, 等. 老年营养风险指数与老年胃癌患者围手术期康复的关系. 安徽医科大学学报, 2022, 57(11): 1816-1820.
8.	Rosenberg IH. Summary comments. Am J Clin Nutr, 1989, 50(5): 1231-1233.
9.	陶平, 潘超. 肌少症对老年胃癌病人术前评估与术后并发症的影响. 实用老年医学, 2021, 35(1): 49-51, 56.
10.	肖海燕, 刘婷, 李岱, 等. 胃癌合并肌少症的研究进展. 中国普通外科杂志, 2022, 31(8): 1121-1128.
11.	郑志芳. 一个全新的基于术前肌少症的预后评分系统预测胃癌R0切除术后的远期疗效. 福州: 福建医科大学, 2019.
12.	Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6 336 patients and results of a survey. Ann Surg, 2004, 240(2): 205-213.
13.	Hirahara N, Tajima Y, Fujii Y, et al. Prediction of postoperative complications and survival after laparoscopic gastrectomy using preoperative Geriatric Nutritional Risk Index in elderly gastric cancer patients. Surg Endosc, 2021, 35(3): 1202-1209.
14.	Teigen LM, Kuchnia AJ, Nagel E, et al. Impact of software selection and image J tutorial corrigendum on skeletal muscle measures at the third lumbar vertebra on computed tomography scans in clinical populations. JPEN J Parenter Enteral Nutr, 2018, 42(5): 933-941.
15.	Su H, Ruan J, Chen T, et al. CT-assessed sarcopenia is a predictive factor for both long-term and short-term outcomes in gastrointestinal oncology patients: a systematic review and meta-analysis. Cancer Imaging, 2019, 19(1): 82. doi: 10.1186/s40644-019-0270-0.
16.	Marcoulides KM, Raykov T. Evaluation of variance inflation factors in regression models using latent variable modeling methods. Educ Psychol Meas, 2019, 79(5): 874-882.
17.	Kobayashi D, Ishigure K, Mochizuki Y, et al. Multi-institutional prospective feasibility study to explore tolerability and efficacy of oral nutritional supplements for patients with gastric cancer undergoing gastrectomy (CCOG1301). Gastric Cancer, 2017, 20(4): 718-727.
18.	张星霞, 胡艳杰, 李卡. 肠内联合肠外与单纯肠内营养支持在胃癌术后患者中应用效果的Meta分析. 中国循证医学杂志, 2022, 22(1): 60-66.
19.	Nelen SD, Bosscha K, Lemmens VEPP, et al. Morbidity and mortality according to age following gastrectomy for gastric cancer. Br J Surg, 2018, 105(9): 1163-1170.
20.	Shibata C, Ogawa H, Nakano T, et al. Influence of age on postoperative complications especially pneumonia after gastrectomy for gastric cancer. BMC Surg, 2019, 19(1): 106. doi: 10.1186/s12893-019-0573-x.
21.	赵建刚. 80岁及以上高龄胃癌外科手术治疗分析. 杭州: 浙江大学, 2016.
22.	Nishibeppu K, Sakuramoto S, Matsui K, et al. Dismal prognosis of elderly gastric cancer patients who underwent gastrectomy with American Society of Anesthesiologists (ASA) 3. Langenbecks Arch Surg, 2022, 407(8): 3413-3421.
23.	李新星, 胡志前. 腹腔镜和机器人在胃癌微创手术中的发展. 外科研究与新技术, 2021, 10(3): 157-161.
24.	方振. 术前骨骼肌状态对胃癌术后并发症的影响. 济南: 山东大学, 2020.
25.	吴国豪, 谈善军. 胃肠外科病人围手术期全程营养管理中国专家共识(2021版). 中国实用外科杂志, 2021, 41(10): 1111-1125.
26.	李向阳, 李凡, 张树泽, 等. 肿瘤相关性肌少症研究进展. 解放军医学杂志, 2022, 47(7): 739-744.
27.	Yang Z, Zhou X, Ma B, et al. Predictive value of preoperative sarcopenia in patients with gastric cancer: a meta-analysis and systematic review. J Gastrointest Surg, 2018, 22(11): 1890-1902.
28.	邹红波, 余鼎业, 严夏霖, 等. 基于CT的肌肉质量对伴有营养风险的老年胃癌病人临床预后的影响. 肠外与肠内营养, 2021, 28(3): 129-134.
29.	Cruz-Jentoft AJ, Bahat G, Bauer J, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing, 2019, 48(1): 16-31.
30.	Chen LK, Woo J, Assantachai P, et al. Asian Working Group for sarcopenia: 2019 consensus update on sarcopenia diagnosis and treatment. J Am Med Dir Assoc, 2020, 21(3): 300-307.
31.	International Working Group on Sarcopenia. Sarcopenia: an undiagnosed condition in older adults. Current consensus definition: prevalence, etiology, and consequences. J Am Med Dir Assoc, 2011, 12(4): 249-256.

1. Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
2. Lidoriki I, Schizas D, Mylonas KS, et al. Postoperative changes in nutritional and functional status of gastroesophageal cancer patients. J Am Nutr Assoc, 2022, 41(3): 301-309.
3. 李文成, 张帆, 牛励, 等. GLIM在胃癌病人营养不良诊断和预后评估中的价值研究及生存预测列线图模型的构建. 肠外与肠内营养, 2021, 28(6): 324-331.
4. Zhang L, Wang S, Gao X, et al. Poor pre-operative nutritional status is a risk factor of post-operative infections in patients with gastrointestinal cancer—A multicenter prospective cohort study. Front Nutr, 2022, 9: 850063. doi: 10.3389/fnut.2022.850063.
5. 韩东, 贺军, 黄秋林. 三种术前营养评价方法对消化道恶性肿瘤患者术后并发症预测价值比较. 中华胃肠外科杂志, 2013, 16(11): 1067-1072.
6. 张丹, 景文江, 张淑莲, 等. GNRI对老年消化道肿瘤患者术后并发症和生存的预测价值研究. 河北医科大学学报, 2022, 43(10): 1142-1146, 1152.
7. 吴寒寒, 蒋建华, 程靖, 等. 老年营养风险指数与老年胃癌患者围手术期康复的关系. 安徽医科大学学报, 2022, 57(11): 1816-1820.
8. Rosenberg IH. Summary comments. Am J Clin Nutr, 1989, 50(5): 1231-1233.
9. 陶平, 潘超. 肌少症对老年胃癌病人术前评估与术后并发症的影响. 实用老年医学, 2021, 35(1): 49-51, 56.
10. 肖海燕, 刘婷, 李岱, 等. 胃癌合并肌少症的研究进展. 中国普通外科杂志, 2022, 31(8): 1121-1128.
11. 郑志芳. 一个全新的基于术前肌少症的预后评分系统预测胃癌R0切除术后的远期疗效. 福州: 福建医科大学, 2019.
12. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6 336 patients and results of a survey. Ann Surg, 2004, 240(2): 205-213.
13. Hirahara N, Tajima Y, Fujii Y, et al. Prediction of postoperative complications and survival after laparoscopic gastrectomy using preoperative Geriatric Nutritional Risk Index in elderly gastric cancer patients. Surg Endosc, 2021, 35(3): 1202-1209.
14. Teigen LM, Kuchnia AJ, Nagel E, et al. Impact of software selection and image J tutorial corrigendum on skeletal muscle measures at the third lumbar vertebra on computed tomography scans in clinical populations. JPEN J Parenter Enteral Nutr, 2018, 42(5): 933-941.
15. Su H, Ruan J, Chen T, et al. CT-assessed sarcopenia is a predictive factor for both long-term and short-term outcomes in gastrointestinal oncology patients: a systematic review and meta-analysis. Cancer Imaging, 2019, 19(1): 82. doi: 10.1186/s40644-019-0270-0.
16. Marcoulides KM, Raykov T. Evaluation of variance inflation factors in regression models using latent variable modeling methods. Educ Psychol Meas, 2019, 79(5): 874-882.
17. Kobayashi D, Ishigure K, Mochizuki Y, et al. Multi-institutional prospective feasibility study to explore tolerability and efficacy of oral nutritional supplements for patients with gastric cancer undergoing gastrectomy (CCOG1301). Gastric Cancer, 2017, 20(4): 718-727.
18. 张星霞, 胡艳杰, 李卡. 肠内联合肠外与单纯肠内营养支持在胃癌术后患者中应用效果的Meta分析. 中国循证医学杂志, 2022, 22(1): 60-66.
19. Nelen SD, Bosscha K, Lemmens VEPP, et al. Morbidity and mortality according to age following gastrectomy for gastric cancer. Br J Surg, 2018, 105(9): 1163-1170.
20. Shibata C, Ogawa H, Nakano T, et al. Influence of age on postoperative complications especially pneumonia after gastrectomy for gastric cancer. BMC Surg, 2019, 19(1): 106. doi: 10.1186/s12893-019-0573-x.
21. 赵建刚. 80岁及以上高龄胃癌外科手术治疗分析. 杭州: 浙江大学, 2016.
22. Nishibeppu K, Sakuramoto S, Matsui K, et al. Dismal prognosis of elderly gastric cancer patients who underwent gastrectomy with American Society of Anesthesiologists (ASA) 3. Langenbecks Arch Surg, 2022, 407(8): 3413-3421.
23. 李新星, 胡志前. 腹腔镜和机器人在胃癌微创手术中的发展. 外科研究与新技术, 2021, 10(3): 157-161.
24. 方振. 术前骨骼肌状态对胃癌术后并发症的影响. 济南: 山东大学, 2020.
25. 吴国豪, 谈善军. 胃肠外科病人围手术期全程营养管理中国专家共识(2021版). 中国实用外科杂志, 2021, 41(10): 1111-1125.
26. 李向阳, 李凡, 张树泽, 等. 肿瘤相关性肌少症研究进展. 解放军医学杂志, 2022, 47(7): 739-744.
27. Yang Z, Zhou X, Ma B, et al. Predictive value of preoperative sarcopenia in patients with gastric cancer: a meta-analysis and systematic review. J Gastrointest Surg, 2018, 22(11): 1890-1902.
28. 邹红波, 余鼎业, 严夏霖, 等. 基于CT的肌肉质量对伴有营养风险的老年胃癌病人临床预后的影响. 肠外与肠内营养, 2021, 28(3): 129-134.
29. Cruz-Jentoft AJ, Bahat G, Bauer J, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing, 2019, 48(1): 16-31.
30. Chen LK, Woo J, Assantachai P, et al. Asian Working Group for sarcopenia: 2019 consensus update on sarcopenia diagnosis and treatment. J Am Med Dir Assoc, 2020, 21(3): 300-307.
31. International Working Group on Sarcopenia. Sarcopenia: an undiagnosed condition in older adults. Current consensus definition: prevalence, etiology, and consequences. J Am Med Dir Assoc, 2011, 12(4): 249-256.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Value of a nomogram based on nutritional risk and sarcopenia on predicting postoperative complications in elderly patients with gastric cancer

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