Relation between preoperative hypoproteinemia and survival prognosis in patients with colorectal cancer after surgery: A real-world data study based on DACCA database_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZHANG Xianglin ^1,2 , WANG Yiqi ^1,3 , ZHENG Yafang ^1,2 , YE Jiaqi ^1,2 ,  WANG Xiaodong ¹ , YANG Lie ¹

1. Division of Gastrointestinal Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
2. West China School of Medicine, Sichuan University, Chengdu 610041, P. R. China;
3. West China School of Public Health, Sichuan University, Chengdu 610041, P. R. China;

Corresponding author：

WANG Xiaodong, Email: wangxiaodong@wchscu.cn

Keywords：

colorectal cancer; hypoproteinemia; survival prognosis; preoperative physical conditions

DOI：

10.7507/1007-9424.202412010

Video：

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Objective To analyze the effects of preoperative protein level on the survival prognosis of patients underwent colorectal cancer (CRC) surgery in the current Database from Colorectal Cancer (DACCA). Methods According to the established screening criteria, the patient information was extracted from the updated version of DACCA on November 24, 2024. The survival curves of the patients with and without preoperative hypoproteinemia were plotted by Kaplan-Meier method and the log-rank test was used to compare. The univariate and multivariate Cox regression analysis were used to analyze the preoperative hypoproteinemia affecting postoperative survival (overall survival and disease-specific survival) of patients with CRC. The test level was α=0.05. Results A total of 1 217 patients with CRC were included, and 252 of 1 217 patients with preoperative hypoproteinemia, with an incidence of 20.7%. The survival curves showed that the overall survival and disease-specific survival of the patients with preoperative hypoproteinemia were worse than those without preoperative hypoproteinemia (χ²=43.411, P<0.001; χ²=41.171, P<0.001). However, the multivariate Cox regression analysis did not find that the preoperative hypoproteinemia was a risk factor for postoperative survival (overall survival and disease-specific survival as observed indicators) in the patients with CRC [overall survival: HR (95%CI)=1.013 (0.741, 1.385), P=0.938; disease-specific survival: HR (95%CI)=1.003 (0.719, 1.399), P=0.987]. Conclusion The results of this study suggest that the incidence rate of preoperative hypoproteinemia in patients with CRC is higher, and the survival prognosis is worse than that in patients without preoperative hypoproteinemia.

1.	汪晓东, 李立. 数据库建设第一部分: 个人数据的标签与结构化. 中国普外基础与临床杂志, 2019, 26(3): 335-342.
2.	汪晓东, 吕炘沂, 黄明君, 等. 数据库建设第二部分: 结直肠癌住院流程管理的标签与结构化. 中国普外基础与临床杂志, 2019, 26(7): 852-855.
3.	汪晓东, 刘健博, 李立. 数据库建设第三部分: 结直肠癌内外科合并症及术前体质状态的标签与结构化. 中国普外基础与临床杂志, 2019, 26(9): 1110-1115.
4.	蒋志强, 李亚兰, 韩广森, 等. 术前血清白蛋白水平与结肠癌临床病理特征及生存预后的关系. 中华胃肠外科杂志, 2016, 19(1): 80-83.
5.	Sofić A, Rašić I, Halilović E, et al. Is preoperative hypoproteinemia associated with colorectal cancer stage and postoperative complications? Med Glas (Zenica), 2021, 18(2): 450-455.
6.	康静, 蒋运兰, 李滔, 等. 结直肠癌患者术后并发肺部感染影响因素的Meta分析. 数理医药学杂志, 2024, 37(10): 746-760.
7.	吴秀文, 张旭飞, 阳怡羽, 等. 2018–2020年中国结直肠术后手术部位感染现状研究. 中华胃肠外科杂志, 2022, 25(9): 804-811.
8.	李亚萍, 寇志坚, 阎文军. 结直肠癌围手术期低蛋白血症的研究进展. 中国医学创新, 2023, 20(7): 182-188.
9.	汪晓东, 刘健博, 张诗, 等. 数据库研究第三部分: 结直肠癌的内外科合并症及术前体质状态. 中国普外基础与临床杂志, 2019, 26(8): 985-991.
10.	汪晓东, 刘健博, 安丽珉, 等. 数据库建设第四部分: 结直肠癌的术前专科检查与评估, 2019, 25(11): 1337-1341.
11.	汪晓东, 刘健博, 李立. 数据库建设第三部分: 结直肠癌内外科合并症及术前体质状态的标签与结构化. 中国普外基础与临床杂志, 2019, 26(09): 1110-1115.
12.	Kondrup J, Rasmussen HH, Hamberg O, et al. Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials. Clin Nutr, 2003, 22(3): 321-336.
13.	汪晓东, 刘健博, 李立. 数据库建设第五部分·结直肠癌的肿瘤特征—模块的设计(二). 中国普外基础与临床杂志, 2020, 27(04): 483-488.
14.	黄理宾, 黄秋实, 杨烈. 全球及中国的结直肠癌流行病学特征及防治: 2022《全球癌症统计报告》解读. 中国普外基础与临床杂志, 2024, 31(5): 530-537.
15.	Truong A, Hanna MH, Moghadamyeghaneh Z, et al. Implications of preoperative hypoalbuminemia in colorectal surgery. World J Gastrointest Surg, 2016, 8(5): 353-362.
16.	李倩, 姜韫赟, 李玲玲, 等. 低蛋白血症的临床研究进展. 世界中西医结合杂志, 2011, 6(5): 438-439, 442.
17.	Hu WH, Eisenstein S, Parry L, Ramamoorthy S. Preoperative malnutrition with mild hypoalbuminemia associated with postoperative mortality and morbidity of colorectal cancer: a propensity score matching study. Nutr J, 2019, 18(1): 33. doi: 10.1186/s12937-019-0458-y.
18.	Garth AK, Newsome CM, Simmance N, et al. Nutritional status, nutrition practices and post-operative complications in patients with gastrointestinal cancer. J Hum Nutr Diet, 2010, 23(4): 393-401.
19.	Lai CC, You JF, Yeh CY, et al. Low preoperative serum albumin in colon cancer: a risk factor for poor outcome. Int J Colorectal Dis, 2011, 26(4): 473-481.
20.	王海燕, 曹红十, 刘素敏, 等. 结直肠癌患者营养状况影响因素的研究进展. 现代临床护理, 2019, 18(8): 77-81.
21.	周春燕, 牟文莲, 代小红, 等. 全周期营养管理对结直肠癌术后化疗患者的营养状况及化疗不良反应影响. 临床护理研究, 2023, 32(20): 149-151.
22.	孙双丹. 结直肠癌患者腹腔镜术后发生动力性肠梗阻的影响因素分析. 中国民康医学, 2022, 34(16): 1-4.
23.	Franch-Arcas G. The meaning of hypoalbuminaemia in clinical practice. Clin Nutr, 2001, 20(3): 265-269.
24.	Lai C, You J, Yeh C, et al. Low preoperative serum albumin in colon cancer: a risk factor for poor outcome. Int J Colorectal Dis, 2011, 26(4): 473-481.
25.	Nazha B, Moussaly E, Zaarour M, et al. Hypoalbuminemia in colorectal cancer prognosis: nutritional marker or inflammatory surrogate? World J Gastrointest Surg2015, 7(12): 370-377.
26.	Cengiz O, Kocer B, Sürmeli S, et al. Are pretreatment serum albumin and cholesterol levels prognostic tools in patients with colorectal carcinoma? Med Sci Monit, 2006, 12(6): CR240-CR247.
27.	郭兰伟, 张兴龙, 蔡林, 等. 全球结直肠癌流行和防控现状. 中华肿瘤杂志, 2024, 46(1): 57-65.
28.	van Westreenen HL, Ijpma FF, Wevers KP, et al. Reoperation after colorectal surgery is an independent predictor of the 1-year mortality rate. Dis Colon Rectum, 2011, 54(11): 1438-1442.
29.	吴泽生, 高华, 张文斌, 等. 结直肠癌患者术后非计划再手术的危险因素分析. 中华胃肠外科杂志, 2015, 18(5): 483-486.
30.	Negrichi S, Taleb S. Evaluation of nutritional status of colorectal cancer patients from Algerian East using anthropometric measurements and laboratory assessment. Iran J Public Health, 2020, 49(7): 1242-1251.
31.	Kwag SJ, Kim JG, Kang WK, et al. The nutritional risk is a independent factor for postoperative morbidity in surgery for colorectal cancer. Ann Surg Treat Res, 2014, 86(4): 206-211.
32.	王罡艳, 罗会华. 营养不良相关因素及代谢相关通路对结直肠癌患者预后的影响. 中国现代普通外科进展, 2019, 22(6): 496-498.
33.	唐翠娟, 荣震, 莫春梅, 等. 恶性肿瘤代谢特点及其与炎性介质的相关性研究进展. 肿瘤防治研究, 2019, 46(5): 476-481.
34.	曹子龙, 任霖霖, 马竟优, 等. 进展期结直肠癌血清白蛋白下降与IL-6、TNF-α和CRP的相关性研究. 转化医学电子杂志, 2015, 2(5): 76-76,78.

1. 汪晓东, 李立. 数据库建设第一部分: 个人数据的标签与结构化. 中国普外基础与临床杂志, 2019, 26(3): 335-342.
2. 汪晓东, 吕炘沂, 黄明君, 等. 数据库建设第二部分: 结直肠癌住院流程管理的标签与结构化. 中国普外基础与临床杂志, 2019, 26(7): 852-855.
3. 汪晓东, 刘健博, 李立. 数据库建设第三部分: 结直肠癌内外科合并症及术前体质状态的标签与结构化. 中国普外基础与临床杂志, 2019, 26(9): 1110-1115.
4. 蒋志强, 李亚兰, 韩广森, 等. 术前血清白蛋白水平与结肠癌临床病理特征及生存预后的关系. 中华胃肠外科杂志, 2016, 19(1): 80-83.
5. Sofić A, Rašić I, Halilović E, et al. Is preoperative hypoproteinemia associated with colorectal cancer stage and postoperative complications? Med Glas (Zenica), 2021, 18(2): 450-455.
6. 康静, 蒋运兰, 李滔, 等. 结直肠癌患者术后并发肺部感染影响因素的Meta分析. 数理医药学杂志, 2024, 37(10): 746-760.
7. 吴秀文, 张旭飞, 阳怡羽, 等. 2018–2020年中国结直肠术后手术部位感染现状研究. 中华胃肠外科杂志, 2022, 25(9): 804-811.
8. 李亚萍, 寇志坚, 阎文军. 结直肠癌围手术期低蛋白血症的研究进展. 中国医学创新, 2023, 20(7): 182-188.
9. 汪晓东, 刘健博, 张诗, 等. 数据库研究第三部分: 结直肠癌的内外科合并症及术前体质状态. 中国普外基础与临床杂志, 2019, 26(8): 985-991.
10. 汪晓东, 刘健博, 安丽珉, 等. 数据库建设第四部分: 结直肠癌的术前专科检查与评估, 2019, 25(11): 1337-1341.
11. 汪晓东, 刘健博, 李立. 数据库建设第三部分: 结直肠癌内外科合并症及术前体质状态的标签与结构化. 中国普外基础与临床杂志, 2019, 26(09): 1110-1115.
12. Kondrup J, Rasmussen HH, Hamberg O, et al. Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials. Clin Nutr, 2003, 22(3): 321-336.
13. 汪晓东, 刘健博, 李立. 数据库建设第五部分·结直肠癌的肿瘤特征—模块的设计(二). 中国普外基础与临床杂志, 2020, 27(04): 483-488.
14. 黄理宾, 黄秋实, 杨烈. 全球及中国的结直肠癌流行病学特征及防治: 2022《全球癌症统计报告》解读. 中国普外基础与临床杂志, 2024, 31(5): 530-537.
15. Truong A, Hanna MH, Moghadamyeghaneh Z, et al. Implications of preoperative hypoalbuminemia in colorectal surgery. World J Gastrointest Surg, 2016, 8(5): 353-362.
16. 李倩, 姜韫赟, 李玲玲, 等. 低蛋白血症的临床研究进展. 世界中西医结合杂志, 2011, 6(5): 438-439, 442.
17. Hu WH, Eisenstein S, Parry L, Ramamoorthy S. Preoperative malnutrition with mild hypoalbuminemia associated with postoperative mortality and morbidity of colorectal cancer: a propensity score matching study. Nutr J, 2019, 18(1): 33. doi: 10.1186/s12937-019-0458-y.
18. Garth AK, Newsome CM, Simmance N, et al. Nutritional status, nutrition practices and post-operative complications in patients with gastrointestinal cancer. J Hum Nutr Diet, 2010, 23(4): 393-401.
19. Lai CC, You JF, Yeh CY, et al. Low preoperative serum albumin in colon cancer: a risk factor for poor outcome. Int J Colorectal Dis, 2011, 26(4): 473-481.
20. 王海燕, 曹红十, 刘素敏, 等. 结直肠癌患者营养状况影响因素的研究进展. 现代临床护理, 2019, 18(8): 77-81.
21. 周春燕, 牟文莲, 代小红, 等. 全周期营养管理对结直肠癌术后化疗患者的营养状况及化疗不良反应影响. 临床护理研究, 2023, 32(20): 149-151.
22. 孙双丹. 结直肠癌患者腹腔镜术后发生动力性肠梗阻的影响因素分析. 中国民康医学, 2022, 34(16): 1-4.
23. Franch-Arcas G. The meaning of hypoalbuminaemia in clinical practice. Clin Nutr, 2001, 20(3): 265-269.
24. Lai C, You J, Yeh C, et al. Low preoperative serum albumin in colon cancer: a risk factor for poor outcome. Int J Colorectal Dis, 2011, 26(4): 473-481.
25. Nazha B, Moussaly E, Zaarour M, et al. Hypoalbuminemia in colorectal cancer prognosis: nutritional marker or inflammatory surrogate? World J Gastrointest Surg2015, 7(12): 370-377.
26. Cengiz O, Kocer B, Sürmeli S, et al. Are pretreatment serum albumin and cholesterol levels prognostic tools in patients with colorectal carcinoma? Med Sci Monit, 2006, 12(6): CR240-CR247.
27. 郭兰伟, 张兴龙, 蔡林, 等. 全球结直肠癌流行和防控现状. 中华肿瘤杂志, 2024, 46(1): 57-65.
28. van Westreenen HL, Ijpma FF, Wevers KP, et al. Reoperation after colorectal surgery is an independent predictor of the 1-year mortality rate. Dis Colon Rectum, 2011, 54(11): 1438-1442.
29. 吴泽生, 高华, 张文斌, 等. 结直肠癌患者术后非计划再手术的危险因素分析. 中华胃肠外科杂志, 2015, 18(5): 483-486.
30. Negrichi S, Taleb S. Evaluation of nutritional status of colorectal cancer patients from Algerian East using anthropometric measurements and laboratory assessment. Iran J Public Health, 2020, 49(7): 1242-1251.
31. Kwag SJ, Kim JG, Kang WK, et al. The nutritional risk is a independent factor for postoperative morbidity in surgery for colorectal cancer. Ann Surg Treat Res, 2014, 86(4): 206-211.
32. 王罡艳, 罗会华. 营养不良相关因素及代谢相关通路对结直肠癌患者预后的影响. 中国现代普通外科进展, 2019, 22(6): 496-498.
33. 唐翠娟, 荣震, 莫春梅, 等. 恶性肿瘤代谢特点及其与炎性介质的相关性研究进展. 肿瘤防治研究, 2019, 46(5): 476-481.
34. 曹子龙, 任霖霖, 马竟优, 等. 进展期结直肠癌血清白蛋白下降与IL-6、TNF-α和CRP的相关性研究. 转化医学电子杂志, 2015, 2(5): 76-76,78.

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Latest ArticlesRelation between preoperative hypoproteinemia and survival prognosis in patients with colorectal cancer after surgery: A real-world data study based on DACCA database

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