Prognostic nutritional index in predicting survival of patients with gastric or gastroesophageal junction adenocarcinoma: A systematic review

BACKGROUND Gastric cancer is the third most common cause of cancer related death worldwide.Surgery with or without chemotherapy is the most common approach with curative intent;however,the prognosis is poor as mortality rates remain high.Several indexes have been proposed in the past few years in order to estimate the survival of patients undergoing gastrectomy.The preoperative nutritional status of gastric cancer patients has recently gained attention as a factor that could affect the postoperative course and various indexes have been developed.The aim of this systematic review was to assess the role of the prognostic nutritional index(PNI)in predicting the survival of patients with gastric or gastroesophageal adenocarcinoma who underwent gastrectomy with curative intent.AIM To investigate the role of PNI in predicting the survival of patients with gastric or gastroesophageal junction adenocarcinoma.METHODS A thorough literature search of PubMed and the Cochrane library was performed for studies comparing the overall survival(OS)of patients with gastric or gastroesophageal cancer after surgical resection depending on the preoperative PNI value.The PRISMA algorithm was used in the screening process and finally 16 studies were included in this systematic review.The review protocol was registered in the International Prospective Register of Systematic Reviews(PRO) RESULTS Sixteen studies involving 14551 patients with gastric or esophagogastric junction adenocarcinoma undergoing open or laparoscopic or robotic gastrectomy with or without adjuvant chemotherapy were included in this systematic review.The patients were divided into high-and low-PNI groups according to cut-off values that were set according to previous reports or by using receiver operating characteristic curve analysis in each individual study.The 5-year OS of patients in the low-PNI groups ranged between 39%and 70.6%,while in the high-PNI groups,it ranged between 54.9%and 95.8%.In most of the included studies,patients with high preoperative PNI showed statistically significant better OS than the low PNI groups.In multivariate analyses,low PNI was repeatedly recognised as an independent prognostic factor for poor survival.CONCLUSION According to the present study,low preoperative PNI seems to be an indicator of poor OS of patients undergoing gastrectomy for gastric or gastroesophageal cancer.

Preoperative prognostic nutritional index predicts long-term outcomes of patients with ampullary adenocarcinoma after curative pancreatoduodenectomy

BACKGROUND The prognostic nutritional index(PNI),a marker of immune-nutrition balance,has predictive value for the survival and prognosis of patients with various cancers.AIM To explore the clinical significance of the preoperative PNI on the prognosis of ampullary adenocarcinoma(AC)patients who underwent curative pancreaticoduodenectomy.METHODS The data concerning 233 patients diagnosed with ACs were extracted and analyzed at our institution from January 1998 to December 2020.All patients were categorized into low and high PNI groups based on the cutoff value determined by receiver operating characteristic curve analysis.We compared disease-free survival(DFS)and overall survival(OS)between these groups and assessed prognostic factors through univariate and multivariate analyses.RESULTS The optimal cutoff value for the PNI was established at 45.3.Patients with a PNI≥45.3 were categorized into the PNI-high group,while those with a PNI<45.3 were assigned to the PNI-low group.Patients within the PNI-low group tended to be of advanced age and exhibited higher levels of aspartate transaminase and total bilirubin and a lower creatinine level than were those in the PNI-high group.The 5-year OS rates for patients with a PNI≥45.3 and a PNI<45.3 were 61.8%and 43.4%,respectively,while the 5-year DFS rates were 53.5%and 38.3%,respectively.Patients in the PNI-low group had shorter OS(P=0.006)and DFS(P=0.012).In addition,multivariate analysis revealed that the PNI,pathological T stage and pathological N stage were found to be independent prognostic factors for both OS and DFS.CONCLUSION The PNI is a straightforward and valuable marker for predicting long-term survival after pancreatoduodenectomy.The PNI should be incorporated into the standard assessment of patients with AC.

Prognostic nutritional index predicts postoperative complications and long-term outcomes of gastric cancer

AIM: To investigate the impact of prognostic nutritional index (PNI) on the postoperative complications and long-term outcomes in gastric cancer patients undergoing total gastrectomy.

Prognostic nutritional index is an independent prognostic factor for gastric cancer patients with peritoneal dissemination

Objective： The predictive and prognostic role of prognostic nutritional index（PNI） in gastric cancer patients with peritoneal dissemination remains unclear. This study aims to explore the role of the PNI in predicting outcomes of gastric cancer patients with peritoneal dissemination.Methods： A total of 660 patients diagnosed with gastric adenocarcinoma with peritoneal metastasis between January 2000 and April 2014 at Sun Yat-sen University Cancer Center and the Sixth Affiliated Hospital of Sun Yatsen University were retrospectively analyzed. The clinicopathologic characteristics and clinical outcomes of patients with peritoneal dissemination were analyzed.Results： Compared with PNI-high group, PNI-low group was correlated with advanced age（P=0.036）, worse performance status（P0.001）, higher frequency of ascites（P0.001） and higher frequency of multisite distant metastasis（P0.001）. Kaplan-Meier survival curves showed that PNI-high group had a significantly longer median overall survival than PNI-low group（13.13 vs. 9.03 months, P0.001）. Multivariate survival analysis revealed that Borrmann type IV（P=0.014）, presence of ascites（P=0.017） and lower PNI（P=0.041） were independent poor prognostic factors, and palliative surgery（P0.001） and first-line chemotherapy（P0.001） were good prognostic factors. For patients receiving palliative surgery, the postoperative morbidity rates in the PNI-low group and PNIhigh group were 9.1% and 9.9%, respectively（P=0.797）. The postoperative mortality rate was not significantly different between PNI-low and PNI-high groups（2.3% vs. 0.9%, P=0.362）.Conclusions： PNI is a useful and practical tool for evaluating the nutritional status of gastric cancer patients with peritoneal dissemination, and is an independent prognostic factor for these patients.

Onodera's Prognostic Nutritional Index is a novel and useful prognostic marker for gastrointestinal stromal tumors

BACKGROUND Immunoinflammatory markers such as the peripheral blood neutrophil-tolymphocyte ratio(NLR)and the platelet-to-lymphocyte ratio(PLR)have gained considerable attention as prognostic markers in gastrointestinal stromal tumors(GISTs).AIM To assess the prognostic value of Onodera’s Prognostic Nutritional Index(OPNI)for GISTs.METHODS All patients who had undergone surgical resection for a primary,localized GIST from 2009 to 2016 at our cancer center were initially and retrospectively identified.Recurrence-free survival(RFS)was calculated by the Kaplan-Meier method and compared by the log-rank test.We used multivariate Cox proportional hazard regression models to identify associations with outcome variables.RESULTS A total of 235 GISTs were identified and included for analysis under our inclusion criteria.Univariate and multivariate analyses both identified the OPNI as an independent prognostic marker,and the OPNI was associated with the primary site,tumor size,mitotic index,tumor rupture,necrosis,and modified NIH risk classification.Low OPNI(<51.30;hazard ratio=5.852;95% confidence interval:1.072–31.964;P=0.0414)was associated with worse RFS.The 2-and 5-year RFS rates of the patients with a low OPNI were 92.83% and 76.22%,respectively,whereas 100% and 98.41% were achieved by the patients with a high OPNI.CONCLUSION The preoperative OPNI is a novel and useful prognostic marker for GISTs.

Evaluation of the prognostic nutritional index for the prognosis of Chinese patients with high/extremely high-risk prostate cancer after radical prostatectomy

BACKGROUND The incidence of prostate cancer(PCa)is on the rise in China.The risk level of patients with PCa is associated with disease-free survival rate at 10 years after radical prostatectomy.Predicting prognosis in advance according to the degree of risk can provide a reference for patients,especially treatment options and postoperative adjuvant treatment measures for high-risk/extremely high-risk patients.AIM To explore the predictive value of the prognostic nutritional index(PNI)for biological recurrence in Chinese patients with high/extremely high-risk PCa after radical prostatectomy.METHODS The biochemical test results and clinical data of 193 patients who underwent radical prostatectomy for the first time from January 2015 to December 2020 were retrospectively collected.The PNI value of peripheral blood within 1 wk before surgery was calculated,and during the follow-up period,prostate-specific antigen≥0.2 ng/mL was considered to have biological recurrence.The receiver operating characteristic(ROC)curve was used to calculate the optimal critical value and area under the curve(AUC)of the patients.According to the critical value,the progression-free survival of the high PNI group and low PNI group was compared.The independent influencing factors of the patients’prognosis were obtained by the Cox proportional hazards regression model.RESULTS The non-biological recurrence rates at 1,3,and 5 years were 92.02%,84.05%,and 74.85%,respectively.The optimal critical value for PNI to predict biological recurrence was 46.23,and the AUC was 0.789(95%confidence interval:0.651-0.860;P<0.001).The sensitivity and specificity were 82.93%and 62.30%,respectively.In accordance with the optimal critical value of the ROC curve(46.23),193 patients were further divided into a high PNI group(PNI≤46.23,n=108)and low PNI group(PNI>46.23,n=85).The incidence of postoperative complications in the high PNI group was lower than that in the low PNI group(21.18%vs 38.96%).Kaplan-Meier survival analysis showed that the overall survival rate at 5 years in the low PNI group was 87.96%(13/108),which was lower than that in the high PNI group(61.18%,33/85;P<0.05).Low PNI[hazard ratio(HR)=1.74;P=0.003]and positive incisal margin status(HR=2.14;P=0.001)were independent predictors of biological recurrence in patients with high/extremely high-risk PCa.CONCLUSION The PNI has predictive value for the prognosis of patients with high/extremely high-risk PCa,and is an independent prognostic factor.Patients with low PNI value have a shorter time of nonbiological recurrence after prostatectomy.It is expected that the combined prediction of other clinicopathological data will further improve the accuracy and guide postoperative adjuvant therapy to improve the quality of prognosis.

Actuality and underlying mechanisms of systemic immuneinflammation index and geriatric nutritional risk index prognostic value in hepatocellular carcinoma

This editorial contains comments on the article“Correlation between preoperative systemic immune inflammation index,nutritional risk index,and prognosis of radical resection of liver cancer”in a recent issue of the World Journal of Gastrointestinal Surgery.It pointed out the actuality and importance of the article and focused primarily on the underlying mechanisms making the systemic immuneinflammation index(SII)and geriatric nutritional risk index(GNRI)prediction features valuable.There are few publications on both SII and GNRI together in hepatocellular carcinoma(HCC)and patient prognosis after radical surgery.Neutrophils release cytokines,chemokines,and enzymes,degrade extracellular matrix,reduce cell adhesion,and create conditions for tumor cell invasion.Neutrophils promote the adhesion of tumor cells to endothelial cells,through physical anchoring.That results in the migration of tumor cells.Pro-angiogenic factors from platelets enhance tumor angiogenesis to meet tumor cell supply needs.Platelets can form a protective film on the surface of tumor cells.This allows avoiding blood flow damage as well as immune system attack.It also induces the epithelial-mesenchymal transformation of tumor cells that is critical for invasiveness.High SII is also associated with macro-and microvascular invasion and increased numbers of circulating tumor cells.A high GNRI was associated with significantly better progression-free and overall survival.HCC patients are a very special population that requires increased attention.SII and GNRI have significant survival prediction value in both palliative treatment and radical surgery settings.The underlying mechanisms of their possible predictive properties lie in the field of essential cancer features.Those features provide tumor nutrition,growth,and distribution throughout the body,such as vascular invasion.On the other hand,they are tied to the possibility of patients to resist tumor progression and development of complications in both postoperative and cancer-related settings.The article is of considerable interest.It would be helpful to continue the study follow-up to 2 years and longer.External validation of the data is needed.

Malnutrition Assessed Using the Geriatric Nutritional Risk Index Is Associated with Preoperative Incidence of Deep Vein Thrombosis in Japanese Patients Undergoing Total Knee Arthroplasty

Purpose: Few studies have evaluated the association between malnutrition and the risk of preoperative deep vein thrombosis (DVT) in patients undergoing primary total joint arthroplasty. This study aimed to investigate the prevalence of preoperative DVT in Japanese patients undergoing total knee arthroplasty (TKA) and the importance of malnutrition in the risk of preoperative DVT. Methods: We retrospectively analyzed 394 patients admitted for primary TKA at our institution between January 2019 and December 2023. All patients scheduled for TKA at our institution had serum D-dimer levels measured preoperatively. Lower-limb ultrasonography was examined to confirm the presence of DVT in patients with D-dimer levels ≥ 1.0 µg/mL or who were considered to be at high risk of DVT by the treating physician. Based on the results of lower-limb ultrasonography, all patients were divided into the non-DVT and DVT groups. The incidence of and risk factors for preoperative DVT were investigated, as well as the correlation of DVT with the patient’s nutritional parameters. We used two representative tools for nutritional assessment: the Geriatric Nutritional Risk Index (GNRI) and Controlling Nutritional Status Score. Results: The mean age was 77.8 ± 6.9 years. Preoperative DVT was diagnosed in 57 of the 394 (14.5%) patients. Multivariate logistic regression analysis showed that advanced age and malnutrition status, assessed using the GNRI, were independent risk factors for preoperative DVT. Conclusion: A high incidence of preoperative DVT was observed in patients who underwent TKA. Malnutrition status, as assessed using the GNRI, increased the risk of preoperative DVT. Our findings suggest that clinicians should consider these factors when tailoring preventive strategies to mitigate DVT risk in patients undergoing TKA.

Correlation between preoperative systemic immune inflammation index, nutritional risk index, and prognosis of radical resection of liver cancer

BACKGROUND Radical surgery is the most commonly used treatment for hepatocellular carcinoma(HCC).However,the surgical effect remains not ideal,and prognostic evaluation is insufficient.Furthermore,clinical intervention is rife with uncertainty and not conducive to prolonging patient survival.AIM To explore correlations between the systemic immune inflammatory index(SII)and geriatric nutritional risk index(GNRI)and HCC operation prognosis.METHODS This retrospective study included and collected follow up data from 100 HCC.Kaplan–Meier survival curves were used to analyze the correlation between SII and GNRI scores and survival.SII and GNRI were calculated as follows:SII=neutrophil count×platelet count/lymphocyte count;GNRI=[1.489×albumin(g/L)+41.7×actual weight/ideal weight].We analyzed the predictive efficacy of the SII and GNRI in HCC patients using receiver operating characteristic(ROC)curves,and the relationships between the SII,GNRI,and survival rate using Kaplan–Meier survival curves.Cox regression analysis was utilized to analyze independent risk factors influencing prognosis.RESULTS After 1 year of follow-up,24 patients died and 76 survived.The area under the curve(AUC),sensitivity,specificity,and the optimal cutoff value of SII were 0.728(95%confidence interval:0.600-0.856),79.2%,63.2%,and 309.14,respectively.According to ROC curve analysis results for predicting postoperative death in HCC patients,the AUC of SII and GNRI combination was higher than that of SII or GNRI alone,and SII was higher than that of GNRI(P<0.05).The proportion of advanced differentiated tumors,tumor maximum diameter(5–10 cm,>10 cm),lymph node metastasis,and TNM stage III-IV in patients with SII>309.14 was higher than that in patients with SII≤309.14(P<0.05).The proportion of patients aged>70 years was higher in patients with GNRI≤98 than that in patients with GNRI>98(P<0.05).The 1-year survival rate of the SII>309.14 group(compared with the SII≤309.14 group)and GNRI≤98 group(compared with the GNRI>98 group)was lower(P<0.05).CONCLUSION The prognosis after radical resection of HCC is related to the SII and GNRI and poor in high SII or low GNRI patients.

Associations between Geriatric Nutrition Risk Index,bone mineral density and body composition in type 2 diabetes patients

BACKGROUND Type 2 diabetes mellitus(T2DM),a fast-growing issue in public health,is one of the most common chronic metabolic disorders in older individuals.Osteoporosis and sarcopenia are highly prevalent in T2DM patients and may result in fractures and disabilities.In people with T2DM,the association between nutrition,sarcopenia,and osteoporosis has rarely been explored.AIM To evaluate the connections among nutrition,bone mineral density(BMD)and body composition in patients with T2DM.METHODS We enrolled 689 patients with T2DM for this cross-sectional study.All patients underwent dual energy X-ray absorptiometry(DXA)examination and were categorized according to baseline Geriatric Nutritional Risk Index(GNRI)values calculated from serum albumin levels and body weight.The GNRI was used to evaluate nutritional status,and DXA was used to investigate BMD and body composition.Multivariate forward linear regression analysis was used to identify the factors associated with BMD and skeletal muscle mass index.RESULTS Of the total patients,394 were men and 295 were women.Compared with patients in tertile 1,those in tertile 3 who had a high GNRI tended to be younger and had lower HbA1c,higher BMD at all bone sites,and higher appendicular skeletal muscle index(ASMI).These important trends persisted even when the patients were divided into younger and older subgroups.The GNRI was positively related to ASMI(men:r=0.644,P<0.001;women:r=0.649,P<0.001),total body fat(men:r=0.453,P<0.001;women:r=0.557,P<0.001),BMD at all bone sites,lumbar spine(L1-L4)BMD(men:r=0.110,P=0.029;women:r=0.256,P<0.001),FN-BMD(men:r=0.293,P<0.001;women:r=0.273,P<0.001),and hip BMD(men:r=0.358,P<0.001;women:r=0.377,P<0.001).After adjustment for other clinical parameters,the GNRI was still significantly associated with BMD at the lumbar spine and femoral neck.Additionally,a low lean mass index and higherβ-collagen special sequence were associated with low BMD at all bone sites.Age was negatively correlated with ASMI,whereas weight was positively correlated with ASMI.CONCLUSION Poor nutrition,as indicated by a low GNRI,was associated with low levels of ASMI and BMD at all bone sites in T2DM patients.Using the GNRI to evaluate nutritional status and using DXA to investigate body composition in patients with T2DM is of value in assessing bone health and physical performance.

Prognostic impact of preoperative nutritional and immune inflammatory parameters on liver cancer

The immune response to tissue damage or infection involves inflammation,a multifaceted biological process distinguished by immune cell activation,mediator secretion,and immune cell recruitment to the site of injury.Several blood-based immune-inflammatory biomarkers with prognostic significance in malignancies have been identified.In this issue of the World Journal of Gastrointestinal Surgery,they examined the prognosis of liver cancer radical resection in relation to pre-operative systemic immune-inflammation and nutritional risk indices.Comparing older and younger individuals often reveals compromised nutritional and immu-nological statuses in the former.Therefore,performing preoperative evaluations of the nutritional status and immunity in geriatric patients is critical.In addition to being a primary treatment modality,radical resection is associated with a sig-nificant mortality rate following surgery.Insufficient dietary consump-tion and an elevated metabolic rate within tumor cells contribute to the increased proba-bility of malnutrition associated with the ailment,consequently leading to a sub-stantial deterioration in prognosis.Recent studies,reinforce the importance of nu-tritional and immune-inflammatory biomarkers.Prior to surgical intervention,geriatric nutritional risk and systemic immune-inflammatory indices should be prioritized,particularly in older patients with malignant diseases.

The prognostic nutritional index on postoperative day one is associated with one-year mortality after burn surgery in elderly patients

Background:Burn injury in elderly patients can result in poor outcomes.Prognostic nutritional index(PNI)can predict the perioperative nutritional status and postoperative outcomes.We aim to evaluate the risk factors,including PNI,for one-year mortality after burn surgery in elderly patients.Methods:Burn patients aged≥65 years were retrospectively included.PNIwas calculated using the following equation:10×serum albumin level(g/dL)+0.005×total lymphocyte count(per mm3).Cox regression,receiver operating characteristic curve and Kaplan–Meier survival analyses were performed to evaluate the risk factors for postoperative one-year mortality.Results:Postoperative one-year mortality occurred in 71(37.6%)of the 189 elderly burn patients.Risk factors for one-year mortality were PNI on postoperative day one(hazard ratio(HR)=0.872;95%CI=0.812–0.936;p<0.001),Sequential Organ Failure Assessment score(HR=1.112;95%CI=1.005–1.230;p=0.040),American Society of Anesthesiologists physical status(HR=2.064;95%CI=1.211–3.517;p=0.008),total body surface area burned(HR=1.017;95%CI=1.003–1.032;p=0.015)and preoperative serum creatinine level(HR=1.386;95%CI=1.058–1.816;p=0.018).The area under the curve of PNI for predicting one-year mortality after burn surgery was 0.774(optimal cut-off value=25.5).Patients with PNI≤25.5 had a significantly lower one-year survival rate than those with PNI>25.5(32.1%vs 75.9%,p<0.001).Conclusions:PNI on postoperative day one was associated with postoperative one-year mortality in elderly burn patients.The postoperative one-year survival rate was lower in patients with PNI≤25.5 than in those with PNI>25.5.These findings indicate the importance of identifying elderly burn patients with low PNI,thereby reducing the mortality after burn surgery.

Prognostic value of preoperative immune-nutritional scoring systems in remnant gastric cancer patients undergoing surgery

BACKGROUND Remnant gastric cancer(GC)is defined as GC that occurs five years or more after gastrectomy.Systematically evaluating the preoperative immune and nutritional status of patients and analyzing its prognostic impact on postoperative remnant gastric cancer(RGC)patients are crucial.A simple scoring system that combines multiple immune or nutritional indicators to identify nutritional or immune status before surgery is necessary.AIM To evaluate the value of preoperative immune-nutritional scoring systems in predicting the prognosis of patients with RGC.METHODS The clinical data of 54 patients with RGC were collected and analyzed retrospectively.Prognostic nutritional index(PNI),controlled nutritional status(CONUT),and Naples prognostic score(NPS)were calculated by preoperative blood indicators,including absolute lymphocyte count,lymphocyte to monocyte ratio,neutrophil to lymphocyte ratio,serum albumin,and serum total cholesterol.Patients with RGC were divided into groups according to the immune-nutritional risk.The relationship between the three preoperative immune-nutritional scores and clinical characteristics was analyzed.Cox regression and Kaplan–Meier analysis was performed to analyze the difference in overall survival(OS)rate between various immune-nutritional score groups.RESULTS The median age of this cohort was 70.5 years(ranging from 39 to 87 years).No significant correlation was found between most pathological features and immune-nutritional status(P>0.05).Patients with a PNI score<45,CONUT score or NPS score≥3 were considered to be at high immune-nutritional risk.The areas under the receiver operating characteristic curves of PNI,CONUT,and NPS systems for predicting postoperative survival were 0.611[95%confidence interval(CI):0.460–0.763;P=0.161],0.635(95%CI:0.485–0.784;P=0.090),and 0.707(95%CI:0.566–0.848;P=0.009),respectively.Cox regression analysis showed that the three immunenutritional scoring systems were significantly correlated with OS(PNI:P=0.002;CONUT:P=0.039;NPS:P<0.001).Survival analysis revealed a significant difference in OS between different immune-nutritional groups(PNI:75 mo vs 42 mo,P=0.001;CONUT:69 mo vs 48 mo,P=0.033;NPS:77 mo vs 40 mo,P<0.001).CONCLUSION These preoperative immune-nutritional scores are reliable multidimensional prognostic scoring systems for predicting the prognosis of patients with RGC,in which the NPS system has relatively effective predictive performance.

Prognostic Significance of Prognostic Nutritional Index in Elderly Patients Receiving Heart Valve Replacement

Background Valvular heart disease has become a concerning problem globally and has gradually been solved by valve replacement surgery. However, the prognostic significance of preoperative Prognostic Nutritional Index(PNI) in elderly patients receiving heart valve replacement remains unclear. Method Our study enrolled 3745elderly patients receiving heart valve replacement from January 2010 to December 2017 in Guangdong Provincial People’s Hospital. The PNI were calculated at admission and patients were divided into three groups according to the tertiles of PNI: >49(n=1181), 44-49(n=1341) and <44(n=1223). Univariate and multivariable analysis were conducted to explore the relationship between PNI and in-hospital death. Results Patients with lower PNI may be indicated with worse nutritional status and with higher rate of in-hospital death. Age(OR: 1.052, P=0.004), NYHA classification(OR: 2.547, P<0.001), anemia(OR: 1.508, P=0.033), platelet count(OR: 0.994, P<0.001), LVEF(OR: 0.983, P<0.05), tricuspid regurgitation(OR: 1.898, P=0.002), CABG(OR: 2.119, P<0.001), PNI(OR: 1.57,P=0.012) were all independent predictor for in-hospital mortality of patients receiving heart valve replacement after accounting for confounding factors. Kaplan-Meier analysis proved that patients with lower PNI would have higher risk to suffer from one-year mortality compared with the group with higher PNI(Log-rank: 55.682, P<0.001). Conclusions In general, PNI was an independent factor for evaluating nutritional status and could predict in-hospital death in elderly patients receiving heart valve replacement.

Validation of nutritional risk index method against patientgenerated subjective global assessment in screening malnutrition in colorectal cancer patients

Objective：To validate malnutrition screening tool of nutrition risk index （NRI） against patent-generated subjective global assessment （PG-SGA） as a gold standard tool in colorectal cancer patients before radiotherapy.Methods：Nutritional status of 52 volunteer colorectal cancer patients with a mean age of 54.1±16.8 years who referred to radiotherapy center were assessed by PG-SGA （gold standard method） and NRI.Serum albumin levels of patients were determined by colorimetric method.A contingency table was used to determine the sensitivity,specificity,and predictive value of the NRI in screening patients at risk of malnutrition,in comparison with the PG-SGA in patients before radiotherapy.Results：The findings of PG-SGA and NRI showed that 52％ and 45％ of patients in our study were moderately or severely malnourished respectively.The NRI had a sensitivity of 66％ and a specificity of 60％ against PG-SGA.The positive predictive value was 64％ and the negative predicative value was 62％.The agreement between NRI and PG-SGA was statistically insignificant （kappa =0.267; P＞0.05）.Conclusions：The findings of present study showed that the prevalence of malnutrition was high in patients with colorectal cancer.Moreover,NRI method had low sensitivity and specificity in assessing nutritional status of patients with cancer.It seems that the combination of anthropometric,laboratory parameters and a subjective scoring system may be helpful tools in screening of malnutrition in cancer patients.

Nutritional risk index as a predictor of postoperative wound complications after gastrectomy

AIM： To investigate the correlation between the nutri- tional risk index （NRI） and postoperative wound com- plications.

The Values of the Prognostic Nutrition Index and the Patient Generated-Subjective Global Assessment during the Nutritional Assessment of Patients with Gastrointestinal Tumors

Objective To compare the value and consistency among the Patient Generated-Subjective Global Assessment(PG-SGA)and the Prognostic Nutrition Index(PNI)for assessing nutritional status in gastrointestinal tumor patients.Methods 251 patients from gastric cancer surgical ward from January 2019 to January 2020 were recruited through convenience sampling in this respective study.Nutritional screening and assessment were conducted for 251 gastrointestinal tumor patients using the nutritional risk screening 2002(NRS 2002)PG-SGA,and the PNI.PNI was calculated using the serum albumin level and the total lymphocyte count obtained from the patients’routine laboratory examination when they were admitted to the hospital.The receiver operating characteristic(ROC)of the PG SGA and the PNI were plotted with the NRS 2002 used as the gold standard,and the diagnostic value of the PG-SGA and PNI was reflected by the area under the curve(AUC),sensitivity,specificity and Youden index.We then determined the optimal cut-off for the PNI and tested the consistency of the PG-SGA and PNI.Results The optimal cut-off point for the PNI was calculated to be 50.78.The AUC of the PG-SGA was 0.908(95%CI 0.871-0.944).The sensitivity was 89.9%,specificity was 76.2%and the Youden index was 0.661.The AUC of the PNI was 0.594(95%CI 0.516-0.572).The sensitivity was 73.8%,specificity was 44.3%and the Youden index was 0.181.In the consistency test,the kappa value was 0.838(P<0.001).Conclusion The PNI is of limited value for assessing malnutrition,although it did have good consistency with the PG-SGA.The combination of the PNI and PG-SGA can be used for diagnosing assessing malnutrition in clinical practice.

Novel prognostic factors after radical resection of hepatocellular carcinoma: Updating an old issue

In this editorial,I comment on the article by Li et al published in the recent issue of the World Journal of Gastrointestinal Surgery in 2023,investigating the role of some novel prognostic factors for early survival after radical resection of liver cancer.Liver cancer is an important burden among Asian and Western popu-lations,despite recent advances in both medicine(from virus eradication to systemic target therapies)and surgery.However,survival after proven radical surgery remains poor,with recurrences being the rule.Many prognostic scores have been developed and validated to select those patients who will best benefit from radical liver surgery,although the final general and oncological outcomes continue to be highly jeopardized.Unfortunately,no single biomarker can resolve all these issues for hepatocellular carcinoma,and it remains to be proven whether some of them main-tain predictive power in the long-term follow-up.In the ongoing era of“preci-sion”medicine,the novel prognostic markers,including immune inflammatory and nutritional indexes could be of great help in better stratify surgical candi-dates.

An optimized strategy of nitrogen-split application based on the leaf positional differences in chlorophyll meter readings

Modern rice production faces the dual challenges of increasing grain yields while reducing inputs of chemical fertilizer.However,the disequilibrium between the nitrogen(N)supplement from the soil and the demand for N of plants is a serious obstacle to achieving these goals.Plant-based diagnosis can help farmers make better choices regarding the timing and amount of topdressing N fertilizer.Our objective was to evaluate a non-destructive assessment of rice N demands based on the relative SPAD value(RSPAD)due to leaf positional differences.In this study,two field experiments were conducted,including a field experiment of different N rates(Exp.I)and an experiment to evaluate the new strategy of nitrogen-split application based on RSPAD(Exp.II).The results showed that higher N inputs significantly increased grain yield in modern high yielding super rice,but at the expense of lower nitrogen use efficiency(NUE).The N nutrition index(NNI)can adequately differentiate situations of excessive,optimal,and insufficient N nutrition in rice,and the optimal N rate for modern high yielding rice is higher than conventional cultivars.The RSPAD is calculated as the SPAD value of the top fully expanded leaf vs.the value of the third leaf,which takes into account the non-uniform N distribution within a canopy.The RSPAD can be used as an indicator for higher yield and NUE,and guide better management of N fertilizer application.Furthermore,we developed a new strategy of nitrogen-split application based on RSPAD,in which the N rate was reduced by 18.7%,yield was increased by 1.7%,and the agronomic N use efficiency was increased by 27.8%,when compared with standard farmers'practices.This strategy of N fertilization shows great potential for ensuring high yielding and improving NUE at lower N inputs.

Development of a novel critical nitrogen concentration-cumulative transpiration curve for optimizing nitrogen management under varying irrigation conditions in winter wheat

Accurate nitrogen(N)nutrition diagnosis is essential for improving N use efficiency in crop production.The widely used critical N(Nc)dilution curve traditionally depends solely on agronomic variables,neglecting crop water status.With three-year field experiments with winter wheat,encompassing two irrigation levels(rainfed and irrigation at jointing and anthesis)and three N levels(0,180,and 270 kg ha1),this study aims to establish a novel approach for determining the Nc dilution curve based on crop cumulative transpiration(T),providing a comprehensive analysis of the interaction between N and water availability.The Nc curves derived from both crop dry matter(DM)and T demonstrated N concentration dilution under different conditions with different parameters.The equation Nc=6.43T0.24 established a consistent relationship across varying irrigation regimes.Independent test results indicated that the nitrogen nutrition index(NNI),calculated from this curve,effectively identifies and quantifies the two sources of N deficiency:insufficient N supply in the soil and insufficient soil water concentration leading to decreased N availability for root absorption.Additionally,the NNI calculated from the Nc-DM and Nc-T curves exhibited a strong negative correlation with accumulated N deficit(Nand)and a positive correlation with relative grain yield(RGY).The NNI derived from the Nc-T curve outperformed the NNI derived from the Nc-DM curve concerning its relationship with Nand and RGY,as indicated by larger R2 values and smaller AIC.The novel Nc curve based on T serves as an effective diagnostic tool for assessing winter wheat N status,predicting grain yield,and optimizing N fertilizer management across varying irrigation conditions.These findings would provide new insights and methods to improve the simulations of water-N interaction relationship in crop growth models.