Skip to main content

Advertisement

SpringerLink
Log in

A large-scale study integrating nutritional indicators and clinicopathological parameters to evaluate prognosis, follow-up, and postoperative chemotherapy decisions in rectal cancer patients

  • Research
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Objective

The aim of this study was to evaluate the role of nutritional indicators and clinicopathological parameters in predicting the progression and prognosis for pathological stage II-III rectal cancer (RC) patients without neoadjuvant radiotherapy. In addition, we sought to explore the high-risk population who may require postoperative chemotherapy.

Methods

A total of 894 consecutive RC patients were enrolled in this study. Univariate and multivariate Cox analysis were performed to identify the independent risk factors for PFS and OS. The nomogram and calibration curves were conducted according to multivariable analysis result. Kaplan–Meier survival curves and log-rank tests were performed for different groups. Finally, random survival forest (RSF) model was developed to predict the probability of progression.

Results

Our results revealed that CEA level, pathological stage, tumor deposit, and PNI were independently associated with PFS in RC patients. Similarly, the results indicated that CEA level, pathological stage, tumor deposit, PNI, and NRI were independently associated with OS. RSF model revealed that group 1 had the highest risk of progression at the 12th month of follow-up, group 2 had the highest risk of progression at the 15th month of follow-up, while group 3 had the highest risk of progression at the 9th month of follow-up. Besides, subgroup analysis suggested that the high-risk group needs postoperative adjuvant chemotherapy, while patients in the low- and moderate-risk groups may not need postoperative adjuvant chemotherapy. Finally, we validated our results with the SEER database.

Conclusions

In conclusion, we demonstrated that preoperative nutritional indicator and clinicopathological parameters could act as auxiliary prognostication tools for RC patients without neoadjuvant radiotherapy. We also established follow-up strategies for different groups of patients. Collectively, incorporating nutritional assessment into risk stratification for RC resection is crucial and should be an integral part of preoperative planning.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Abbreviations

RC :

Rectal cancer

LARC :

Locally advanced rectal cancer

KPS :

Karnofsky performance status

AJCC :

American joint Committee on cancer

TNM :

Tumor-node-metastasis

CEA :

Carcinoembryonic antigen

BMI :

Body mass index

PNI :

Prognostic nutritional index

NRI :

Nutritional risk index

PAR :

Platelet to albumin ratio

CT :

Computed tomography

MRI :

Magnetic resonance imaging

PET-CT :

Positron emission tomography-CT

PFS :

Progression-free survival

OS :

Overall survival

SEER :

Surveillance, Epidemiology, and End Results

RSF :

Random survival forest

C-index :

Concordance-index

HR :

Hazard ratio

CI :

Confidence interval

References

  1. Siegel RL, Miller KD, Fuchs HE, Jemal A (2022) Cancer statistics, 2022. CA Cancer J Clin 72:7–33

    Article  PubMed  Google Scholar 

  2. Liu Z, Meng X, Zhang H, Li Z, Liu J, Sun K et al (2020) Predicting distant metastasis and chemotherapy benefit in locally advanced rectal cancer. Nat Commun 11:4308

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Dossa F, Acuna SA, Rickles AS, Berho M, Wexner SD, Quereshy FA et al (2018) Association between adjuvant chemotherapy and overall survival in patients with rectal cancer and pathological complete response after neoadjuvant chemotherapy and resection. JAMA Oncol 4:930–937

    Article  PubMed  PubMed Central  Google Scholar 

  4. Dinaux AM, Amri R, Bordeianou LG, Hong TS, Wo JY, Blaszkowsky LS et al (2017) The impact of pathologic complete response in patients with neoadjuvantly treated locally advanced rectal cancer-a large single-center experience. J Gastrointest Surg 21:1153–1158

    Article  CAS  PubMed  Google Scholar 

  5. Thanikachalam K, Khan G (2019) Colorectal cancer and nutrition. Nutrients;11

  6. Muscaritoli M, Arends J, Bachmann P, Baracos V, Barthelemy N, Bertz H et al (2021) ESPEN practical guideline: clinical nutrition in cancer. Clin Nutr 40:2898–2913

    Article  PubMed  Google Scholar 

  7. Tisdale MJ (2002) Cachexia in cancer patients. Nat Rev Cancer 2:862–871

    Article  CAS  PubMed  Google Scholar 

  8. Iseki Y, Shibutani M, Maeda K, Nagahara H, Tamura T, Ohira G et al (2017) The impact of the preoperative peripheral lymphocyte count and lymphocyte percentage in patients with colorectal cancer. Surg Today 47:743–754

    Article  CAS  PubMed  Google Scholar 

  9. Arends J, Baracos V, Bertz H, Bozzetti F, Calder PC, Deutz NEP et al (2017) ESPEN expert group recommendations for action against cancer-related malnutrition. Clin Nutr 36:1187–1196

    Article  CAS  PubMed  Google Scholar 

  10. Lai CC, You JF, Yeh CY, Chen JS, Tang R, Wang JY et al (2011) Low preoperative serum albumin in colon cancer: a risk factor for poor outcome. Int J Colorectal Dis 26:473–481

    Article  PubMed  Google Scholar 

  11. Hu WH, Eisenstein S, Parry L, Ramamoorthy S (2019) Preoperative malnutrition with mild hypoalbuminemia associated with postoperative mortality and morbidity of colorectal cancer: a propensity score matching study. Nutr J 18:33

    Article  PubMed  PubMed Central  Google Scholar 

  12. Yamano T, Yoshimura M, Kobayashi M, Beppu N, Hamanaka M, Babaya A et al (2016) Malnutrition in rectal cancer patients receiving preoperative chemoradiotherapy is common and associated with treatment tolerability and anastomotic leakage. Int J Colorectal Dis 31:877–884

    Article  PubMed  PubMed Central  Google Scholar 

  13. Burden S, Todd C, Hill J, Lal S (2012) Pre-operative nutrition support in patients undergoing gastrointestinal surgery. Cochrane Database Syst Rev 11:CD008879

    PubMed  Google Scholar 

  14. Xu J, Zhong Y, Jing D, Wu Z (2006) Preoperative enteral immunonutrition improves postoperative outcome in patients with gastrointestinal cancer. World J Surg 30:1284–1289

    Article  PubMed  Google Scholar 

  15. Baracos VE (2018) Cancer-associated malnutrition. Eur J Clin Nutr 72:1255–1259

    Article  PubMed  Google Scholar 

  16. Schiessel DL, Baracos VE (2018) Barriers to cancer nutrition therapy: excess catabolism of muscle and adipose tissues induced by tumour products and chemotherapy. Proc Nutr Soc 77:394–402

    Article  CAS  PubMed  Google Scholar 

  17. Lee DU, Fan GH, Hastie DJ, Addonizio EA, Suh J, Prakasam VN et al (2021) The clinical impact of malnutrition on the postoperative outcomes of patients undergoing colorectal resection surgery for colon or rectal cancer: propensity score matched analysis of 2011–2017 US hospitals. Surg Oncol 38:101587

    Article  PubMed  Google Scholar 

  18. Mahar AL, Compton C, Halabi S, Hess KR, Weiser MR, Groome PA (2017) Personalizing prognosis in colorectal cancer: a systematic review of the quality and nature of clinical prognostic tools for survival outcomes. J Surg Oncol 116:969–982

    Article  PubMed  PubMed Central  Google Scholar 

  19. Yang Y, Gao P, Chen X, Song Y, Shi J, Zhao J et al (2016) Prognostic significance of preoperative prognostic nutritional index in colorectal cancer: results from a retrospective cohort study and a meta-analysis. Oncotarget 7:58543–58552

    Article  PubMed  PubMed Central  Google Scholar 

  20. Yang Y, Gao P, Song Y, Sun J, Chen X, Zhao J et al (2016) The prognostic nutritional index is a predictive indicator of prognosis and postoperative complications in gastric cancer: a meta-analysis. Eur J Surg Oncol 42:1176–1182

    Article  CAS  PubMed  Google Scholar 

  21. Kouzu K, Tsujimoto H, Sugasawa H, Ishibashi Y, Hase K, Kishi Y et al (2021) Modified geriatric nutrition risk index as a prognostic predictor of esophageal cancer. Esophagus 18:278–287

    Article  PubMed  Google Scholar 

  22. Kanda M, Fujii T, Kodera Y, Nagai S, Takeda S, Nakao A (2011) Nutritional predictors of postoperative outcome in pancreatic cancer. Br J Surg 98:268–274

    Article  CAS  PubMed  Google Scholar 

  23. Jian-Hui C, Iskandar EA, Cai ShI, Chen CQ, Wu H, Xu JB et al (2016) Significance of onodera’s prognostic nutritional index in patients with colorectal cancer: a large cohort study in a single Chinese institution. Tumour Biol 37:3277–3283

    Article  PubMed  Google Scholar 

  24. Okugawa Y, Toiyama Y, Oki S, Ide S, Yamamoto A, Ichikawa T et al (2018) Feasibility of assessing prognostic nutrition index in patients with rectal cancer who receive preoperative chemoradiotherapy. JPEN J Parenter Enteral Nutr 42:998–1007

    Article  CAS  PubMed  Google Scholar 

  25. Ray-Coquard I, Cropet C, Van Glabbeke M, Sebban C, Le Cesne A, Judson I et al (2009) Lymphopenia as a prognostic factor for overall survival in advanced carcinomas, sarcomas, and lymphomas. Cancer Res 69:5383–5391

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Iseki Y, Shibutani M, Maeda K, Nagahara H, Ohtani H, Sugano K et al (2015) Impact of the Preoperative Controlling Nutritional Status (CONUT) Score on the survival after curative surgery for colorectal cancer. PLoS ONE 10:e0132488

    Article  PubMed  PubMed Central  Google Scholar 

  27. Kathiresan AS, Brookfield KF, Schuman SI, Lucci JA 3rd (2011) Malnutrition as a predictor of poor postoperative outcomes in gynecologic cancer patients. Arch Gynecol Obstet 284:445–451

    Article  CAS  PubMed  Google Scholar 

  28. Kanda M, Mizuno A, Tanaka C, Kobayashi D, Fujiwara M, Iwata N et al (2016) Nutritional predictors for postoperative short-term and long-term outcomes of patients with gastric cancer. Medicine (Baltimore) 95:e3781

    Article  CAS  PubMed  Google Scholar 

  29. Cai B, Chen H, Sun H, Wan P, Sun H, Pan J (2016) Production of immunoregulatory polysaccharides from Crassostrea hongkongensis and their positive effects as a nutrition factor in modulating the effectiveness and toxicity of 5-FU chemotherapy in mice. Food Funct 7:390–397

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

We thank all the investigators and patients who participated in the present study.

Funding

This work was supported by the Joint Funds for the National Clinical Key Specialty Construction Program (Grant No. 2021), the Fujian Provincial Clinical Research Center for Cancer Radiotherapy and Immunotherapy (Grant No. 2020Y2012), and Fujian Clinical Research Center for Radiation and Therapy of Digestive, Respiratory and Genitourinary Malignancies (Grant No. 2021Y2014).

Author information

Authors and Affiliations

  1. Department of Radiation Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, Fujian, China

    Yilin Yu, Junxin Wu, Zhiping Wang, Shiji Wu, Liang Hong & Lingdong Shao

  2. Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China

    Haixia Wu

  3. Department of Radiation Oncology, Fujian Medical University Union Hospital, Fuzhou, Fujian, China

    Benhua Xu

Authors
  1. Yilin Yu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Junxin Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Haixia Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Zhiping Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Shiji Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Liang Hong
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Benhua Xu
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Lingdong Shao
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

YY, JW, HW, ZW, BX, and LS designed this study. YY, HW, SW, and LH contributed to the data collection. YY, HW, and ZW analyzed the data. JW, BX, and LS supervised the study. YY, HW, and ZW wrote the manuscript. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Junxin Wu, Benhua Xu or Lingdong Shao.

Ethics declarations

Ethical approval and consent to participate

The current study was approved by the ethics committee of Fujian Medical University Cancer Hospital (K2021-050–01), Fuzhou, China, and conducted in accordance with the principles of the Declaration of Helsinki and its amendment. All patients provided written informed consent prior to treatment, and all the information was anonymized prior to analysis.

Consent for publication

The manuscript has been approved by all authors for publication.

Competing interests

The authors declare no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Yilin Yu, Haixia Wu and Zhiping Wang contributed equally as first authors to this manuscript.

Junxin Wu, Benhua Xu and Lingdong Shao contributed equally as corresponding authors to this manuscript.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yu, Y., Wu, J., Wu, H. et al. A large-scale study integrating nutritional indicators and clinicopathological parameters to evaluate prognosis, follow-up, and postoperative chemotherapy decisions in rectal cancer patients. Support Care Cancer 31, 686 (2023). https://doi.org/10.1007/s00520-023-08147-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s00520-023-08147-x

Keywords

Search

Navigation