Compromised nutritional, immunological status ups infection risk after gastric cancer surgery

Infection is a common complication in gastric cancer stage II/III patients after gastrectomy, a recent study has found. A low prognostic nutritional index (PNI) score seems to be an important risk factor for such an outcome.

Researchers retrospectively reviewed the medical records of 2,352 consecutive stage II/III gastric cancer patients (mean age 56.05 years, 66.5 percent men), all of whom underwent radical gastrectomy. The mean PNI score was 47.47. More than a quarter (26.9 percent) had PNI score <43.9 and were thus diagnosed to have poor nutritional and immunological status.

Over the study duration, 160 patients developed a total of 187 infectious complications, most of which were intra-abdominal in nature (n=96). Multivariate regression analysis found that PNI <43.9 was a strong and independent risk factor for infections, increasing such likelihood by nearly 70 percent (odds ratio, 1.694, 95 percent confidence interval [CI], 1.200–2.392; p=0.003).

Other significant risk factors for infectious complications were operation time ≥240 minutes, the presence of comorbidities, and body mass index ≥25 kg/m².

In turn, poor nutritional and immunological status worsened survival, with a mortality rate of 48.0 percent among patients with PNI <43.9, as opposed to only 38.0 percent in those with PNI ≥43.9 (p<0.001). This was confirmed by multivariate analysis (hazard ratio, 1.163, 95 percent CI, 1.007–1.343; p=0.039).

“Both low PNI and infections adversely impacted on survival times, and an additive impact was verified in patients who had low PNI and developed infections,” the researchers said. “Thus, strategies to decrease the incidence of postoperative infection and to complete the planned chemotherapy is essential for stage II/III gastric cancer patients with low PNI to improve their survival times.”

“Perioperative immunonutrition supplementation and NAC seem to be possible approaches, but further prospective studies are required,” they added.