Naples Skoru: Mide Kanseri Ölümlerini Tahmin Etmede Mevcut Skorlardan Daha İyi Performans Gösterebilir mi?

Year 2024, , 331 - 339, 14.10.2024

Bahadır Kartal , Mehmet Berksun Tutan , Fatih Şahin , Ertugrul Gazi Alkurt

https://doi.org/10.52827/hititmedj.1516777

Abstract

Amaç: Küratif ve palyatif prosedürler dahil olmak üzere mide kanseri cerrahisi, mide kanserinin yönetiminde çok önemlidir. Beslenme durumunun doğru değerlendirilmesi, risk sınıflandırması ve hasta sonuçlarının iyileştirilmesi için esastır. Bu retrospektif çalışma, dört beslenme skoru ile mide kanseri cerrahisi sonrası mortalite oranı arasındaki ilişkiyi inceleyerek postoperatif mortalitenin en güvenilir öngörücülerini belirlemeyi amaçlamaktadır.
Gereç ve Yöntem: Bu retrospektif çalışma, Nisan 2021 ile Eylül 2023 arasında Hitit Üniversitesi Genel Cerrahi Kliniğinde ameliyat edilen mide adenokarsinomu tanısı konulan 50 hastayı değerlendirdi. Beslenme skorları, albümin, kolesterol, nötrofil-lenfosit oranı, lenfosit-monosit oranı ve mortalite oranları kullanılarak hesaplandı. Toplanan veriler arasında yaş, cinsiyet, operasyon tipi, laparoskopi kullanımı, albümin, kolesterol, nötrofil-lenfosit oranı, lenfosit-monosit oranı, mortalite oranları ve TNM evreleri yer aldı. Beslenme skorları hesaplandı ve mortaliteyi öngörmedeki doğrulukları zaman bağımlı Alıcı İşletim Karakteristik eğrisi analizi kullanılarak değerlendirildi.
Bulgular: Albümin seviyeleri, nötrofil-lenfosit oranı, lenfosit-monosit oranı ve beslenme skorları arasında ölen ve hayatta kalan hastalar arasında anlamlı farklılıklar bulundu. Özellikle, albümin seviyeleri ölen hastalarda (medyan = 3,5 mg/dL) hayatta kalan hastalara kıyasla (medyan = 4,1 mg/dL, p=0,001) anlamlı derecede daha düşüktü. Ölen hastalarda medyan nötrofil-lenfosit oranı daha yüksekti (p=0,005) ve medyan lenfosit-monosit oranı daha düşüktü (p=0,009). Skorlar arasında, Naples Prognostic Skoru mortalite ile anlamlı derecede ilişkiliydi ancak Prognostic Nutritional Index tarafından aşıldı. Prognostic Nutritional Index, 0,792’lik bir eğri altındaki alan, %76 duyarlılık ve %86,2 özgüllük ile en yüksek öngörü doğruluğuna sahipti ve diğerlerini geride bıraktı.
Sonuç: Değerlendirilen skorlar arasında, Prognostic Nutritional Index prognozun en etkili öngörücüsüdür. Üstün öngörü doğruluğu, PNI’nin mide kanseri cerrahisi geçiren hastalarda risk değerlendirmesini geliştirmek ve beslenme müdahalelerini yönlendirmek için kullanılabileceğini önermektedir.

Keywords

Mide kanseri, mortalite, öngörücü

The Naples Score: Can it Outperform Existing Scores in Predicting Gastric Cancer Mortality?

Abstract

Objective: Gastric cancer surgery, including curative and palliative procedures, is crucial for managing gastric cancer. Accurate assessment of nutritional status is essential for risk stratification and improving patient outcomes. This retrospective study aims to identify the most reliable predictors of postoperative mortality by investigating the correlation between four nutritional scores and the mortality rate following gastric cancer surgery.
Material and Method: This retrospective study evaluated 50 patients diagnosed with gastric adenocarcinoma and operated on at Hitit University Department of General Surgery between April 2021 and September 2023. Nutritional scores were calculated using albumin, cholesterol, neutrophil-to-lymphocyte ratio, and lymphocyte-to-monocyte ratio, along with mortality rates. Data collected included age, gender, operation type, laparoscopy usage, albumin, cholesterol, neutrophil-to-lymphocyte ratio, lymphocyte-to-monocyte ratio, mortality rates, and TNM stages. Nutritional scores were calculated, and their predictive accuracy for mortality was assessed using time-dependent Receiver Operating Characteristic curve analysis.
Results: Significant differences in albumin levels, neutrophil-to-lymphocyte ratio, lymphocyte-to-monocyte ratio, and nutritional scores were found between deceased and surviving patients. Specifically, albumin levels were significantly lower in deceased patients (median = 3.5 mg/dL) compared to surviving patients (median = 4.1 mg/ dL, p=0.001). The median neutrophil-to-lymphocyte ratio was higher in deceased patients (p=0.005), and the median lymphocyte-to-monocyte ratio was lower in deceased patients (p=0.009). Among the scores, the Naples Prognostic Score was significantly associated with mortality but was outperformed by the Prognostic Nutritional Index. The Prognostic Nutritional Index had the highest predictive accuracy with an Area Under the curve of 0.792, a sensitivity of 76%, and a specificity of 86.2%, outperforming the others.
Conclusion: Among the evaluated scores, the Prognostic Nutritional Index is the most effective predictor of prognosis. Its superior predictive accuracy suggests that the PNI can be utilized to enhance risk assessment and guide nutritional interventions in gastric cancer patients undergoing surgery.

Keywords

Gastric cancer, mortality, predictor

Ethical Statement

This research received ethical approval from the Institutional Review Board of the Hitit University Faculty of Medicine Clinical Research Ethics Committee (Protocol Number: 2023/178).

Supporting Institution

The funder had no role in the design, data collection, data analysis or reporting of this study

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