Comparison of three nutritional scoring systems for outcomes after complete resection of non-small cell lung cancer

Lung Cancer
10/08/2020

J Thorac Cardiovasc Surg. 2020 Jun 29:S0022-5223(20)31751-7. doi: 10.1016/j.jtcvs.2020.06.030. Online ahead of print.

ABSTRACT

OBJECTIVES: Mounting evidence suggests that preoperative nutritional status can predict postoperative outcomes in patients with non-small cell lung cancer. However, a consensus on the optimal evaluation tool among the various nutritional assessment methods has not been reached. This study aimed at validating the predictive value of 3 nutritional scoring systems for clinical outcomes in patients with completely resected non-small cell lung cancer.

METHODS: We retrospectively reviewed the preoperative data of 475 consecutive patients with completely resected non-small cell lung cancer to assess the following 3 albumin-based nutritional methods: prognostic nutritional index, controlling nutritional status score, and geriatric nutritional risk index.

RESULTS: Receiver operating characteristic curves of the prognostic nutritional index, controlling nutritional status score, and geriatric nutritional risk index identified the optimal cutoff values for predicting the postoperative complications as 47, 2, and 101, respectively. Stratification of patients using these cutoff values indicated a higher postoperative complication rate in the malnutrition group than in the group with proper nutrition (P < .05 for all nutritional assessment methods). Additionally, patients with malnutrition exhibited significantly lower 5-year overall and recurrence-free survivals, regardless of the assessment method (P < .05 for all 3 nutritional assessment methods). Multivariate analyses showed that all 3 nutritional parameters were independent prognostic factors for overall survival after lung resection.

CONCLUSIONS: The 3 nutritional assessment methods we used were found to have high predictive values for postoperative complications and survival. Preoperative nutritional conditioning may improve the postoperative outcomes in patients with resectable non-small cell lung cancer.