Impact of Nutritional Indices on the Survival Outcomes of Patients with Colorectal Cancer

Figures & data

Table 1 Clinicopathological Characteristics of Patients with Colon and Rectal Cancer

Characteristic	Colon Cancer	Rectal Cancer
	n=180 (%)	n=181 (%)
Age	63.0 (61.0±14.3)	61.0 (60.1±14.6)
≤60 y	86 (47.8)	87 (48.1)
>60 y	94 (52.2)	94 (51.9)
Gender
Male	104 (57.8)	115 (63.5)
Female	76 (42.2)	66 (36.5)
Tumor Size
≤5cm	114 (63.3)	155 (85.6)
>5cm	66 (36.7)	26 (14.4)
Morphological type
Elevated	42 (23.3)	54 (29.8)
Ulcerated	120 (66.7)	112 (61.9)
Infiltrated	18 (10.0)	15 (8.3)
Tumor deposits
Negative	152 (84.4)	141 (77.9)
Positive	28 (15.6)	40 (22.1)
TNM stage
I/II	112 (62.2)	95 (52.5)
III/IV	68 (37.8)	86 (47.5)
PAB
≤170mg/L	52 (28.9)	24 (13.3)
>170mg/L	128 (71.1)	157 (86.7)
PNI
Low	92 (51.1)	10 (5.5)
High	88 (48.9)	171 (94.5)
AGR
Low	60 (33.3)	104 (57.5)
High	120 (66.7)	77 (42.5)

Notes: In colon cancer, the cut off values of PNI and AGR are 48.225 and 1.325, respectively. In rectal cancer, the cut off values of PNI and AGR are 39.625 and 1.615, respectively.

Abbreviations: PAB, Prealbumin; PNI, Prognostic nutritional index; AGR, Albumin to globulin ratio; TNM, T, Tumor (Topography), N, Lymph Node, M, Metastasis.

Figure 1 Schematic flow diagram of inclusion and exclusion criteria for our study cohort.

Table 2 Clinicopathological Characteristics of Colon and Rectal Cancer Associated with OS

Characteristic	Colon Cancer		Rectal Cancer
	OS (Months) [Mean (95% CI)]	P value	OS (Months) [Mean (95% CI)]	P value
Age
≤60 y	71.9 (66.6–77.2)	0.067	63.9 (57.8–70.0)	0.323
>60 y	63.9 (58.2–69.7)		60.4 (54.6–66.1)
Gender
Male	69.1 (64.0–74.1)	0.337	64.3 (59.6–69.0)	0.814
Female	65.8 (59.5–72.1)		58.3 (50.3–66.3)
Tumor Size
≤5cm	70.6 (66.1–75.2)	0.015	61.9 (57.3–66.5)	0.645
>5cm	62.8 (55.5–70.0)		62.7 (53.2–72.3)
Morphological type
Elevated	66.0 (57.6–74.4)	0.881	67.6 (61.1–74.1)	0.059
Ulcerated	68.5 (63.8–73.2)		60.6 (54.9–66.2)
Infiltrated	59.7 (47.3–72.1)		49.2 (39.2–59.2)
Tumor deposits
Negative	70.2 (66.2–74.3)	0.002	65.2 (60.6–69.8)	0.001
Positive	53.5 (42.1–64.9)		51.3 (42.3–60.2)
TNM stage
I/II	77.1 (73.6–80.5)	<0.0001	71.2 (66.6–75.9)	<0.0001
III/IV	52.5 (45.1–60.0)		50.8 (44.5–57.1)
PAB
≤170mg/L	56.0 (48.1–63.9)	<0.0001	49.9 (37.2–62.6)	0.031
>170mg/L	72.5 (68.2–76.8)		63.8 (59.5–68.2)
PNI
Low	59.3 (52.9–65.7)	<0.0001	21.8 (7.3–36.3)	<0.0001
High	76.8 (73.0–80.6)		64.5 (60.4–68.5)
AGR
Low	52.7 (45.0–60.4)	<0.0001	58.5 (53.0–64.0)	0.038
High	74.6 (70.8–78.5)		66.4 (60.1–72.6)

Notes: P-value<0.05 are shown in bold. In colon cancer, the cut off values of PNI and AGR are 48.225 and 1.325, respectively. In rectal cancer, the cut off values of PNI and AGR are 39.625 and 1.615, respectively.

Abbreviations: PAB, Prealbumin; PNI, Prognostic nutritional index; AGR, Albumin to globulin ratio; TNM, T, Tumor (Topography), N, Lymph Node, M, Metastasis; OS, overall survival; CI, confidence interval.

Figure 2 Kaplan-Meier survival curves of different variables in patients with colon cancer. (A) Tumor size; (B) Tumor deposits; (C) TNM stage; (D) Prealbumin (PAB); (E) Prognostic nutritional index (PNI); (F) Albumin and globulin ratio (AGR).

Abbreviations: TNM stage, T, Tumor (Topography), N, Lymph Node, M, Metastasis.

Figure 3 Kaplan-Meier survival curves of different variables in patients with rectal cancer. (A) Tumor size; (B) Tumor deposits; (C) TNM stage; (D) Prealbumin (PAB); (E) Prognostic nutritional index (PNI); (F) Albumin and globulin ratio (AGR).

Abbreviations: TNM stage, T, Tumor (Topography), N, Lymph Node, M, Metastasis.

Table 3 Univariate and Multivariate Analysis of Prognostic Factors for Overall Survival (OS) of Colon Cancer Patients

Characteristic	Univariate Analysis		Multivariate Analysis
	Hazard Ratio [95%CI]	P value	Hazard Ratio [95%CI]	P value
Age
≤60 y	1
>60 y	1.691 [0.951–3.000]	0.072
Gender
Male	1
Female	1.303 [0.755–2.247]	0.342
Tumor Size
≤5cm	1		1
>5cm	1.933 [1.120–3.335]	0.018	-	0.985
Morphological type
Elevated	1
Ulcerated	1.165 [0.601–2.259]	0.651
Infiltrated	1.008 [0.321–3.169]	0.989
Tumor deposits
Negative	1		1
Positive	2.575 [1.387–4.780]	0.003	0.472 [0.234–0.954]	0.037
TNM stage
I/II	1		1
III/IV	7.137 [3.734–13.639]	<0.0001	9.002 [4.372–18.536]	<0.0001
PAB
≤170mg/L	1		1
>170mg/L	0.267 [0.154–0.465]	<0.0001	-	0.482
PNI
Low	1		1
High	0.226 [0.113–0.452]	<0.0001	0.479 [0.233–0.985]	0.045
AGR
Low	1		1
High	0.241 [0.136–0.428]	<0.0001	0.230 [0.121–0.435]	<0.0001

Notes: P-value<0.05 are shown in bold. In colon cancer, the cut off values of PNI and AGR are 48.225 and 1.325, respectively. In rectal cancer, the cut off values of PNI and AGR are 39.625 and 1.615, respectively.

Abbreviations: PAB, Prealbumin; PNI, Prognostic nutritional index; AGR, Albumin to globulin ratio; TNM, T, Tumor (Topography), N, Lymph Node, M, Metastasis; OS, overall survival; CI, confidence interval.

Table 4 Univariate and Multivariate Analysis of Prognostic Factors for Overall Survival (OS) of Rectal Cancer Patients

Characteristic	Univariate Analysis		Multivariate Analysis
	Hazard Ratio [95%CI]	P value	Hazard Ratio [95%CI]	P value
Age
≤60 y	1
>60 y	1.267 [0.789–2.036]	0.327
Gender
Male	1
Female	1.061 [0.647–1.738]	0.816
Tumor Size
≤5cm	1
>5cm	1.156 [0.621–2.154]	0.647
Morphological type
Elevated	1
Ulcerated	1.336 [0.768–2.323]	0.305
Infiltrated	2.508 [1.150–5.472]	0.021
Tumor deposits
Negative	1		1
Positive	2.209 [1.344–3.631]	0.002	-	0.927
TNM stage
I/II	1		1
III/IV	3.305 [1.987–5.495]	<0.0001	2.816 [1.662–4.771]	<0.0001
PAB
≤170mg/L	1		1
>170mg/L	0.532 [0.296–0.956]	0.035	-	0.353
PNI
Low	1		1
High	0.141 [0.071–0.280]	<0.0001	0.225 [0.111–0.454]	<0.0001
AGR
Low	1		1
High	0.591 [0.357–0.980]	0.042	-	0.366

Notes: P-value<0.05 are shown in bold. In colon cancer, the cut off values of PNI and AGR are 48.225 and 1.325, respectively. In rectal cancer, the cut off values of PNI and AGR are 39.625 and 1.615, respectively.

Abbreviations: PAB, Prealbumin; PNI, Prognostic nutritional index; AGR, Albumin to globulin ratio; TNM, T, Tumor (Topography), N, Lymph Node, M, Metastasis; OS, overall survival; CI, confidence interval.

Table 5 The Area Under the Curve (AUC) of PAB, PNI and AGR in Patients with Colon and Rectal Cancer

Characteristics	Colon Cancer			Rectal Cancer
	AUC	95% CI	P value	Area	95% CI	P value
PAB	0.703	[0.630–0.768]	<0.0001	0.555	[0.479–0.629]	0.209
PNI	0.709	[0.636–0.774]	<0.0001	0.571	[0.496–0.645]	0.641
AGR	0.671	[0.597–0.739]	<0.0001	0.591	[0.515–0.663]	0.017

Notes: P-value<0.05 are shown in bold. In colon cancer, the cut off values of PNI and AGR are 48.225 and 1.325, respectively. In rectal cancer, the cut off values of PNI and AGR are 39.625 and 1.615, respectively.

Abbreviations: AUC, Area under the curve; CI, confidence interval; PAB, Prealbumin; PNI, Prognostic nutritional index; AGR, Albumin to globulin ratio.

Figure 4 Receiver operating characteristic (ROC) analysis of prealbumin (PAB), prognostic nutritional index (PNI), and albumin and globulin ratio (AGR) in colon and rectal cancer. (A) Colon cancer; (B) Rectal cancer.