Relation between preoperative hypoproteinemia and survival prognosis in patients with colorectal cancer after surgery: A real-world data study based on DACCA database_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZHANG Xianglin ^1,2 , WANG Yiqi ^1,3 , ZHENG Yafang ^1,2 , YE Jiaqi ^1,2 ,  WANG Xiaodong ¹ , YANG Lie ¹

1. Division of Gastrointestinal Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
2. West China School of Medicine, Sichuan University, Chengdu 610041, P. R. China;
3. West China School of Public Health, Sichuan University, Chengdu 610041, P. R. China;

Corresponding?author：

WANG Xiaodong, Email: wangxiaodong@wchscu.cn

Keywords：

colorectal cancer; hypoproteinemia; survival prognosis; preoperative physical conditions

DOI：

10.7507/1007-9424.202412010

Video：

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Objective To analyze the effects of preoperative protein level on the survival prognosis of patients underwent colorectal cancer (CRC) surgery in the current Database from Colorectal Cancer (DACCA). Methods According to the established screening criteria, the patient information was extracted from the updated version of DACCA on April, 2024. The survival curves of the patients with and without preoperative hypoproteinemia were plotted by Kaplan-Meier method and the log-rank test was used to compare. The univariate and multivariate Cox proportional hazards regression model were used to analyze the preoperative hypoproteinemia affecting postoperative survival (overall survival and disease-specific survival) of patients with CRC. The test level was α=0.05. Results A total of 1 217 patients with CRC were included, and 252 of 1 217 patients with preoperative hypoproteinemia, with an incidence of 20.7%. The survival curves showed that the overall survival and disease-specific survival of the patients with preoperative hypoproteinemia were worse than those without preoperative hypoproteinemia (χ²=43.411, P<0.001; χ²=41.171, P<0.001). However, the multivariate Cox proportional hazards regression model analysis did not find that the preoperative hypoproteinemia was a risk factor for postoperative survival (overall survival and disease-specific survival as observed indicators) in the patients with CRC [overall survival: HR (95%CI)=1.013 (0.741, 1.385), P=0.938; disease-specific survival: HR (95%CI)=1.003 (0.719, 1.399), P=0.987].Conclusion The results of this study suggest that the incidence rate of preoperative hypoproteinemia in patients with CRC is higher and its survival prognosis is worse than that in patients without preoperative hypoproteinemia.

Citation： ZHANG Xianglin, WANG Yiqi, ZHENG Yafang, YE Jiaqi, WANG Xiaodong, YANG Lie. Relation between preoperative hypoproteinemia and survival prognosis in patients with colorectal cancer after surgery: A real-world data study based on DACCA database. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2025, 32(1): 67-73. doi: 10.7507/1007-9424.202412010 Copy

1.	汪曉東, 李立. 數據庫建設第一部分: 個人數據的標簽與結構化. 中國普外基礎與臨床雜志, 2019, 26(3): 335-342.
2.	汪曉東, 呂炘沂, 黃明君, 等. 數據庫建設第二部分: 結直腸癌住院流程管理的標簽與結構化. 中國普外基礎與臨床雜志, 2019, 26(7): 852-855.
3.	汪曉東, 劉健博, 李立. 數據庫建設第三部分: 結直腸癌內外科合并癥及術前體質狀態的標簽與結構化. 中國普外基礎與臨床雜志, 2019, 26(9): 1110-1115.
4.	蔣志強, 李亞蘭, 韓廣森, 等. 術前血清白蛋白水平與結腸癌臨床病理特征及生存預后的關系. 中華胃腸外科雜志, 2016, 19(1): 80-83.
5.	Sofi? A, Ra?i? I, Halilovi? E, et al. Is preoperative hypoproteinemia associated with colorectal cancer stage and postoperative complications? Med Glas (Zenica), 2021, 18(2): 450-455.
6.	康靜, 蔣運蘭, 李滔, 等. 結直腸癌患者術后并發肺部感染影響因素的Meta分析. 數理醫藥學雜志, 2024, 37(10): 746-760.
7.	吳秀文, 張旭飛, 陽怡羽, 等. 2018–2020年中國結直腸術后手術部位感染現狀研究. 中華胃腸外科雜志, 2022, 25(9): 804-811.
8.	李亞萍, 寇志堅, 閻文軍. 結直腸癌圍手術期低蛋白血癥的研究進展. 中國醫學創新, 2023, 20(7): 182-188.
9.	汪曉東, 劉健博, 張詩, 等. 數據庫研究第三部分: 結直腸癌的內外科合并癥及術前體質狀態. 中國普外基礎與臨床雜志, 2019, 26(8): 985-991.
10.	汪曉東, 劉健博, 安麗珉, 等. 數據庫建設第四部分: 結直腸癌的術前專科檢查與評估, 2019, 25(11): 1337-1341.
11.	Kondrup J, Rasmussen HH, Hamberg O, et al. Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials. Clin Nutr, 2003, 22(3): 321-336.
12.	汪曉東, 劉健博, 李立. 數據庫建設第五部分·結直腸癌的腫瘤特征—模塊的設計(二). 中國普外基礎與臨床雜志, 2020, 27(04): 483-488.
13.	黃理賓, 黃秋實, 楊烈. 全球及中國的結直腸癌流行病學特征及防治: 2022《全球癌癥統計報告》解讀. 中國普外基礎與臨床雜志, 2024, 31(5): 530-537.
14.	Truong A, Hanna MH, Moghadamyeghaneh Z, et al. Implications of preoperative hypoalbuminemia in colorectal surgery. World J Gastrointest Surg, 2016, 8(5): 353-362.
15.	李倩, 姜韞赟, 李玲玲, 等. 低蛋白血癥的臨床研究進展. 世界中西醫結合雜志, 2011, 6(5): 438-439, 442.
16.	Hu WH, Eisenstein S, Parry L, Ramamoorthy S. Preoperative malnutrition with mild hypoalbuminemia associated with postoperative mortality and morbidity of colorectal cancer: a propensity score matching study. Nutr J, 2019, 18(1): 33. doi: 10.1186/s12937-019-0458-y.
17.	Garth AK, Newsome CM, Simmance N, et al. Nutritional status, nutrition practices and post-operative complications in patients with gastrointestinal cancer. J Hum Nutr Diet, 2010, 23(4): 393-401.
18.	Lai CC, You JF, Yeh CY, et al. Low preoperative serum albumin in colon cancer: a risk factor for poor outcome. Int J Colorectal Dis, 2011, 26(4): 473-481.
19.	王海燕, 曹紅十, 劉素敏, 等. 結直腸癌患者營養狀況影響因素的研究進展. 現代臨床護理, 2019, 18(8): 77-81.
20.	周春燕, 牟文蓮, 代小紅, 等. 全周期營養管理對結直腸癌術后化療患者的營養狀況及化療不良反應影響. 臨床護理研究, 2023, 32(20): 149-151.
21.	孫雙丹. 結直腸癌患者腹腔鏡術后發生動力性腸梗阻的影響因素分析. 中國民康醫學, 2022, 34(16): 1-4.
22.	Franch-Arcas G. The meaning of hypoalbuminaemia in clinical practice. Clin Nutr, 2001, 20(3): 265-269.
23.	Lai C, You J, Yeh C, et al. Low preoperative serum albumin in colon cancer: a risk factor for poor outcome. Int J Colorectal Dis, 2011, 26(4): 473-481.
24.	Nazha B, Moussaly E, Zaarour M, et al. Hypoalbuminemia in colorectal cancer prognosis: nutritional marker or inflammatory surrogate? World J Gastrointest Surg2015, 7(12): 370-377.
25.	Cengiz O, Kocer B, Sürmeli S, et al. Are pretreatment serum albumin and cholesterol levels prognostic tools in patients with colorectal carcinoma? Med Sci Monit, 2006, 12(6): CR240-CR247.
26.	郭蘭偉, 張興龍, 蔡林, 等. 全球結直腸癌流行和防控現狀. 中華腫瘤雜志, 2024, 46(1): 57-65.
27.	van Westreenen HL, Ijpma FF, Wevers KP, et al. Reoperation after colorectal surgery is an independent predictor of the 1-year mortality rate. Dis Colon Rectum, 2011, 54(11): 1438-1442.
28.	吳澤生, 高華, 張文斌, 等. 結直腸癌患者術后非計劃再手術的危險因素分析. 中華胃腸外科雜志, 2015, 18(5): 483-486.
29.	葉子, 周凡琳, 饒佳媛, 等. 結直腸癌患者的文化程度對長期預后的影響: 基于DACCA的真實世界數據研究. 中國普外基礎與臨床雜志, 2024, 31(4): 427-432.
30.	Liu XY, Zhang X, Ruan GT, et al. Relationship between educational level and survival of patients with cancer: A multicentre cohort study. Cancer Med, 2024, 13(7): e7141. doi: 10.1002/cam4.7141.Liu XY, Zhang X, Ruan GT, et al. Relationship between educational level and survival of patients with cancer: A multicentre cohort study. Cancer Med, 2024, 13(7): e7141. doi: 10.1002/cam4.7141.
31.	Negrichi S, Taleb S. Evaluation of nutritional status of colorectal cancer patients from Algerian East using anthropometric measurements and laboratory assessment. Iran J Public Health, 2020, 49(7): 1242-1251.
32.	Kwag SJ, Kim JG, Kang WK, et al. The nutritional risk is a independent factor for postoperative morbidity in surgery for colorectal cancer. Ann Surg Treat Res, 2014, 86(4): 206-211.
33.	王罡艷, 羅會華. 營養不良相關因素及代謝相關通路對結直腸癌患者預后的影響. 中國現代普通外科進展, 2019, 22(6): 496-498.
34.	唐翠娟, 榮震, 莫春梅, 等. 惡性腫瘤代謝特點及其與炎性介質的相關性研究進展. 腫瘤防治研究, 2019, 46(5): 476-481.
35.	曹子龍, 任霖霖, 馬竟優, 等. 進展期結直腸癌血清白蛋白下降與IL-6、TNF-α和CRP的相關性研究. 轉化醫學電子雜志, 2015, 2(5): 76-76, 78.

1. 汪曉東, 李立. 數據庫建設第一部分: 個人數據的標簽與結構化. 中國普外基礎與臨床雜志, 2019, 26(3): 335-342.
2. 汪曉東, 呂炘沂, 黃明君, 等. 數據庫建設第二部分: 結直腸癌住院流程管理的標簽與結構化. 中國普外基礎與臨床雜志, 2019, 26(7): 852-855.
3. 汪曉東, 劉健博, 李立. 數據庫建設第三部分: 結直腸癌內外科合并癥及術前體質狀態的標簽與結構化. 中國普外基礎與臨床雜志, 2019, 26(9): 1110-1115.
4. 蔣志強, 李亞蘭, 韓廣森, 等. 術前血清白蛋白水平與結腸癌臨床病理特征及生存預后的關系. 中華胃腸外科雜志, 2016, 19(1): 80-83.
5. Sofi? A, Ra?i? I, Halilovi? E, et al. Is preoperative hypoproteinemia associated with colorectal cancer stage and postoperative complications? Med Glas (Zenica), 2021, 18(2): 450-455.
6. 康靜, 蔣運蘭, 李滔, 等. 結直腸癌患者術后并發肺部感染影響因素的Meta分析. 數理醫藥學雜志, 2024, 37(10): 746-760.
7. 吳秀文, 張旭飛, 陽怡羽, 等. 2018–2020年中國結直腸術后手術部位感染現狀研究. 中華胃腸外科雜志, 2022, 25(9): 804-811.
8. 李亞萍, 寇志堅, 閻文軍. 結直腸癌圍手術期低蛋白血癥的研究進展. 中國醫學創新, 2023, 20(7): 182-188.
9. 汪曉東, 劉健博, 張詩, 等. 數據庫研究第三部分: 結直腸癌的內外科合并癥及術前體質狀態. 中國普外基礎與臨床雜志, 2019, 26(8): 985-991.
10. 汪曉東, 劉健博, 安麗珉, 等. 數據庫建設第四部分: 結直腸癌的術前專科檢查與評估, 2019, 25(11): 1337-1341.
11. Kondrup J, Rasmussen HH, Hamberg O, et al. Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials. Clin Nutr, 2003, 22(3): 321-336.
12. 汪曉東, 劉健博, 李立. 數據庫建設第五部分·結直腸癌的腫瘤特征—模塊的設計(二). 中國普外基礎與臨床雜志, 2020, 27(04): 483-488.
13. 黃理賓, 黃秋實, 楊烈. 全球及中國的結直腸癌流行病學特征及防治: 2022《全球癌癥統計報告》解讀. 中國普外基礎與臨床雜志, 2024, 31(5): 530-537.
14. Truong A, Hanna MH, Moghadamyeghaneh Z, et al. Implications of preoperative hypoalbuminemia in colorectal surgery. World J Gastrointest Surg, 2016, 8(5): 353-362.
15. 李倩, 姜韞赟, 李玲玲, 等. 低蛋白血癥的臨床研究進展. 世界中西醫結合雜志, 2011, 6(5): 438-439, 442.
16. Hu WH, Eisenstein S, Parry L, Ramamoorthy S. Preoperative malnutrition with mild hypoalbuminemia associated with postoperative mortality and morbidity of colorectal cancer: a propensity score matching study. Nutr J, 2019, 18(1): 33. doi: 10.1186/s12937-019-0458-y.
17. Garth AK, Newsome CM, Simmance N, et al. Nutritional status, nutrition practices and post-operative complications in patients with gastrointestinal cancer. J Hum Nutr Diet, 2010, 23(4): 393-401.
18. Lai CC, You JF, Yeh CY, et al. Low preoperative serum albumin in colon cancer: a risk factor for poor outcome. Int J Colorectal Dis, 2011, 26(4): 473-481.
19. 王海燕, 曹紅十, 劉素敏, 等. 結直腸癌患者營養狀況影響因素的研究進展. 現代臨床護理, 2019, 18(8): 77-81.
20. 周春燕, 牟文蓮, 代小紅, 等. 全周期營養管理對結直腸癌術后化療患者的營養狀況及化療不良反應影響. 臨床護理研究, 2023, 32(20): 149-151.
21. 孫雙丹. 結直腸癌患者腹腔鏡術后發生動力性腸梗阻的影響因素分析. 中國民康醫學, 2022, 34(16): 1-4.
22. Franch-Arcas G. The meaning of hypoalbuminaemia in clinical practice. Clin Nutr, 2001, 20(3): 265-269.
23. Lai C, You J, Yeh C, et al. Low preoperative serum albumin in colon cancer: a risk factor for poor outcome. Int J Colorectal Dis, 2011, 26(4): 473-481.
24. Nazha B, Moussaly E, Zaarour M, et al. Hypoalbuminemia in colorectal cancer prognosis: nutritional marker or inflammatory surrogate? World J Gastrointest Surg2015, 7(12): 370-377.
25. Cengiz O, Kocer B, Sürmeli S, et al. Are pretreatment serum albumin and cholesterol levels prognostic tools in patients with colorectal carcinoma? Med Sci Monit, 2006, 12(6): CR240-CR247.
26. 郭蘭偉, 張興龍, 蔡林, 等. 全球結直腸癌流行和防控現狀. 中華腫瘤雜志, 2024, 46(1): 57-65.
27. van Westreenen HL, Ijpma FF, Wevers KP, et al. Reoperation after colorectal surgery is an independent predictor of the 1-year mortality rate. Dis Colon Rectum, 2011, 54(11): 1438-1442.
28. 吳澤生, 高華, 張文斌, 等. 結直腸癌患者術后非計劃再手術的危險因素分析. 中華胃腸外科雜志, 2015, 18(5): 483-486.
29. 葉子, 周凡琳, 饒佳媛, 等. 結直腸癌患者的文化程度對長期預后的影響: 基于DACCA的真實世界數據研究. 中國普外基礎與臨床雜志, 2024, 31(4): 427-432.
30. Liu XY, Zhang X, Ruan GT, et al. Relationship between educational level and survival of patients with cancer: A multicentre cohort study. Cancer Med, 2024, 13(7): e7141. doi: 10.1002/cam4.7141.Liu XY, Zhang X, Ruan GT, et al. Relationship between educational level and survival of patients with cancer: A multicentre cohort study. Cancer Med, 2024, 13(7): e7141. doi: 10.1002/cam4.7141.
31. Negrichi S, Taleb S. Evaluation of nutritional status of colorectal cancer patients from Algerian East using anthropometric measurements and laboratory assessment. Iran J Public Health, 2020, 49(7): 1242-1251.
32. Kwag SJ, Kim JG, Kang WK, et al. The nutritional risk is a independent factor for postoperative morbidity in surgery for colorectal cancer. Ann Surg Treat Res, 2014, 86(4): 206-211.
33. 王罡艷, 羅會華. 營養不良相關因素及代謝相關通路對結直腸癌患者預后的影響. 中國現代普通外科進展, 2019, 22(6): 496-498.
34. 唐翠娟, 榮震, 莫春梅, 等. 惡性腫瘤代謝特點及其與炎性介質的相關性研究進展. 腫瘤防治研究, 2019, 46(5): 476-481.
35. 曹子龍, 任霖霖, 馬竟優, 等. 進展期結直腸癌血清白蛋白下降與IL-6、TNF-α和CRP的相關性研究. 轉化醫學電子雜志, 2015, 2(5): 76-76, 78.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Relation between preoperative hypoproteinemia and survival prognosis in patients with colorectal cancer after surgery: A real-world data study based on DACCA database

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