Association of Nutritional Risk Assessment 2002 score with recurrence-free survival time and overall survival time in patients undergoing hepatectomy

Objective To investigate the association of Nutritional Risk Assessment 2002 ( NRS-2002) score with recurrence-free survival time and overall survival time in hepatocellular carcinoma ( HCC) patients undergoing hepatectomy. Methods The HCC patients who underwent hepatectomy for the first time in Wuhan Central Hospital from January 2013 to January 2017 were enrolled. The NRS-2002 score was used to evaluate nutritional status before surgery. All patients were followed up, and recurrence-free survival time and overall survival time were recorded. The chi-square test was used for comparison of categorical data between groups. The Kaplan-Meier method was used to analyze recurrence-free survival time and overall survival time. The multivariate Cox proportional hazard model was used to investigate the independent risk factors for recurrence and death. Results According to the NRS-2002 score, 72 HCC patients had nutritional risk and 158 patients had normal nutrition before surgery, with an incidence rate of nutritional risk of 31. 3%. The patients were followed up for7-80 months ( mean 46. 14 ± 10. 52 months) . Of all patients, 91 ( 39. 6%) experienced recurrence and 43 ( 18. 7%) died. The 1-, 3-, and 5-year recurrence rates were 10% ( 23/230) , 28. 3% ( 65/230) , and 35. 2% ( 81/230) , respectively, and the 1-, 3-, and5-year mortality rates were 1. 7% ( 4/230) , 12. 2% ( 28/230) , and 16. 1% ( 37/230) , respectively. Among the 72 patients with nutritional risk, 37 ( 51. 4%) experienced recurrence and 20 ( 27. 8%) died, and among the 158 patients with normal nutrition, 54 ( 34. 2%) experienced recurrence and 23 ( 14. 6%) died. The patients with normal nutrition had significantly longer overall survival time and recurrence-free survival time than those with nutritional risk ( P < 0. 05) . The number of tumors ( hazard ratio [HR]= 1. 682, 95% confidence interval [CI]: 1. 161-2. 438) , vascular invasion ( HR = 1. 996, 95% CI: 1. 372-2. 904) , and nutritional risk ( HR = 2. 186, 95% CI:1. 517-3. 150) were independent risk factors for recurrence in HCC patients, and vascular invasion ( HR = 1. 823, 95% CI: 1. 265-2. 627) and nutritional risk ( HR = 2. 068, 95% CI: 1. 431-2. 990) were independent risk factors for death in HCC patients. Conclusion According to the nutritional screening results based on the NRS-2002 score, there is a high proportion of HCC patients with nutritional risk before surgery, which is associated with postoperative recurrence and death.