Preoperative Nutritional Evaluation of Elderly Patients with Prostate Cancer Undergoing Laparoscopic Radical Prostatectomy

Preoperative Nutritional Evaluation of Elderly Patients with Prostate Cancer Undergoing Laparoscopic Radical Prostatectomy | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Help Center Sign In Submit a Preprint Cite Share Download PDF Research Preoperative Nutritional Evaluation of Elderly Patients with Prostate Cancer Undergoing Laparoscopic Radical Prostatectomy Shu Wang, Jie Fan, Chunyan Hu, Tao Wu, Yuan Liu, Yan Xu, Huan Zhang, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-332306/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective The purpose of this study is to evaluate the association and predictive value of geriatric nutritional risk index (GNRI) in elderly patients with prostate cancer(PCa) undergoing laparoscopic radical prostatectomy (LRP). Methods the clinical data of 72 elderly patients (aged ≥ 65 y) with PCa undergoing LRP in the Department of Urology, Affiliated Hospital of North Sichuan Medical College from January 2018 to December 2020 were retrospectively analyzed. The basic information, laboratory examination indexes, operation conditions, postoperative complications and postoperative recovery indexes of patients were included. Clavien-Dindo Classification System (CDCS) was used to assess the postoperative complications. T-test was used to analyze the grouping variables. ROC curve was drawn to study the predictive value of GNRI for postoperative complications. Results The body weight, BMI, preoperative HGB, ALB values of malnutrition group (MNg) and normal nutrition group (NNg) were significantly positively correlated (P༜0.01); the incidence and severity of postoperative complications of MNg were significantly higher than those of NNg (P༜0.05). The average hospitalization costs of MNg was higher, the duration of postanesthesia care unit (PACU), duration of antibiotic use was longer and the duration of indwelling drainage tube were longer than NNg (P༜0.05). The volume of indwelling drainage tube were more than NNg (P༜0.05). Conclusion GNRI is an effective and reliable tool to evaluate preoperative nutritional status of prostate cancer, which is closely related to postoperative recovery and complications,and has predictive value. Surgery Oncology Figures Figure 1 Figure 2 Introduction Prostate cancer (PCa) is one of the most common malignant tumors in men[ 1 ], the incidence of PCa is 2.93/million in the world, ranking second in all male malignant tumors [ 2 ]. The incidence of PCa is closely related to age. The incidence of PCa is above in male urogenital system [ 3 ]. The European Urological Association recommends surgery as an important treatment for PCa. Laparoscopic radical prostatectomy(LRP) is the standard treatment for limited PCa, which is recommended as the first-line treatment by the major guidelines [ 4 – 5 ]. However, laparoscopic surgery in urology also has postoperative complications that can not be ignored, and the incidence increases with the difficulty of surgery. Nutrition is the basis of maintaining the normal physiological function of the human body, and the nutritional status of patients has always been considered to be closely related to the prognosis of surgical operation [ 6 ]. The elderly (aged ≥ 65) have higher incidence of complications and mortality due to aging and the influence of cancer itself [ 7 ]. Some studies have pointed out that nutritional factors are closely related to the occurrence and progress of PCa [ 8 ]. Geriatric Nutritional Risk Index(GNRI) as an objective index for evaluating nutritional status of elderly people over 65 years old, has been shown to be effective in predicting the prognosis of patients with lung cancer, esophageal cancer, soft tissue sarcoma, renal cancer and pancreatic cancer in previous studies [ 9 – 13 ]. However, there is no clinical study on GNRI in predicting complications and postoperative recovery of PCa patients undergoing LRP. Objects And Methods Objects From January 2018 to December 2020, all 72 hospitalized patients with PCa undergoing LRP in the Department of Urology, Affiliated Hospital of North Sichuan Medical College were enrolled, all of them were Han male. Exclusion criteria: 1. Prostate biopsy was performed in our hospital before operation, and PCa was confirmed by pathology; 2. Age ≥ 65 years old; 3. Only LRP was performed during this hospitalization. Exclusion criteria: 1. Patients with malnutrition caused by other serious diseases, 2. Patients with urinary calculi, other tumors and other urinary diseases, 3. Patients with infectious diseases (respiratory tract infection, pulmonary infection, etc.) or other chronic wasting diseases. Methods Research indicators The height, weight, age, hospitalization costs, postoperative length of stay and other basic information of all patients were recorded; the operation duration, operation method, intraoperative blood loss, duration of postanesthesia care unit (PACU), duration of postoperative catheter indwelling, duration of indwelling drainage tube, volume of indwelling drainage tube, duration of antibiotic use were recorded. complications such as ileus, urethrorectal fistula, ureteral injury, cardio cerebral vascular accident, postoperative infection, postoperative massive hemorrhage, urinary retention, urinary incontinence were recorded. blood routine and liver function tests were used to record the hemoglobin value (HGB), total lymphocyte (TLC), white blood cell (WBC) and serum albumin (ALB) before and after operation. Evaluation and grading standard of complications Clavien Dindo classification system (CDCS) was used for the grading of complications [ 14 ]. Grade I: any postoperative abnormalities that do not require drug treatment, surgery, endoscopy or intervention; the following treatment regimens are given: antiemetics, antipyretics, analgesics, diuretics, electrolytes, physical therapy, etc. Grade II: in addition to the drugs listed in grade I above, other drug treatments include blood transfusion and total parenteral nutrition. Grade III: surgical, endoscopic or interventional intervention is required. Grade Ⅲa: no intervention under general anesthesia. Grade Ⅲb: intervention under general anesthesia is needed. Grade IV: life threatening complications requiring ICU treatment or intermediate care. Grade IVa: single organ dysfunction (including dialysis treatment). Grade IVb: multiple organ dysfunction. GradeV: death. When a single patient had multiple complications, only the most serious one was counted. Urinary incontinence was evaluated by the International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF) [ 15 ]. Postoperative infection includes urinary tract infection, pulmonary infection, abdominal and retroperitoneal infection. Incision complications included hematoma, fat liquefaction, incision dehiscence or infection. Nutritional status indicators the nutritional status was evaluated by geriatric nutritional risk index (GNRI) [ 16 ]. All evaluation indexes were collected within one week before operation. The formula of GNRI was GNRI = 1.489 × ALB (g / L) + 41.7 × (actual weight / ideal weight). Male ideal weight = height (cm) − 100 - [(height (cm) − 150) / 4]. When the preoperation actual weight ≧ the ideal weight, the ratio is 1. Statistical Method all data were entered and analyzed by spss19.0 statistical software. The mean ± standard deviation was used to describe the continuous data which obeyed normal distribution. T-test was used to analyze the nutritional indexes of patients, the general situation of patients, perioperative indexes and hematological indexes. Results General situation of research objects 72 patients were included, aged 65–83 years, with an average of 72.93 ± 5.05 years; height 150-177cm, with an average of 163.61 ± 6.22cm; weight 45-90kg, with an average of 62.65 ± 8.78kg; BMI 18.0-31.1, with an average of 23.42 ± 2.80; GNRI 89.6–118.0, with an average of 101.05 ± 6.26. 26 Patients with GNRI ≤ 98 were classified into malnutrition group (MNg); 46 patients with GNRI > 98 were classified into normal nutrition group (NNg) [ 17 ]. The comparison of age, height, weight, BMI, HGB, ALB, PSA, Intraoperative blood loss and intraoperative blood transfusion between the two groups is shown in Table 1 . It can be seen from Table 1 that weight, BMI, preoperative HGB and ALB values were significantly positively correlated between the two groups (P ≤ 0.01); there were no significant differences in age, height, PSA, intraoperative blood loss and intraoperative blood transfusion between the two groups (P > 0.05). Table 1 general situation, preoperative laboratory indexes and intraoperative conditions of patients indexes Age Height Weight BMI HGB ALB PSA Intraoperative blood loss Intraoperative blood transfusion NNg (N = 46) 72.15 ± 4.51 164.15 ± 5.85 65.72 ± 7.48 24.42 ± 2.51 137.28 ± 13.09 42.61 ± 3.12 21.44 ± 21.63 345.65 ± 267.05 59.78 ± 166.54 MNg (N = 26) 74.31 ± 5.71 162.65 ± 6.84 57.21 ± 8.36 21.64 ± 2.39 125.19 ± 11.28 37.41 ± 2.16 22.65 ± 25.55 425.00 ± 343.29 107.69 ± 246.45 t -1.766 0.981 4.441 4.586 3.949 8.310 -0.215 -1.091 -0.982 P 0.082 0.330 0༎000** 0.000** 0.000** 0.000** 0.830 0.279 0.329 **. Correlation is significant at the 0.01 level (2-tailed). *. Correlation is significant at the 0.05 level (2-tailed). Comparison and predictive value of GNRI in postoperative complications between NMg and MMg As shown in Table 2 , the rates of urinary incontinence, infection and incision complications in MNg were significantly higher than those in NNg(P > 0.05), and urethrorectal fistula, ureteral injury, cardio cerebrovascular accident and massive hemorrhage only occurred in MNg. The incidence of complications in MNg was significantly higher than that in NNg (t = 3.618, P < 0.01). As shown in Table 3 , the complication free percentage of NNg was significantly higher than that of MNg, the incidence of grade I and II complications was lower than that of MNg, and there were no grade III or above complications. There were no grade IV and V complications in both groups. The average grade of CDCS in NNg(0.63 ± 0.71) was significantly lower than that in MNg(1.31 ± 0.88) (t = 3.553, P < 0.01). According to the occurrence of complications, 72 patients were divided into non complication group and complication group. ROC curve was used to judge the predictive value of GNRI for postoperative complications. According to Fig. 1: area under the curve (AUC) = 0.716, 95% CI = 0.598–0.834, we know that if the GNRI cutoff value is 100.75, the sensitivity is 0.741, the specificity is 0.667, the Youden index is the highest, 0.407; if the GNRI cutoff value is 98.85, the sensitivity is 0.852, the specificity is 0.633, the Youden index is the second highest, 0.385. Table 2 comparison of postoperative complications between two groups (person-time) Complications NNg(N = 46) MNg(N = 26) Urinary incontinence 4(8.7%) 13(50.0%) Urethrorectal fistula 0(0%) 1(3.8%) Ureteral injury 0(0%) 1(3.8%) Cardiovascular and cerebrovascular accident 0(0%) 1(3.8%) Incomplete ileus 4(8.7%) 1(3.8%) Infection 19(41.3%) 14(53.8%) Massive hemorrhage 0(0%) 2(7.7%) Incision complications 5(10.9%) 5(19.2%) Total 32(69.6%) 38(146.2%) Table 3 comparison of CDCS between two groups CDCS NNg(N = 46) MNg(N = 26) 0(no complication) 23(50.0%) 4(15.4%) I 17(37.0%) 13(50.0%) II 6(13.0%) 6(23.1%) III 0(0%) 3(11.5%) Ⅳ 0(0%) 0(0%) V 0(0%) 0(0%) Total 46(100.0%) 26(100.0%) Figure 1: ROC curve of GNRI in predicting postoperative complications Comparison Of Postoperative Recovery Between Nmg And Mmg As shown in Fig. 2 a, the average postoperative hospital stay of MNg and NNg patients were 12.42 ± 7.04 and 10.89 ± 6.96 days respectively, and there was no significant difference between the two groups (P > 0.05). As shown in Fig. 2 b, the average hospitalization costs of MNg and NNg patients were 44752.70 ± 9620.31 and 38862.25 ± 8580.68 yuan respectively, and the average hospitalization costs of MNg were higher (P < 0.01). As shown in Fig. 2 c, the average duration of PACU of MNg and NNg patients were 3.08 ± 0.80 and 2.58 ± 1.30 hours respectively, and the average duration of PACU of MNg patients was longer (P < 0.05). As shown in Fig. 2 d, the average postoperative feeding time of MNg and NNg patients was 2.08 ± 1.41 and 2.48 ± 2.59 days respectively, and there was no statistical difference between the two groups (P > 0.05). As shown in Fig. 2 e, the average duration of antibiotic use in MNg and NNg patients was 10.04 ± 4.27 and 7.74 ± 4.34 days respectively, and the average duration of antibiotic use in MNg was longer (P < 0.05). As shown in Fig. 2 f, the average duration of indwelling drainage tube in MNg and NNg patients was 11.12 ± 8.26 and 7.48 ± 5.14 days respectively, and the average duration of indwelling drainage tube in MNg patients was longer (P < 0.05). As shown in Fig. 2 g, the average duration of indwelling catheter in MNg and NNg patients was 29.19 ± 7.95 and 26.33 ± 10.24 days respectively, and there was no statistical difference between the two groups (P > 0.05). As shown in Fig. 2 h, the average volume of indwelling drainage tube in MNg and NNg patients was 953.46 ± 1122.04 and 445.43 ± 537.93 ml respectively, and the average drainage volume of MNg patients was more (P < 0.05). Discussion Selection Of Nutritional Indicators There are more than 50 different nutrition assessment tools, and GNRI is one of the effective and reliable tools [ 18 ]. GNRI was proposed by bouillanne et al. In 2005 and is related to ALB level and the ratio of actual body weight to ideal body weight [ 16 ]. GNRI is suitable for elderly community patients and inpatients over 65 years old, and it is an effective way to evaluate the nutritional status. If the GNRI score of patients is lower, it indicates that the more serious malnutrition is. GNRI has high sensitivity, good specificity and low false positive rate [ 19 ], which is a simple and easy screening method with strong operability. GNRI has been applied to predict the prognosis and postoperative complications of many kinds of malignant tumors, but only the level of BMI or serum albumin is not closely related to the prognosis of cancer patients [ 17 , 20 ]. The incidence and mortality of PCa increased with age. In 2017, more than 70% of PCa patients were over 64 years old in the world, and 80% of PCa deaths were more than 65 years old [ 21 ], which was in line with the applicable age range of GNRI . In this study, we found that there were no significant differences in age, height, PSA, intraoperative blood loss, intraoperative blood transfusion and other baseline indicators between the two groups. Preoperative nutritional indicators such as weight, BMI, HGB, ALB of PCa patients were significantly positively correlated with GNRI, which fully indicated that GNRI could well reflect the nutritional status of patients, and was not interfered by other factors. So GNRI was selected to predict the postoperative recovery and complications of PCa patients undergoing LRP. The relationship between nutritional status and postoperative complications in PCa patients The average CDCS grade of MNg was significantly higher than that of NNg, and there were grade III complications in MNg. There were no grade IV and V complications in the two groups because of the small statistical samples. Zhou J and other scholars believe that malnutrition is an important factor leading to postoperative complications and higher CDCS grade [ 22 ]. In patients with malnutrition, the body is in a state of nutritional risk, and a series of compensatory changes will appear in the organs and tissues of the whole body to adapt to this state, such as decreased muscle strength, prolonged recovery time of the whole body and wound, decreased immunity, delayed wound healing, weakened function of neutrophils, macrophages and lymphocytes [ 23 ]. This situation leads to more serious postoperative complications in patients with malnutrition. As shown in Table 2 , the incidence of complications of MNg was higher than that of NNg, especially the incidence of urinary incontinence, infection and incision complications was significantly higher than that of NNg. The maintenance of urinary continence in men is mainly related to bladder function and urethral sphincter system. The key to reduce urinary incontinence is to dissect prostate and its surrounding tissues carefully during operation, protect the distal sphincter system and its innervating nerve and supporting tissue [ 24 ], but other related factors include the age and physical condition of the patients are also very important. This study shows that the incidence of urinary incontinence in malnutrition patients is higher than that in normal nutrition patients, which may be related to the weakening of urethral sphincter function and the decline of autonomic contraction of pelvic floor muscle. Postoperative infection is the most common complication of LRP. According to the literature, malnutrition can lead to fluid overload, further leading to and aggravating postoperative infection [ 25 ]. This study shows that the incidence of postoperative infection of MNg is higher than that of NNg. The preoperative HGB and ALB of MNg patients are lower than that of NNg, and the im duration of munity is lower, which increases the risk of infection. At the same time, as shown in Fig. 2 , the average duration of indwelling drainage tube and indwelling catheter in MNg was longer than that in NNg, so the normal physiological structure of abdominal cavity and urethra was destroyed, which reduced the function of mucosa to resist bacteria, resulting in infection. MNg patients with low preoperative ALB can affect the body enzyme production ability, weaken the ability of tissue and organ self repair, resulting in delayed wound healing. In particular, hypoalbuminemia has a particularly significant impact on humoral immunity, which can cause pathogen translocation, conditional pathogen transformation, and fungal reproduction; in addition, the blood supply under the incision is reduced due to emaciation, thus increasing the probability of incision infection, tissue necrosis, and dehiscence [ 26 ]. In this study, we found that the best Youden value, sensitivity and specificity can be obtained if GNRI = 100.75 is taken as the cut-off value to determine whether there are complications, which can preliminarily predict the occurrence of postoperative complications. If GNRI = 98.85 is taken as the cut-off value to determine whether there are complications, it can obtain higher sensitivity and acceptable specificity; if GNRI < 98.85, the possibility of postoperative complications is very high. In line with the principle of operation safety first and adequate preoperative preparation, nutritional support should be actively given before operation to improve the nutritional level of patients. The sample size of this single center study is small, resulting in the ROC curve is not smooth enough, only a preliminary cut-off value can be obtained. In the future, we plan to carry out a large sample study of multi-center study to find a more accurate cut-off value, which can be used to guide the preoperative nutritional status evaluation of pre PCa patients undergoing LRP. the relationship between nutritional status and postoperative recovery in patients with PCa In this study, we observed that duration of PACU in MNg is longer, which is consistent with foreign research results [ 27 ]. The decreased ALB level and lower body weight of MNg prolong the metabolism time of sevoflurane and other anesthetics [ 28 ], resulting in slower anesthesia recovery of patients. Anesthesiologists need to observe patients for a longer time, so the duration of PACU in MNg is also longer. In this study, ALB in MNg is lower than that in NNg, resulting in more intra-abdominal fluid leakage, higher infection and incision complications, also lead to more inflammatory exudate, and then the duration of indwelling drainage tube is longer, volume of indwelling drainage tube is more. The higher incidence of infection complications and incision complications of MNg, as well as its unique complications of urethrorectal fistula, ureteral injury and massive hemorrhage, make the postoperative recovery time of MNg patients longer, and also force doctors to use antibiotics for a longer time. At the same time, there was no significant difference between the two groups in WBC values (MNg: 8.60 ± 2.40 mg / L, NNg: 8.59 ± 2.82 mg / L) on the 3rd postoperative day (P > 0.05), but the WBC values in MNg(7.80 ± 1.64 mg / L) on the 7th postoperative day were significantly higher than those in NNg(6.51 ± 1.88 mg / L) on the 7th postoperative day (P < 0.05). This also shows that longer duration of antibiotic use in MNg is necessary. The low levels of ALB and HGB of MNg lead to a significant increase in the use of enteral and parenteral nutrition preparations, albumin and blood products during hospitalization; the low immunity of MNg and a series of infection related complications lead to the use of longer and higher level antibiotics; the longer duration of PACU treatment leads that the hospitalization costs of MNg higher than NNg significantly, increased the burden of patients. Conclusions To sum up, GNRI is an effective and reliable tool to evaluate the preoperative nutritional status of PCa, which is closely related to the postoperative recovery and complications; preoperative GNRI examination and effective preoperative nutritional support may benefit PCa patients undergoing LRP. Ethics Approval and Consent The study was approved by the medical ethics committee of Affiliated Hospital of North Sichuan Medical College, Nanchong, China. The study has received the informed consents from all patients and followed the guidelines outlined in the declaration of Helsinki. Consent for publication All patients have been informed suitably, and we`ve asked for their verbal consent. Data Availability Statement : All relevant data are in the paper and Supporting Information files. Declarations Ethics Approval and Consent The study was approved by the medical ethics committee of Affiliated Hospital of North Sichuan Medical College, Nanchong, China. The study has received the informed consents from all patients and followed the guidelines outlined in the declaration of Helsinki. Consent for publication All patients have been informed suitably, and we`ve asked for their verbal consent. Data Availability Statement: All relevant data are in the paper and Supporting Information files. Competing Interests The authors declare that they have no competing interests. Funding: This research is supported by the project of Sichuan Provincial Health and Family Planning Commission (17PJ106), the project of Sichuan Primary Health Development Center (SWFZ18-Y-14), the project of Affiliated Hospital of North Sichuan Medical College (2021ZD018), and the project of school level of (North Sichuan Medical College ( CBY18-A-YB17). Author Contributions Conceptualization: Xie Liang, Fan Jie. Data curation: Wang Shu. Investigation: Fan Jie, Liu Yuan, Xu Yan, Zhang Huan Project administration: Hu Chunyan Resources: Xie Liang ,Wu Tao. Writing – original draft: Wang Shu. Writing – review & editing: Xie Liang Acknowledgements References Bray F, Ferlay J, Soerjomataram I,et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries [J]. CA Cancer J Clin. 2018;68(6):394–424. Erratum. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2020 Jul;70(4):313. Chen W,et al. Cancer statistics in China,2015. CA Cancer J Clin. 2016;66(2):115–32. Bekelman JE, Rumble RB, Freedland SJ. Clinically Localized Prostate Cancer: ASCO Clinical Practice Guideline Endorsement of an AUA/ASTRO/SUO Guideline Summary [J]. J Oncol Pract. 2018;14(10):618–24. Sanda MG, Cadeddu JA, Kirkby E, et al. Clinically Localized Prostate Cancer: AUA/ASTRO/SUO Guideline. Part II: Recommended Approaches and Details of Specific Care Options[J]. J Urol. 2018;199(4):990–7. Patient-Generated Subjective Global Assessment [Internet] Cancer Network. 2013 Feb;17(2) [cited 2018 Jul 8]. Available from: http://www.cancernetwork . com/ palliative-and-supportive-care/patient-generated-subjective-globalassessment . Pezzana A, Cereda E, Avagnina P, et al. Nutritional Care Needs in Elderly Residents of Long-Term Care Institytions: Potential Implications for Policies[J]. J Nutr Health Aging. 2018;19(9):947–54. Matsushita M, Fujita K, Nonomura N. Influence of Diet and Nutrition on Prostate Cancer. Int J Mol Sci. 2020 Feb 20;21(4):1447. SHOJI F, MATSUBARA T, KOZUMA Y, et al. Preoperative geriatric nutritional risk index: a predictive and prognostic factor in patients with pathological stage I non-small cell lung cancer[J].Surg Oncol,2017,26(4):483–488. WANG Y, WANG L, FANG M, et al. Prognostic value of the geriatric nutritional risk index in patients exceeding 70years old with esophageal squamous cell carcinoma[J]. NutrCancer,2020,72(4): 620–626. Balzano G, Dugnani E, Crippa S, Scavini M, Pasquale V, Aleotti F, Liberati D, Gandolfi A, Belfiori G, Reni M, et al. A preoperative score to predict early death after pancreatic cancer resection. Dig Liver Dis. 2017;49(9):1050–6. Gu W, Zhang G, Sun L, Ma Q, Cheng Y, Zhang H, Shi G, Zhu Y, Ye D. Nutritional screening is strongly associated with overall survival in patients treated with targeted agents for metastatic renal cell carcinoma. J Cachexia Sarcopenia Muscle. 2015;6(3):222–30. Sasaki H, Nagano S, Taniguchi N, Setoguchi T. Risk Factors for Surgical Site Infection after Soft-Tissue Sarcoma Resection, Including the Preoperative Geriatric Nutritional Risk Index. Nutrients. 2018;10(12):1900. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey[J]. Ann Surg. 2004;240(2):205–13. Soto-González M, Da Cuña-Carrera I, Gutiérrez-Nieto M, Lantarón-Caeiro EM. Assessment of male urinary incontinence postprostatectomy through the Consultation on Incontinence Questionnaire-Short Form. Prog Urol. 2020;30(4):209–13. Bouillanne O, Morineau G, Dupont C, Coulombel I, Vincent JP, Nicolis I, Benazeth S, Cynober L, Aussel C. Geriatric Nutritional Risk Index: a new index for evaluating at-risk elderly medical patients. Am J Clin Nutr. 2005 Oct;82(4):777–83. Lidoriki I, Schizas D, Frountzas M, Machairas N, Prodromidou A, Kapelouzou A, Karavokyros I, Pikoulis E, Kales SN, Liakakos T. GNRI as a Prognostic Factor for Outcomes in Cancer Patients: A Systematic Review of the Literature. Nutr Cancer. 2021;73(3):391–403. Jayanth KS, Maroju NK. Utility of nutritional indices in preoperative assessment of cancer patients. Clin Nutr ESPEN. 2020 Jun;37:141–7. Tripathy S, MIshra JC. Assessing nutrition in the critically ill elderly patient: a comparison of two screening tools. Indian J Crit Care Med. 2015 Sep;19(9):518e22. Gyan E, Raynard B, Durand J-P, Lacau Saint Guily J, Gouy S, Movschin ML, Khemissa F, Flori N, Oziel-Taieb S, Bannier Braticevic C, et al. Malnutrition in Patients With Cancer. JPEN J Parenter Enteral Nutr. 2017;42(1):255–60. Zhai Z, Zheng Y, Li N, et al. Incidence and disease burden of prostate cancer from 1990 to 2017: Results from the Global Burden of Disease Study 2017[J]. Cancer. 2020;126(9):1969–78. Zhou J, Zhou Y, Cao S, Li S, Wang H, Niu Z, Chen D, Wang D, Lv L, Zhang J, Li Y, Jiao X, Tan X, Zhang J, Wang H, Zhang B, Lu Y, Sun Z. Multivariate logistic regression analysis of postoperative complications and risk model establishment of gastrectomy for gastric cancer: A single-center cohort report. Scand J Gastroenterol. 2016 Jan;51(1):8–15. Wu Guohao. Causes and prevention of malnutrition in patients with malignant tumor [J]. Chinese Journal of gastrointestinal surgery, 2010 (03): 170–172. Kretschmer A, Nitti V. Surgical Treatment of Male Postprostatectomy Incontinence: Current Concepts[J]. Eur Urol Focus. 2017;3(4–5):364–76. Dekker MJE, Konings C, Canaud B, van der Sande FM, Stuard S, Raimann JG, Öztürk E, Usvyat L, Kotanko P, Kooman JP. Interactions Between Malnutrition, Inflammation, and Fluid Overload and Their Associations With Survival in Prevalent Hemodialysis Patients. J Ren Nutr. 2018 Nov;28(6):435–44. Renner R, Garibaldi MDS, Benson S, Ronicke M, Erfurt-Berge C. Nutrition status in patients with wounds: a cross-sectional analysis of 50 patients with chronic leg ulcers or acute wounds. Eur J Dermatol. 2019 Dec 1;29(6):619–626. Loncar Y, Lefevre T, Nafteux L, Genser L, Manceau G, Lemoine L, Vaillant JC, Eyraud D. Preoperative nutrition forseverely malnourished patients in digestive surgery: A retrospective study. J Visc Surg. 2020 Apr;157(2):107–16. Artru AA. Renal effects of sevoflurane during conditions of possible increased risk. J Clin Anesth. 1998 Nov;10(7):531–8. Supplementary Files DataEnglish.xlsx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-332306","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research","associatedPublications":[],"authors":[{"id":19731656,"identity":"f142a90e-2849-44f5-a14c-d90ff6347bf7","order_by":0,"name":"Shu Wang","email":"","orcid":"","institution":"Affiliated Hospital of North Sichuan Medical College","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Shu","middleName":"","lastName":"Wang","suffix":""},{"id":19731657,"identity":"447b9df1-d325-41d1-b1b3-b610c0aedf61","order_by":1,"name":"Jie Fan","email":"","orcid":"","institution":"Affiliated Hospital of North Sichuan Medical College","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Jie","middleName":"","lastName":"Fan","suffix":""},{"id":19731658,"identity":"daa68b2b-e083-4fb5-ae47-f29ab5f91651","order_by":2,"name":"Chunyan Hu","email":"","orcid":"","institution":"Affiliated Hospital of North Sichuan Medical College","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Chunyan","middleName":"","lastName":"Hu","suffix":""},{"id":19731659,"identity":"f7de51f7-9d10-4785-ab69-03f63c9967b2","order_by":3,"name":"Tao Wu","email":"","orcid":"","institution":"Affiliated Hospital of North Sichuan Medical College","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Tao","middleName":"","lastName":"Wu","suffix":""},{"id":19731660,"identity":"d3eb95ba-4ba8-4208-87f1-81fbd5b6de15","order_by":4,"name":"Yuan Liu","email":"","orcid":"","institution":"Affiliated Hospital of North Sichuan Medical College","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Yuan","middleName":"","lastName":"Liu","suffix":""},{"id":19731661,"identity":"39f5c4eb-a9b1-4e13-98cb-31e28dbf36c1","order_by":5,"name":"Yan Xu","email":"","orcid":"","institution":"Affiliated Hospital of North Sichuan Medical College","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Yan","middleName":"","lastName":"Xu","suffix":""},{"id":19731662,"identity":"0cc9717e-a80f-49c3-94c8-7526adcaee29","order_by":6,"name":"Huan Zhang","email":"","orcid":"","institution":"Affiliated Hospital of North Sichuan Medical College","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Huan","middleName":"","lastName":"Zhang","suffix":""},{"id":19731663,"identity":"7b4a73e5-816d-4cf1-baf6-d77797b2e8a1","order_by":7,"name":"Liang Xie","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAt0lEQVRIiWNgGAWjYLCCBxVyYPrAA6K1JJwxhmhJIFpLYpsxVC8xquXbz5hJJM4zkDO4dvgh0BY7Od0GAloMzuQYGyRuMzCWnJ1mANSSbGx2gJAWCR7DB4nb/iT2SyeAtBxI3EZIi/wMHoMDiXMMEtuk0z8Qp4XhBsiWBgOgLTlE2mJwJq3YIOEYyC85BQcSDIjwi3z74W0SH2qAIXY7ffOHDxV2cgS1oFtKmvJRMApGwSgYBTgAALoeQjM2fgstAAAAAElFTkSuQmCC","orcid":"","institution":"Department of Urology Hepatobiliary Surgery","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Liang","middleName":"","lastName":"Xie","suffix":""}],"badges":[],"createdAt":"2021-03-15 12:42:19","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-332306/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-332306/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":7666124,"identity":"741a80c2-696a-4343-b216-84a72427fbf1","added_by":"auto","created_at":"2021-04-05 14:14:20","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":11052,"visible":true,"origin":"","legend":"ROC curve of GNRI in predicting postoperative complications ","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-332306/v1/e3bc6f1c3c3f24eaa4c4b89a.png"},{"id":7665811,"identity":"75ac201d-96a6-47a3-a778-b34ceef51c3a","added_by":"auto","created_at":"2021-04-05 14:11:20","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":197329,"visible":true,"origin":"","legend":"comparison of postoperative recovery between two groups","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-332306/v1/a153de8d707fc5c407714ccb.jpeg"},{"id":13683856,"identity":"d967be59-9ba8-49a4-9164-36919f586db6","added_by":"auto","created_at":"2021-09-17 12:04:48","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":490488,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-332306/v1/a1a86b7d-114b-4efb-aa50-bab17e0ad47a.pdf"},{"id":7665312,"identity":"12137aa5-ec41-43f2-9e58-7ffe40154d64","added_by":"auto","created_at":"2021-04-05 14:08:20","extension":"xlsx","order_by":6,"title":"","display":"","copyAsset":false,"role":"supplement","size":30598,"visible":true,"origin":"","legend":"","description":"","filename":"DataEnglish.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-332306/v1/5216a0359dc767746730146a.xlsx"}],"financialInterests":"","formattedTitle":"\u003cp\u003ePreoperative Nutritional Evaluation of Elderly Patients with Prostate Cancer Undergoing Laparoscopic Radical Prostatectomy\u003c/p\u003e","fulltext":[{"header":"Introduction","content":" \u003cp\u003eProstate cancer (PCa) is one of the most common malignant tumors in men[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], the incidence of PCa is 2.93/million in the world, ranking second in all male malignant tumors [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The incidence of PCa is closely related to age. The incidence of PCa is above in male urogenital system [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The European Urological Association recommends surgery as an important treatment for PCa. Laparoscopic radical prostatectomy(LRP) is the standard treatment for limited PCa, which is recommended as the first-line treatment by the major guidelines [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. However, laparoscopic surgery in urology also has postoperative complications that can not be ignored, and the incidence increases with the difficulty of surgery.\u003c/p\u003e \u003cp\u003eNutrition is the basis of maintaining the normal physiological function of the human body, and the nutritional status of patients has always been considered to be closely related to the prognosis of surgical operation [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. The elderly (aged\u0026thinsp;\u0026ge;\u0026thinsp;65) have higher incidence of complications and mortality due to aging and the influence of cancer itself [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Some studies have pointed out that nutritional factors are closely related to the occurrence and progress of PCa [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eGeriatric Nutritional Risk Index(GNRI) as an objective index for evaluating nutritional status of elderly people over 65 years old, has been shown to be effective in predicting the prognosis of patients with lung cancer, esophageal cancer, soft tissue sarcoma, renal cancer and pancreatic cancer in previous studies [\u003cspan additionalcitationids=\"CR10 CR11 CR12\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. However, there is no clinical study on GNRI in predicting complications and postoperative recovery of PCa patients undergoing LRP.\u003c/p\u003e "},{"header":"Objects And Methods","content":" \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eObjects\u003c/h2\u003e \u003cp\u003eFrom January 2018 to December 2020, all 72 hospitalized patients with PCa undergoing LRP in the Department of Urology, Affiliated Hospital of North Sichuan Medical College were enrolled, all of them were Han male. Exclusion criteria: 1. Prostate biopsy was performed in our hospital before operation, and PCa was confirmed by pathology; 2. Age\u0026thinsp;\u0026ge;\u0026thinsp;65 years old; 3. Only LRP was performed during this hospitalization. Exclusion criteria: 1. Patients with malnutrition caused by other serious diseases, 2. Patients with urinary calculi, other tumors and other urinary diseases, 3. Patients with infectious diseases (respiratory tract infection, pulmonary infection, etc.) or other chronic wasting diseases.\u003c/p\u003e \u003c/div\u003e "},{"header":"Methods","content":" \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eResearch indicators\u003c/h2\u003e \u003cp\u003eThe height, weight, age, hospitalization costs, postoperative length of stay and other basic information of all patients were recorded; the operation duration, operation method, intraoperative blood loss, duration of postanesthesia care unit (PACU), duration of postoperative catheter indwelling, duration of indwelling drainage tube, volume of indwelling drainage tube, duration of antibiotic use were recorded. complications such as ileus, urethrorectal fistula, ureteral injury, cardio cerebral vascular accident, postoperative infection, postoperative massive hemorrhage, urinary retention, urinary incontinence were recorded. blood routine and liver function tests were used to record the hemoglobin value (HGB), total lymphocyte (TLC), white blood cell (WBC) and serum albumin (ALB) before and after operation.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eEvaluation and grading standard of complications\u003c/h2\u003e \u003cp\u003eClavien Dindo classification system (CDCS) was used for the grading of complications [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Grade I: any postoperative abnormalities that do not require drug treatment, surgery, endoscopy or intervention; the following treatment regimens are given: antiemetics, antipyretics, analgesics, diuretics, electrolytes, physical therapy, etc. Grade II: in addition to the drugs listed in grade I above, other drug treatments include blood transfusion and total parenteral nutrition. Grade III: surgical, endoscopic or interventional intervention is required. Grade Ⅲa: no intervention under general anesthesia. Grade Ⅲb: intervention under general anesthesia is needed. Grade IV: life threatening complications requiring ICU treatment or intermediate care. Grade IVa: single organ dysfunction (including dialysis treatment). Grade IVb: multiple organ dysfunction. GradeV: death. When a single patient had multiple complications, only the most serious one was counted.\u003c/p\u003e \u003cp\u003eUrinary incontinence was evaluated by the International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF) [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Postoperative infection includes urinary tract infection, pulmonary infection, abdominal and retroperitoneal infection. Incision complications included hematoma, fat liquefaction, incision dehiscence or infection.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eNutritional status indicators\u003c/h2\u003e \u003cp\u003ethe nutritional status was evaluated by geriatric nutritional risk index (GNRI) [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. All evaluation indexes were collected within one week before operation. The formula of GNRI was GNRI\u0026thinsp;=\u0026thinsp;1.489 \u0026times; ALB (g / L)\u0026thinsp;+\u0026thinsp;41.7 \u0026times; (actual weight / ideal weight). Male ideal weight\u0026thinsp;=\u0026thinsp;height (cm) \u0026minus;\u0026thinsp;100 - [(height (cm) \u0026minus;\u0026thinsp;150) / 4]. When the preoperation actual weight\u0026thinsp;≧\u0026thinsp;the ideal weight, the ratio is 1.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Method\u003c/h2\u003e \u003cp\u003eall data were entered and analyzed by spss19.0 statistical software. The mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation was used to describe the continuous data which obeyed normal distribution. T-test was used to analyze the nutritional indexes of patients, the general situation of patients, perioperative indexes and hematological indexes.\u003c/p\u003e \u003c/div\u003e "},{"header":"Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\n\u003ch2\u003eGeneral situation of research objects\u003c/h2\u003e\n\u003cp\u003e72 patients were included, aged 65\u0026ndash;83 years, with an average of 72.93\u0026thinsp;\u0026plusmn;\u0026thinsp;5.05 years; height 150-177cm, with an average of 163.61\u0026thinsp;\u0026plusmn;\u0026thinsp;6.22cm; weight 45-90kg, with an average of 62.65\u0026thinsp;\u0026plusmn;\u0026thinsp;8.78kg; BMI 18.0-31.1, with an average of 23.42\u0026thinsp;\u0026plusmn;\u0026thinsp;2.80; GNRI 89.6\u0026ndash;118.0, with an average of 101.05\u0026thinsp;\u0026plusmn;\u0026thinsp;6.26.\u003c/p\u003e\n\u003cp\u003e26 Patients with GNRI\u0026thinsp;\u0026le;\u0026thinsp;98 were classified into malnutrition group (MNg); 46 patients with GNRI\u0026thinsp;\u0026gt;\u0026thinsp;98 were classified into normal nutrition group (NNg) [\u003cspan class=\"CitationRef\"\u003e17\u003c/span\u003e]. The comparison of age, height, weight, BMI, HGB, ALB, PSA, Intraoperative blood loss and intraoperative blood transfusion between the two groups is shown in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e. It can be seen from Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e that weight, BMI, preoperative HGB and ALB values were significantly positively correlated between the two groups (P\u0026thinsp;\u0026le;\u0026thinsp;0.01); there were no significant differences in age, height, PSA, intraoperative blood loss and intraoperative blood transfusion between the two groups (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003egeneral situation, preoperative laboratory indexes and intraoperative conditions of patients\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eindexes\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eAge\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eHeight\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eWeight\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eBMI\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eHGB\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eALB\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003ePSA\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eIntraoperative blood loss\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eIntraoperative blood transfusion\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNNg\u003c/p\u003e\n\u003cp\u003e(N\u0026thinsp;=\u0026thinsp;46)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e72.15\u0026thinsp;\u0026plusmn;\u0026thinsp;4.51\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e164.15\u0026thinsp;\u0026plusmn;\u0026thinsp;5.85\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e65.72\u0026thinsp;\u0026plusmn;\u0026thinsp;7.48\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e24.42\u0026thinsp;\u0026plusmn;\u0026thinsp;2.51\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e137.28\u0026thinsp;\u0026plusmn;\u0026thinsp;13.09\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e42.61\u0026thinsp;\u0026plusmn;\u0026thinsp;3.12\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e21.44\u0026thinsp;\u0026plusmn;\u0026thinsp;21.63\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e345.65\u0026thinsp;\u0026plusmn;\u0026thinsp;267.05\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e59.78\u0026thinsp;\u0026plusmn;\u0026thinsp;166.54\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMNg\u003c/p\u003e\n\u003cp\u003e(N\u0026thinsp;=\u0026thinsp;26)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e74.31\u0026thinsp;\u0026plusmn;\u0026thinsp;5.71\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e162.65\u0026thinsp;\u0026plusmn;\u0026thinsp;6.84\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e57.21\u0026thinsp;\u0026plusmn;\u0026thinsp;8.36\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e21.64\u0026thinsp;\u0026plusmn;\u0026thinsp;2.39\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e125.19\u0026thinsp;\u0026plusmn;\u0026thinsp;11.28\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e37.41\u0026thinsp;\u0026plusmn;\u0026thinsp;2.16\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e22.65\u0026thinsp;\u0026plusmn;\u0026thinsp;25.55\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e425.00\u0026thinsp;\u0026plusmn;\u0026thinsp;343.29\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e107.69\u0026thinsp;\u0026plusmn;\u0026thinsp;246.45\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003et\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-1.766\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.981\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4.441\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4.586\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3.949\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8.310\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.215\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-1.091\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.982\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.082\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.330\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0༎000**\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.000**\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.000**\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.000**\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.830\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.279\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.329\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr /\u003e**. Correlation is significant at the 0.01 level (2-tailed).\u003c/p\u003e\n\u003cp\u003e*. Correlation is significant at the 0.05 level (2-tailed).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eComparison and predictive value of GNRI in postoperative complications between NMg and MMg\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAs shown in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e, the rates of urinary incontinence, infection and incision complications in MNg were significantly higher than those in NNg(P\u0026thinsp;\u0026gt;\u0026thinsp;0.05), and urethrorectal fistula, ureteral injury, cardio cerebrovascular accident and massive hemorrhage only occurred in MNg. The incidence of complications in MNg was significantly higher than that in NNg (t\u0026thinsp;=\u0026thinsp;3.618, P\u0026thinsp;\u0026lt;\u0026thinsp;0.01).\u003c/p\u003e\n\u003cp\u003eAs shown in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e, the complication free percentage of NNg was significantly higher than that of MNg, the incidence of grade I and II complications was lower than that of MNg, and there were no grade III or above complications. There were no grade IV and V complications in both groups. The average grade of CDCS in NNg(0.63\u0026thinsp;\u0026plusmn;\u0026thinsp;0.71) was significantly lower than that in MNg(1.31\u0026thinsp;\u0026plusmn;\u0026thinsp;0.88) (t\u0026thinsp;=\u0026thinsp;3.553, P\u0026thinsp;\u0026lt;\u0026thinsp;0.01).\u003c/p\u003e\n\u003cp\u003eAccording to the occurrence of complications, 72 patients were divided into non complication group and complication group. ROC curve was used to judge the predictive value of GNRI for postoperative complications. According to Fig.\u0026nbsp;1: area under the curve (AUC)\u0026thinsp;=\u0026thinsp;0.716, 95% CI\u0026thinsp;=\u0026thinsp;0.598\u0026ndash;0.834, we know that if the GNRI cutoff value is 100.75, the sensitivity is 0.741, the specificity is 0.667, the Youden index is the highest, 0.407; if the GNRI cutoff value is 98.85, the sensitivity is 0.852, the specificity is 0.633, the Youden index is the second highest, 0.385.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab2\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003ecomparison of postoperative complications between two groups (person-time)\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eComplications\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eNNg(N\u0026thinsp;=\u0026thinsp;46)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eMNg(N\u0026thinsp;=\u0026thinsp;26)\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eUrinary incontinence\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4(8.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e13(50.0%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eUrethrorectal fistula\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0(0%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1(3.8%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eUreteral injury\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0(0%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1(3.8%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCardiovascular and cerebrovascular accident\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0(0%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1(3.8%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eIncomplete ileus\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4(8.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1(3.8%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eInfection\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e19(41.3%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e14(53.8%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMassive hemorrhage\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0(0%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2(7.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eIncision complications\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5(10.9%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e5(19.2%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eTotal\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e32(69.6%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e38(146.2%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab3\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003ecomparison of CDCS between two groups\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eCDCS\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eNNg(N\u0026thinsp;=\u0026thinsp;46)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eMNg(N\u0026thinsp;=\u0026thinsp;26)\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0(no complication)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e23(50.0%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4(15.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eI\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e17(37.0%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e13(50.0%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eII\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6(13.0%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6(23.1%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eIII\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0(0%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3(11.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eⅣ\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0(0%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0(0%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eV\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0(0%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0(0%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eTotal\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e46(100.0%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e26(100.0%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eFigure\u0026nbsp;1: ROC curve of GNRI in predicting postoperative complications\u003c/p\u003e\n\u003c/div\u003e\n\u003ch2\u003eComparison Of Postoperative Recovery Between Nmg And Mmg\u003c/h2\u003e\n\u003cp\u003eAs shown in Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003ea, the average postoperative hospital stay of MNg and NNg patients were 12.42\u0026thinsp;\u0026plusmn;\u0026thinsp;7.04 and 10.89\u0026thinsp;\u0026plusmn;\u0026thinsp;6.96 days respectively, and there was no significant difference between the two groups (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05). As shown in Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003eb, the average hospitalization costs of MNg and NNg patients were 44752.70\u0026thinsp;\u0026plusmn;\u0026thinsp;9620.31 and 38862.25\u0026thinsp;\u0026plusmn;\u0026thinsp;8580.68 yuan respectively, and the average hospitalization costs of MNg were higher (P\u0026thinsp;\u0026lt;\u0026thinsp;0.01). As shown in Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003ec, the average duration of PACU of MNg and NNg patients were 3.08\u0026thinsp;\u0026plusmn;\u0026thinsp;0.80 and 2.58\u0026thinsp;\u0026plusmn;\u0026thinsp;1.30 hours respectively, and the average duration of PACU of MNg patients was longer (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). As shown in Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003ed, the average postoperative feeding time of MNg and NNg patients was 2.08\u0026thinsp;\u0026plusmn;\u0026thinsp;1.41 and 2.48\u0026thinsp;\u0026plusmn;\u0026thinsp;2.59 days respectively, and there was no statistical difference between the two groups (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e\n\u003cp\u003eAs shown in Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003ee, the average duration of antibiotic use in MNg and NNg patients was 10.04\u0026thinsp;\u0026plusmn;\u0026thinsp;4.27 and 7.74\u0026thinsp;\u0026plusmn;\u0026thinsp;4.34 days respectively, and the average duration of antibiotic use in MNg was longer (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). As shown in Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003ef, the average duration of indwelling drainage tube in MNg and NNg patients was 11.12\u0026thinsp;\u0026plusmn;\u0026thinsp;8.26 and 7.48\u0026thinsp;\u0026plusmn;\u0026thinsp;5.14 days respectively, and the average duration of indwelling drainage tube in MNg patients was longer (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). As shown in Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003eg, the average duration of indwelling catheter in MNg and NNg patients was 29.19\u0026thinsp;\u0026plusmn;\u0026thinsp;7.95 and 26.33\u0026thinsp;\u0026plusmn;\u0026thinsp;10.24 days respectively, and there was no statistical difference between the two groups (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05). As shown in Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003eh, the average volume of indwelling drainage tube in MNg and NNg patients was 953.46\u0026thinsp;\u0026plusmn;\u0026thinsp;1122.04 and 445.43\u0026thinsp;\u0026plusmn;\u0026thinsp;537.93 ml respectively, and the average drainage volume of MNg patients was more (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e"},{"header":"Discussion","content":" \u003ch2\u003eSelection Of Nutritional Indicators\u003c/h2\u003e\n \u003cp\u003eThere are more than 50 different nutrition assessment tools, and GNRI is one of the effective and reliable tools [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. GNRI was proposed by bouillanne et al. In 2005 and is related to ALB level and the ratio of actual body weight to ideal body weight [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. GNRI is suitable for elderly community patients and inpatients over 65 years old, and it is an effective way to evaluate the nutritional status. If the GNRI score of patients is lower, it indicates that the more serious malnutrition is. GNRI has high sensitivity, good specificity and low false positive rate [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e], which is a simple and easy screening method with strong operability. GNRI has been applied to predict the prognosis and postoperative complications of many kinds of malignant tumors, but only the level of BMI or serum albumin is not closely related to the prognosis of cancer patients [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe incidence and mortality of PCa increased with age. In 2017, more than 70% of PCa patients were over 64 years old in the world, and 80% of PCa deaths were more than 65 years old [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], which was in line with the applicable age range of GNRI .\u003c/p\u003e \u003cp\u003eIn this study, we found that there were no significant differences in age, height, PSA, intraoperative blood loss, intraoperative blood transfusion and other baseline indicators between the two groups. Preoperative nutritional indicators such as weight, BMI, HGB, ALB of PCa patients were significantly positively correlated with GNRI, which fully indicated that GNRI could well reflect the nutritional status of patients, and was not interfered by other factors. So GNRI was selected to predict the postoperative recovery and complications of PCa patients undergoing LRP.\u003c/p\u003e \u003cp\u003e \u003cb\u003eThe relationship between nutritional status and postoperative complications in PCa patients\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe average CDCS grade of MNg was significantly higher than that of NNg, and there were grade III complications in MNg. There were no grade IV and V complications in the two groups because of the small statistical samples. Zhou J and other scholars believe that malnutrition is an important factor leading to postoperative complications and higher CDCS grade [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. In patients with malnutrition, the body is in a state of nutritional risk, and a series of compensatory changes will appear in the organs and tissues of the whole body to adapt to this state, such as decreased muscle strength, prolonged recovery time of the whole body and wound, decreased immunity, delayed wound healing, weakened function of neutrophils, macrophages and lymphocytes [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. This situation leads to more serious postoperative complications in patients with malnutrition.\u003c/p\u003e \u003cp\u003eAs shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, the incidence of complications of MNg was higher than that of NNg, especially the incidence of urinary incontinence, infection and incision complications was significantly higher than that of NNg.\u003c/p\u003e \u003cp\u003eThe maintenance of urinary continence in men is mainly related to bladder function and urethral sphincter system. The key to reduce urinary incontinence is to dissect prostate and its surrounding tissues carefully during operation, protect the distal sphincter system and its innervating nerve and supporting tissue [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e], but other related factors include the age and physical condition of the patients are also very important. This study shows that the incidence of urinary incontinence in malnutrition patients is higher than that in normal nutrition patients, which may be related to the weakening of urethral sphincter function and the decline of autonomic contraction of pelvic floor muscle.\u003c/p\u003e \u003cp\u003ePostoperative infection is the most common complication of LRP. According to the literature, malnutrition can lead to fluid overload, further leading to and aggravating postoperative infection [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. This study shows that the incidence of postoperative infection of MNg is higher than that of NNg. The preoperative HGB and ALB of MNg patients are lower than that of NNg, and the im duration of munity is lower, which increases the risk of infection. At the same time, as shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e2\u003c/span\u003e, the average duration of indwelling drainage tube and indwelling catheter in MNg was longer than that in NNg, so the normal physiological structure of abdominal cavity and urethra was destroyed, which reduced the function of mucosa to resist bacteria, resulting in infection.\u003c/p\u003e \u003cp\u003eMNg patients with low preoperative ALB can affect the body enzyme production ability, weaken the ability of tissue and organ self repair, resulting in delayed wound healing. In particular, hypoalbuminemia has a particularly significant impact on humoral immunity, which can cause pathogen translocation, conditional pathogen transformation, and fungal reproduction; in addition, the blood supply under the incision is reduced due to emaciation, thus increasing the probability of incision infection, tissue necrosis, and dehiscence [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn this study, we found that the best Youden value, sensitivity and specificity can be obtained if GNRI\u0026thinsp;=\u0026thinsp;100.75 is taken as the cut-off value to determine whether there are complications, which can preliminarily predict the occurrence of postoperative complications. If GNRI\u0026thinsp;=\u0026thinsp;98.85 is taken as the cut-off value to determine whether there are complications, it can obtain higher sensitivity and acceptable specificity; if GNRI\u0026thinsp;\u0026lt;\u0026thinsp;98.85, the possibility of postoperative complications is very high. In line with the principle of operation safety first and adequate preoperative preparation, nutritional support should be actively given before operation to improve the nutritional level of patients. The sample size of this single center study is small, resulting in the ROC curve is not smooth enough, only a preliminary cut-off value can be obtained. In the future, we plan to carry out a large sample study of multi-center study to find a more accurate cut-off value, which can be used to guide the preoperative nutritional status evaluation of pre PCa patients undergoing LRP.\u003c/p\u003e \u003cp\u003e \u003cb\u003ethe relationship between nutritional status and postoperative recovery in patients with PCa\u003c/b\u003e \u003c/p\u003e \u003cp\u003eIn this study, we observed that duration of PACU in MNg is longer, which is consistent with foreign research results [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. The decreased ALB level and lower body weight of MNg prolong the metabolism time of sevoflurane and other anesthetics [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e], resulting in slower anesthesia recovery of patients. Anesthesiologists need to observe patients for a longer time, so the duration of PACU in MNg is also longer.\u003c/p\u003e \u003cp\u003eIn this study, ALB in MNg is lower than that in NNg, resulting in more intra-abdominal fluid leakage, higher infection and incision complications, also lead to more inflammatory exudate, and then the duration of indwelling drainage tube is longer, volume of indwelling drainage tube is more. The higher incidence of infection complications and incision complications of MNg, as well as its unique complications of urethrorectal fistula, ureteral injury and massive hemorrhage, make the postoperative recovery time of MNg patients longer, and also force doctors to use antibiotics for a longer time.\u003c/p\u003e \u003cp\u003eAt the same time, there was no significant difference between the two groups in WBC values (MNg: 8.60\u0026thinsp;\u0026plusmn;\u0026thinsp;2.40 mg / L, NNg: 8.59\u0026thinsp;\u0026plusmn;\u0026thinsp;2.82 mg / L) on the 3rd postoperative day (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05), but the WBC values in MNg(7.80\u0026thinsp;\u0026plusmn;\u0026thinsp;1.64 mg / L) on the 7th postoperative day were significantly higher than those in NNg(6.51\u0026thinsp;\u0026plusmn;\u0026thinsp;1.88 mg / L) on the 7th postoperative day (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). This also shows that longer duration of antibiotic use in MNg is necessary.\u003c/p\u003e \u003cp\u003eThe low levels of ALB and HGB of MNg lead to a significant increase in the use of enteral and parenteral nutrition preparations, albumin and blood products during hospitalization; the low immunity of MNg and a series of infection related complications lead to the use of longer and higher level antibiotics; the longer duration of PACU treatment leads that the hospitalization costs of MNg higher than NNg significantly, increased the burden of patients.\u003c/p\u003e "},{"header":"Conclusions","content":" \u003cp\u003eTo sum up, GNRI is an effective and reliable tool to evaluate the preoperative nutritional status of PCa, which is closely related to the postoperative recovery and complications; preoperative GNRI examination and effective preoperative nutritional support may benefit PCa patients undergoing LRP.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eEthics Approval and Consent\u003c/strong\u003e \u003cp\u003e The study was approved by the medical ethics committee of Affiliated Hospital of North Sichuan Medical College, Nanchong, China. The study has received the informed consents from all patients and followed the guidelines outlined in the declaration of Helsinki.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication\u003c/strong\u003e \u003cp\u003e All patients have been informed suitably, and we`ve asked for their verbal consent.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eData Availability Statement\u003c/b\u003e:\u003c/p\u003e \u003cp\u003eAll relevant data are in the paper and Supporting Information files.\u003c/p\u003e "},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics Approval and Consent\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cbr /\u003e The study was approved by the medical ethics committee of Affiliated Hospital of North Sichuan Medical College, Nanchong, China. The study has received the informed consents from all patients and followed the guidelines outlined in the declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll patients have been informed suitably, and we`ve asked for their verbal consent.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability Statement:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll relevant data are in the paper and Supporting Information files.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding: \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research is supported by the project of Sichuan Provincial Health and Family Planning Commission (17PJ106), the project of Sichuan Primary Health Development Center (SWFZ18-Y-14), the project of Affiliated Hospital of North Sichuan Medical College (2021ZD018), and the project of school level of (North Sichuan Medical College ( CBY18-A-YB17).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConceptualization: Xie Liang, Fan Jie.\u003c/p\u003e\n\u003cp\u003eData curation: Wang Shu.\u003c/p\u003e\n\u003cp\u003eInvestigation: Fan Jie, Liu Yuan, Xu Yan, Zhang Huan\u003c/p\u003e\n\u003cp\u003eProject administration: Hu Chunyan\u003c/p\u003e\n\u003cp\u003eResources: Xie Liang ,Wu Tao.\u003c/p\u003e\n\u003cp\u003eWriting \u0026ndash; original draft: Wang Shu.\u003c/p\u003e\n\u003cp\u003eWriting \u0026ndash; review \u0026amp; editing: Xie Liang\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBray F, Ferlay J, Soerjomataram I,et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries [J]. CA Cancer J Clin. 2018;68(6):394\u0026ndash;424.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eErratum. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2020 Jul;70(4):313.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChen W,et al. Cancer statistics in China,2015. CA Cancer J Clin. 2016;66(2):115\u0026ndash;32.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBekelman JE, Rumble RB, Freedland SJ. Clinically Localized Prostate Cancer: ASCO Clinical Practice Guideline Endorsement of an AUA/ASTRO/SUO Guideline Summary [J]. J Oncol Pract. 2018;14(10):618\u0026ndash;24.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSanda MG, Cadeddu JA, Kirkby E, et al. Clinically Localized Prostate Cancer: AUA/ASTRO/SUO Guideline. Part II: Recommended Approaches and Details of Specific Care Options[J]. J Urol. 2018;199(4):990\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePatient-Generated Subjective Global Assessment [Internet] Cancer Network. 2013 Feb;17(2) [cited 2018 Jul 8]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.cancernetwork\u003c/span\u003e\u003c/span\u003e. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ecom/ palliative-and-supportive-care/patient-generated-subjective-globalassessment\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePezzana A, Cereda E, Avagnina P, et al. Nutritional Care Needs in Elderly Residents of Long-Term Care Institytions: Potential Implications for Policies[J]. J Nutr Health Aging. 2018;19(9):947\u0026ndash;54.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMatsushita M, Fujita K, Nonomura N. Influence of Diet and Nutrition on Prostate Cancer. Int J Mol Sci. 2020 Feb 20;21(4):1447.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSHOJI F, MATSUBARA T, KOZUMA Y, et al. Preoperative geriatric nutritional risk index: a predictive and prognostic factor in patients with pathological stage I non-small cell lung cancer[J].Surg Oncol,2017,26(4):483\u0026ndash;488.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWANG Y, WANG L, FANG M, et al. Prognostic value of the geriatric nutritional risk index in patients exceeding 70years old with esophageal squamous cell carcinoma[J]. NutrCancer,2020,72(4): 620\u0026ndash;626.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBalzano G, Dugnani E, Crippa S, Scavini M, Pasquale V, Aleotti F, Liberati D, Gandolfi A, Belfiori G, Reni M, et al. A preoperative score to predict early death after pancreatic cancer resection. Dig Liver Dis. 2017;49(9):1050\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGu W, Zhang G, Sun L, Ma Q, Cheng Y, Zhang H, Shi G, Zhu Y, Ye D. Nutritional screening is strongly associated with overall survival in patients treated with targeted agents for metastatic renal cell carcinoma. J Cachexia Sarcopenia Muscle. 2015;6(3):222\u0026ndash;30.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSasaki H, Nagano S, Taniguchi N, Setoguchi T. Risk Factors for Surgical Site Infection after Soft-Tissue Sarcoma Resection, Including the Preoperative Geriatric Nutritional Risk Index. Nutrients. 2018;10(12):1900.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey[J]. Ann Surg. 2004;240(2):205\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSoto-Gonz\u0026aacute;lez M, Da Cu\u0026ntilde;a-Carrera I, Guti\u0026eacute;rrez-Nieto M, Lantar\u0026oacute;n-Caeiro EM. Assessment of male urinary incontinence postprostatectomy through the Consultation on Incontinence Questionnaire-Short Form. Prog Urol. 2020;30(4):209\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBouillanne O, Morineau G, Dupont C, Coulombel I, Vincent JP, Nicolis I, Benazeth S, Cynober L, Aussel C. Geriatric Nutritional Risk Index: a new index for evaluating at-risk elderly medical patients. Am J Clin Nutr. 2005 Oct;82(4):777\u0026ndash;83.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLidoriki I, Schizas D, Frountzas M, Machairas N, Prodromidou A, Kapelouzou A, Karavokyros I, Pikoulis E, Kales SN, Liakakos T. GNRI as a Prognostic Factor for Outcomes in Cancer Patients: A Systematic Review of the Literature. Nutr Cancer. 2021;73(3):391\u0026ndash;403.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJayanth KS, Maroju NK. Utility of nutritional indices in preoperative assessment of cancer patients. Clin Nutr ESPEN. 2020 Jun;37:141\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTripathy S, MIshra JC. Assessing nutrition in the critically ill elderly patient: a comparison of two screening tools. Indian J Crit Care Med. 2015 Sep;19(9):518e22.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGyan E, Raynard B, Durand J-P, Lacau Saint Guily J, Gouy S, Movschin ML, Khemissa F, Flori N, Oziel-Taieb S, Bannier Braticevic C, et al. Malnutrition in Patients With Cancer. JPEN J Parenter Enteral Nutr. 2017;42(1):255\u0026ndash;60.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhai Z, Zheng Y, Li N, et al. Incidence and disease burden of prostate cancer from 1990 to 2017: Results from the Global Burden of Disease Study 2017[J]. Cancer. 2020;126(9):1969\u0026ndash;78.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhou J, Zhou Y, Cao S, Li S, Wang H, Niu Z, Chen D, Wang D, Lv L, Zhang J, Li Y, Jiao X, Tan X, Zhang J, Wang H, Zhang B, Lu Y, Sun Z. Multivariate logistic regression analysis of postoperative complications and risk model establishment of gastrectomy for gastric cancer: A single-center cohort report. Scand J Gastroenterol. 2016 Jan;51(1):8\u0026ndash;15.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWu Guohao. Causes and prevention of malnutrition in patients with malignant tumor [J]. Chinese Journal of gastrointestinal surgery, 2010 (03): 170\u0026ndash;172.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKretschmer A, Nitti V. Surgical Treatment of Male Postprostatectomy Incontinence: Current Concepts[J]. Eur Urol Focus. 2017;3(4\u0026ndash;5):364\u0026ndash;76.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDekker MJE, Konings C, Canaud B, van der Sande FM, Stuard S, Raimann JG, \u0026Ouml;zt\u0026uuml;rk E, Usvyat L, Kotanko P, Kooman JP. Interactions Between Malnutrition, Inflammation, and Fluid Overload and Their Associations With Survival in Prevalent Hemodialysis Patients. J Ren Nutr. 2018 Nov;28(6):435\u0026ndash;44.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRenner R, Garibaldi MDS, Benson S, Ronicke M, Erfurt-Berge C. Nutrition status in patients with wounds: a cross-sectional analysis of 50 patients with chronic leg ulcers or acute wounds. Eur J Dermatol. 2019 Dec 1;29(6):619\u0026ndash;626.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLoncar Y, Lefevre T, Nafteux L, Genser L, Manceau G, Lemoine L, Vaillant JC, Eyraud D. Preoperative nutrition forseverely malnourished patients in digestive surgery: A retrospective study. J Visc Surg. 2020 Apr;157(2):107\u0026ndash;16.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eArtru AA. Renal effects of sevoflurane during conditions of possible increased risk. J Clin Anesth. 1998 Nov;10(7):531\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-332306/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-332306/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eThe purpose of this study is to evaluate the association and predictive value of geriatric nutritional risk index (GNRI) in elderly patients with prostate cancer(PCa) undergoing laparoscopic radical prostatectomy (LRP).\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003ethe clinical data of 72 elderly patients (aged\u0026thinsp;\u0026ge;\u0026thinsp;65 y) with PCa undergoing LRP in the Department of Urology, Affiliated Hospital of North Sichuan Medical College from January 2018 to December 2020 were retrospectively analyzed. The basic information, laboratory examination indexes, operation conditions, postoperative complications and postoperative recovery indexes of patients were included. Clavien-Dindo Classification System (CDCS) was used to assess the postoperative complications. T-test was used to analyze the grouping variables. ROC curve was drawn to study the predictive value of GNRI for postoperative complications.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe body weight, BMI, preoperative HGB, ALB values of malnutrition group (MNg) and normal nutrition group (NNg) were significantly positively correlated (P༜0.01); the incidence and severity of postoperative complications of MNg were significantly higher than those of NNg (P༜0.05). The average hospitalization costs of MNg was higher, the duration of postanesthesia care unit (PACU), duration of antibiotic use was longer and the duration of indwelling drainage tube were longer than NNg (P༜0.05). The volume of indwelling drainage tube were more than NNg (P༜0.05).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eGNRI is an effective and reliable tool to evaluate preoperative nutritional status of prostate cancer, which is closely related to postoperative recovery and complications,and has predictive value.\u003c/p\u003e","manuscriptTitle":"Preoperative Nutritional Evaluation of Elderly Patients with Prostate Cancer Undergoing Laparoscopic Radical Prostatectomy","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2021-04-05 14:08:19","doi":"10.21203/rs.3.rs-332306/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"fef9b6f7-e51c-4778-981c-77718f3a015d","owner":[],"postedDate":"April 5th, 2021","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":3407367,"name":"Surgery"},{"id":3407368,"name":"Oncology"}],"tags":[],"updatedAt":"2021-04-25T03:07:36+00:00","versionOfRecord":[],"versionCreatedAt":"2021-04-05 14:08:19","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-332306","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-332306","identity":"rs-332306","version":["v1"]},"buildId":"369fNeqWncA4NS6XSWjrt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}