A Novel Clinically Prognostic Stratification Based on Prognostic Nutritional Index Status and Histological Grade in Patients With Gallbladder Cancer After Radical Surgery

Abstract

PurposeGallbladder carcinoma (GBC) is the most common malignancy of the biliary tract, with a 5-year survival rate of 5%. The prognostic models to predict the prognosis of patients with GBC remain controversial. Therefore, to construct a prognosis prediction of GBC, a retrospective cohort study was carried out to investigate the prognostic nutritional index and histological grade in the long-term outcome of patients with GBC after radical surgery (RS).MethodsA retrospective study of a total of 198 patients with GBC who underwent surgical treatment were enrolled. The hematological indicators, imageological data, and perioperative clinical data were acquired for statistical analysis and poor prognosis model construction.ResultsPrognostic nutrition index (PNI) < 45.88, maximum tumor diameter (MTD) > 2.24 cm, and jaundice (JD) were all associated with a poor prognosis in multivariate logistic regression analysis. The prognosis prediction model was based on the three risk factors, which indicated a superior predictive ability in the primary cohort [area under the curve (AUC) = 0.951] and validation cohort (AUC = 0.888). In multivariate Cox regression analysis, poorly differentiation (PD) was associated with poor 3-year survival. In addition, Kaplan–Meier (KM) survival analysis suggested that GBC patients with high-risk scores and PD had a better prognosis after RS (p < 0.05), but there was no significant difference in prognosis for patients with non-poorly differentiation (NPD) or low-risk scores after RS (p > 0.05).ConclusionOur prediction model for GBC patients with prognosis evaluation is accurate and effective. For patients with PD and high-risk scores, RS is highly recommended; a simple cholecystectomy can also be considered for acceptance for patients with NPD or low-risk score. The significant findings provide a new therapeutic strategy for the clinical treatment of GBC.

Can neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, prognostic nutrition index, and albumin be used to predict cholecystectomy morbidity in super-elderly patients?

“…A PNI lower than 45.88 has been associated with a poor prognosis in patients with gallbladder cancer. [ 27 ] In the present study, the AUC for PNI was 0.780 ([95% CI: 0.568–0.991]; P=0.027), and at the cut-off value of 41.70, PNI’s sensitivity was 82.6%, and its specificity was 71.4%.…”

Low Prognostic Nutritional Index Is Common and Associated with Poor Outcomes following Curative-Intent Resection for Gastro-Entero-Pancreatic Neuroendocrine Tumors

“…An R0 resection was defined as the absence of macro-or microscopic disease at the surgical margin, while an R1 resection was classified as microscopic presence of tumor cells at the margin [26]. The prognostic nutrition index (PNI) was calculated based on the baseline preoperative clinical peripheral lymphocyte count (PLC) and serum albumin (ALB): PNI = ALB (g/L) + 5 × Prognostic Nutritional Index in GEP-NETs Neuroendocrinology 2024;114:158-169 DOI: 10.1159/000534075 PLC (×10 9 /L) [9]. The optimal cut-off value for PNI was determined using the bio-informatics tool X-tile [27].…”

“…Other investigators have utilized scoring systems such as the Subjective Global Assessment (SGA) or Nutritional Risk Screening (NRS) tools, but not among patients who were malnourished [14, 23]. More recently, the prognostic nutritional index (PNI), which combines serum albumin and peripheral blood lymphocyte count, has been proposed as means to assess perioperative immune-nutritional status of cancer patients [9, 15, 16, 24]. To date, the predictive potential of nutritional indices such as PNI among patients with GEP-NETs has not been investigated.…”

“…Tumor factors notwithstanding, nutritional status is another important host-related determinant of prognosis among cancer patients [8][9][10]. Nutritional status can impact a patient's inflammatory state, immunocompetence, as well as treatment response.…”

“…In addition, poor nutritional status may compromise a patient's ability to tolerate anti-cancer therapy, thereby compromising prognosis [11][12][13][14]. In fact, malnutrition has been associated with poor cancer-specific outcomes among patients with gallbladder and esophageal carcinoma [9,15,16]. To date, the impact of nutritional status on prognosis among patients with more indolent tumor types such as GEP-NETs has not been well examined.…”