Low prognostic nutrition index is a biomarker for survival in elderly patients with early gastric cancer after gastrectomy

Abstract

Purpose Non-invasive biomarkers are useful in determining treatment strategies for elderly patients with early gastric cancer (EGC). The systemic inflammatory or nutrition-based index including neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR) lymphocyte to monocyte ratio (LMR), and prognostic nutritional index (PNI) are useful for the assessment of prognosis for various cancers. The aim of this study was to investigate the significance of these index for predicting the long-term survival of EGC patients who were 80 years old or older. Methods This study included 80 elderly EGC patients with pStage IA after gastrectomy. The optimal cutoff value for the PNI, NLR, PLR and LMR were set by using a receiver operating curve analysis. The long-term outcomes after gastrectomy were analyzed by univariate and multivariate Cox regression analyses. Results The cutoff value for the PNI, NLR, PLR and LMR was set at 46.5, 2.8, 210 and 4.6, respectively. By univariate analyses, the low PNI, high NLR, high PLR and low LMR were significantly associated with worse OS. By multivariate analysis, only low PNI was confirmed as an independent prognostic factor for OS after gastrectomy (HR 0.17; 95% CI 0.03–0.91; P = 0.04). The 5-year overall survival rate of patients with the low PNI (≤ 46.5) were only 52.4%. Conclusion The low PNI (≤ 46.5) is a significant worse prognostic factor after gastrectomy for the elderly EGC patients with pStage IA. Gastrectomy for the elderly EGC patients with the low PNI might need to be carefully considered for its indications.