Prognostic nutritional index as a predictor of survival in resectable gastric cancer patients with normal preoperative serum carcinoembryonic antigen levels: a propensity score matching analysis

Abstract

BackgroundAn ideal tumor marker should be capable of being detected at any stage of the disease. However, gastric cancer patients do not always have elevated serum carcinoembryonic antigen (CEA) levels, even in advanced cases. Recently, several studies have investigated the associations between preoperative PNI and postoperative long-term outcomes. In this study, we focused on the significance of the prognostic nutritional index (PNI) as a potential predictor of survival in resectable gastric cancer patients with normal preoperative serum CEA levels.MethodsWe retrospectively conducted cohort study to evaluate the PNI as a predictor of survival in 368 resectable gastric cancer patients who underwent potentially curative gastrectomy at our institute between January 2010 and December 2016. We selected 218 patients by propensity score matching to reduce biases due to the different distributions of co-variables among the comparable groups.ResultsIn the multivariate analysis, pStage (hazard ratio [HR]: 14.003, 95% confidence interval [CI]: 5.033–44.487; p < 0.001), PNI (HR: 2.794, 95% CI: 1.352–6.039; p < 0.001) were identified as independent prognostic factors of CSS in 218 propensity matched gastric cancer patients. The Kaplan-Meier analysis demonstrated that low PNI patients had a significantly poorer cancer specific survival (CSS) than high PNI patients (p = 0.008).Among 166 propensity matched gastric cancer patients with normal preoperative serum CEA levels, multivariate analysis demonstrated that pStage (HR: 7.803, 95% CI: 3.015–24.041; p < 0.001) and PNI (HR: 3.078, 95% CI: 1.232–8.707; p = 0.016) were identified as independent prognostic factors of CSS. And Kaplan-Meier analysis demonstrated that low PNI had a significantly poorer CSS than high PNI value (p = 0.011).ConclusionsThis study demonstrates that a low preoperative PNI value is a potential independent risk factor for poorer CSS in patients with gastric cancer, even in those with normal serum CEA levels.

The prognostic value of preoperative fibrinogen-to-prealbumin ratio and a novel FFC score in patients with resectable gastric cancer

“…For instance, GPS or modified GPS based on cancer-related inflammation is an independent predictor of GC survival and can be used as a predictor for patients with GC undergoing platinumbased chemotherapy [30,31]. Moreover, low prognostic nutritional index (PNI), which is calculated from the combination of BMI, lymphocyte count, and albumin, is associated with poor clinical outcome in resectable GC and can act as an independent risk factor [32]. Similarly, controlling nutritional status (CONUT) score, which is obtained from total lymphocyte count, total cholesterol level, and albumin, is associated with survival in patients with GC undergoing curative gastrectomy [33].…”

<p>Peripheral Blood Platelet–Lymphocyte Ratio Is Good Predictor of Chemosensitivity and Prognosis in Gastric Cancer Patients</p>

“…[24][25][26] However, the related mechanism of action remains largely unknown. 4 Although PLR, NLR, and other hematological markers including nutrition indicators have been established as effective prognostic factors for numerous types of cancers, [8][9][10][11] the relationship between these markers and chemotherapy resistance is also unclear.…”

“…Peripheral blood inflammation/immuno-nutrition indicators, such as the platelets-lymphocyte ratio (PLR), neutrophil-lymphocyte ratio (NLR), and prognostic nutritional index (PNI), are widely recognized as useful prognostic predictors in various malignancies. [8][9][10][11] A low NLR or a high peripheral lymphocyte count could be predictors for a high efficacy of preoperative chemotherapy for breast cancer patients. [12][13][14] To our knowledge, this is the first report to investigate whether a peripheral inflammation/ immuno-nutrition indicator could predict the efficacy of preoperative chemotherapy in gastric cancer.…”

The prognostic nutritional index as a predictor of long-term outcome in patients with resected esophageal squamous cell carcinoma

“…In recent studies of long-term results for other organ cancer, significant differences were seen for cutoff values close to or lower than 45; for example, in Hirahara et al and Nozoe et al's studies, the cutoff values were 44.3 for gastric cancer [22] and 40 for colon cancer 40, respectively [8]. Since esophageal cancer has a poor prognosis, a cutoff value slightly higher than 45 would be needed.…”