The role of prognostic nutritional index for clinical outcomes of gastric cancer after total gastrectomy

Abstract

The purpose of this article is to evaluate the relationship between the nutrition-based microenvironment and clinicopathological information for gastric cancer patients and to investigate the prognostic value of nutrition index for gastric cancer patients undergoing total gastrectomy. We retrospectively collected clinical information of 245 gastric cancer patients who underwent total gastrectomy in our hospital between January 1st 2005 and December 30th 2015. According to the prognostic nutritional index (PNI) level, they were divided into low PNI (< 43) group and high PNI (≥ 43) group. The relationship between PNI and the disease-free survival (DFS) and overall survival (OS) were analyzed by statistical analysis. Univariate analyses demonstrated that TNM stage (p = 0.025), patients age (p = 0.042), lymph node metastasis (p = 0.028), tumor differentiation (p = 0.037) and a low PNI (p = 0.033) were closely correlated with a poor prognosis. In multivariate analysis, TNM stage (p = 0.027) and a low PNI (p = 0.041) were found to be independently associated with poor survival. Additionally, when age was considered as a stratified factor, univariate analyses demonstrated that low PNI correlated with shorter DFS in non-elderly (< 65) patients (p = 0.022) and shorter DFS (p = 0.036) and OS (p = 0.047) in elderly (≥ 65) patients. The low prognostic nutritional index is an independent risk factor associated with poor gastric cancer survival which represents the nutritional microenvironment. Patients with low pre-operative prognostic nutritional index levels should be observed more closely after surgery to prevent the occurrence of post-operative complications in the near future.

Preoperative Systemic Immune–Inflammation Index (SII) as a Superior Predictor of Long-Term Survival Outcome in Patients With Stage I–II Gastric Cancer After Radical Surgery

“…Due to high metabolism and proliferation of tumor cells, patients with cancer were more prone to malnutrition that correlated with damaged immune function and increased mortality ( 31 ). Several studies showed that some nutritional indices, such as albumin, BMI, and PNI, were also related to prognosis in GC patients after gastrectomy ( 9 , 32 ). As far as we know, this was the first study to compare multiple hematological markers, such as immunoinflammatory indices, nutritional indices, and serum tumor markers, to find the optimal prognostic factors for stage I–II GC patients after radical gastrectomy.…”

“…Some inflammation-related indices, such as neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), advanced lung cancer inflammation index (ALI), and systemic immune–inflammation index (SII), which systemically calculate the status of immune-inflammatory cells, are considered to be promising prognostic indicators in several solid tumors, including GC ( 4 – 7 ). Due to the close relationship between immune function and cell metabolism and nutritional status ( 8 ), some studies have further found that some nutritional indices, such as albumin, body mass index (BMI), and prognostic nutritional index (PNI), are potential predictors of prognosis in patients with cancer ( 9 , 10 ). In addition, serum tumor markers, recognized as prognostic factors, are widely used in assessing the effect of treatment, predicting prognosis and recurrence ( 11 ).…”

Comparison of nutritional and immunological scoring systems predicting prognosis in T1-2N0 colorectal cancer

“…If those easy-touse serum indicators effectively predict outcome, clinical management of malignancies could be improved. The PNI, which is calculated using serum albumin and total lymphocyte count, has been reported as a predictor in various cancers including CRC [7,15,16]. The CONUT, which is based in serum albumin, total lymphocyte count, and total cholesterol concentration, also has been reported to be independently associated with the survival rate of patients with various cancers including CRC [17][18][19].…”

A Nomogram Model Involving Preoperative Fibrinogen and Prognostic Nutritional Index Score for Predicting Postoperative Outcome in Patients with Gastric Cancer

“… 26 Thus, PNI may reflect systemic inflammation. It was reported that preoperative PNI was a good prognostic indicator of hepatocellular carcinoma, 27 gastric cancer, 6 colorectal carcinoma 28 and pancreatic cancer. 29 In our study, we found that the low PNI values were associated with poor outcome, consistent with previous results.…”

“… 4 , 5 Moreover, several lines of evidences suggest that systemic immune inflammation plays a key role in tumor progression. The prognostic nutritional index (PNI), 6 neutrophil-to-lymphocyte ratio, 7 platelet-to-lymphocyte ratio 8 and other biomarkers have been associated with poor outcome in various cancers. To the best of our knowledge, fibrinogen and PNI have not been simultaneously evaluated as markers of tumor prognosis in patients with GC.…”