Impact of the prognostic nutritional index on the recovery and long-term oncologic outcome of patients with colorectal cancer
- 350 Downloads
The prognostic nutritional index (PNI) has been reported to be a predictive marker for surgical outcomes and prognosis in gastrointestinal malignancies. In this study, we aimed to identify the impact of preoperative PNI on the recovery and long-term oncologic outcome of patients with colorectal cancer (CRC).
A total of 3569 patients who underwent curative resection for CRC were enrolled, and their medical records were analyzed retrospectively. Preoperative PNI was calculated as 10× serum albumin concentration (g/dL) + 0.005 × total lymphocyte count (/mm3). The occurrence of postoperative complications, duration of hospital stay, disease-free survival, and overall survival were analyzed according to the preoperative PNI. In addition, PNI was compared according to the status of pathologic factors.
The postoperative complication rate and postoperative duration of hospital stay increased significantly as PNI increased. Patients with a lower PNI showed a worse survival outcome. Increased depth of tumor invasion, presence of distant metastasis, and poorer histologic grade were associated with a lower PNI. The cut-point of preoperative PNI was calculated as 50, and patients with PNI > 50 showed a markedly better survival outcome. Furthermore, patients with PNI > 50 showed better results in postoperative complication rate and postoperative duration of hospital stay.
Preoperative PNI is a simple and efficient indicator (cut-point 50) for estimating the recovery and oncologic outcome of patients. A low PNI was associated with increased occurrence of postoperative complications, prolonged hospital stay, poor oncologic outcome, and aggressive tumor phenotypes.
KeywordsPrognostic nutritional index Colorectal cancer Postoperative complication Oncologic outcome; tumor phenotype
Compliance with ethical standards
Conflict of interest
The authors declare that thy have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.
- Edge S (2010) American Joint Committee on Cancer (2010) AJCC cancer staging manual. Springer, New YorkGoogle Scholar
- Hothorn T, Lausen B (2002) Maximally selected rank statistics in R R News 2:3–5Google Scholar
- Jian-Hui C, Iskandar EA, Cai Sh I, Chen CQ, Wu H, Xu JB, He YL (2016) Significance of Onodera’s prognostic nutritional index in patients with colorectal cancer: a large cohort study in a single Chinese institution. Tumour Biol J Int Soc Oncodev Biol Med 37:3277–3283. doi: 10.1007/s13277-015-4008-8 CrossRefGoogle Scholar
- Moyes LH, Leitch EF, McKee RF, Anderson JH, Horgan PG, McMillan DC (2009) Preoperative systemic inflammation predicts postoperative infectious complications in patients undergoing curative resection for colorectal cancer. Br J Cancer 100:1236–1239. doi: 10.1038/sj.bjc.6604997 CrossRefPubMedPubMedCentralGoogle Scholar
- National comprehensive cancer network (2015a) National comprehensive cancer network guidelines, Colon cancer. http://www.nccn.org/professionals/physician_gls/f_guidelines.asp#site. Accessed August 01 2016
- National comprehensive cancer network (2015b). National comprehensive cancer network guidelines, Rectal cancer. http://www.nccn.org/professionals/physician_gls/f_guidelines.asp#site. Accessed August 01 2016