Journal of Cancer Research and Clinical Oncology

, Volume 143, Issue 7, pp 1235–1242 | Cite as

Impact of the prognostic nutritional index on the recovery and long-term oncologic outcome of patients with colorectal cancer

  • Gyoung Tae Noh
  • Jeonghee Han
  • Min Soo Cho
  • Hyuk Hur
  • Byung Soh Min
  • Kang Young Lee
  • Nam Kyu Kim
Original Article – Clinical Oncology



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.


Prognostic 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.

Ethical approval

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.


  1. Brenner H, Kloor M, Pox CP (2014) Colorectal cancer. Lancet (London, England) 383:1490–1502 doi: 10.1016/s0140-6736(13)61649-9 CrossRefGoogle Scholar
  2. Chu-Yuan H et al (2013) The impact of chemotherapy-associated neutrophil/ lymphocyte counts on prognosis of adjuvant chemotherapy in colorectal cancer. BMC Cancer 13:177. doi: 10.1186/1471-2407-13-177 CrossRefPubMedPubMedCentralGoogle Scholar
  3. Crumley AB, Stuart RC, McKernan M, McMillan DC (2010) Is hypoalbuminemia an independent prognostic factor in patients with gastric cancer? World J Surg 34:2393–2398. doi: 10.1007/s00268-010-0641-y CrossRefPubMedGoogle Scholar
  4. Edge S (2010) American Joint Committee on Cancer (2010) AJCC cancer staging manual. Springer, New YorkGoogle Scholar
  5. Erdman SE, Poutahidis T (2010) Roles for inflammation and regulatory T cells in colon cancer. Toxicol Pathol 38:76–87 doi: 10.1177/0192623309354110 CrossRefPubMedGoogle Scholar
  6. Feng J-F, Chen Q-X (2014) Significance of the prognostic nutritional index in patients with esophageal squamous cell carcinoma. Ther Clin Risk Manag 10:1PubMedGoogle Scholar
  7. Gao Y, Zhou S, Jiang W, Huang M, Dai X (2003) Effects of ganopoly (a Ganoderma lucidum polysaccharide extract) on the immune functions in advanced-stage cancer patients. Immunol Investig 32:201–215CrossRefGoogle Scholar
  8. Hirashima K et al. (2014) Prognostic significance of the modified Glasgow prognostic score in elderly patients with gastric cancer. J Gastroenterol 49:1040–1046CrossRefPubMedGoogle Scholar
  9. Hothorn T, Lausen B (2002) Maximally selected rank statistics in R R News 2:3–5Google Scholar
  10. Jeon HG et al (2016) Preoperative prognostic nutritional index is a significant predictor of survival in renal cell carcinoma patients undergoing nephrectomy. Ann Surg Oncol 23:321–327. doi: 10.1245/s10434-015-4614-0 CrossRefPubMedGoogle Scholar
  11. 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
  12. Kwag S-J, Kim J-G, Kang W-K, Lee J-K, Oh S-T (2014) The nutritional risk is a independent factor for postoperative morbidity in surgery for colorectal cancer. Ann Surg Treat Res 86:206–211CrossRefPubMedPubMedCentralGoogle Scholar
  13. Laky B, Janda M, Bauer J, Vavra C, Cleghorn G, Obermair A (2007) Malnutrition among gynaecological cancer patients. Eur J Clin Nutr 61:642–646 doi: 10.1038/sj.ejcn.1602540 PubMedGoogle Scholar
  14. Maeda K et al (2014) Low nutritional prognostic index correlates with poor survival in patients with stage IV colorectal cancer following palliative resection of the primary tumor. World J Surg 38:1217–1222. doi: 10.1007/s00268-013-2386-x CrossRefPubMedGoogle Scholar
  15. Mainous MR, Deitch EA (1994) Nutrition and infection. Surg Clin N Am 74:659–676PubMedGoogle Scholar
  16. Mazur G, Bogunia-Kubik K, Wrobel T, Kuliczkowski K, Lange A (2006) TGF-beta1 gene polymorphisms influence the course of the disease in non-Hodgkin’s lymphoma patients. Cytokine 33:145–149. doi: 10.1016/j.cyto.2005.12.010 CrossRefPubMedGoogle Scholar
  17. Mohri Y, Inoue Y, Tanaka K, Hiro J, Uchida K, Kusunoki M (2013) Prognostic nutritional index predicts postoperative outcome in colorectal cancer. World J Surg 37:2688–2692CrossRefPubMedGoogle Scholar
  18. 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
  19. National comprehensive cancer network (2015a) National comprehensive cancer network guidelines, Colon cancer. Accessed August 01 2016
  20. National comprehensive cancer network (2015b). National comprehensive cancer network guidelines, Rectal cancer. Accessed August 01 2016
  21. Nozoe T, Kohno M, Iguchi T, Mori E, Maeda T, Matsukuma A, Ezaki T (2012) The prognostic nutritional index can be a prognostic indicator in colorectal carcinoma. Surg Today 42:532–535 doi: 10.1007/s00595-011-0061-0 CrossRefPubMedGoogle Scholar
  22. Onodera T, Goseki N, Kosaki G (1984) [Prognostic nutritional index in gastrointestinal surgery of malnourished cancer patients]. Nihon Geka Gakkai Zasshi 85:1001–1005PubMedGoogle Scholar
  23. Ray-Coquard I et al (2009) Lymphopenia as a prognostic factor for overall survival in advanced carcinomas, sarcomas, and lymphomas. Cancer Res 69:5383–5391. doi: 10.1158/0008-5472.can-08-3845 CrossRefPubMedPubMedCentralGoogle Scholar
  24. Sakurai K et al (2016) Predictive potential of preoperative nutritional status in long-term outcome projections for patients with gastric cancer. Ann Surg Oncol 23:525–533. doi: 10.1245/s10434-015-4814-7 CrossRefPubMedGoogle Scholar
  25. Schwegler I, Von Holzen A, Gutzwiller JP, Schlumpf R, Mühlebach S, Stanga Z (2010) Nutritional risk is a clinical predictor of postoperative mortality and morbidity in surgery for colorectal cancer. Br J Surg 97:92–97CrossRefPubMedGoogle Scholar
  26. Shibutani M et al (2015) The prognostic significance of the postoperative prognostic nutritional index in patients with colorectal cancer. BMC Cancer 15:521. doi: 10.1186/s12885-015-1537-x CrossRefPubMedPubMedCentralGoogle Scholar
  27. Shoji F et al. (2016) Predictive impact for postoperative recurrence using the preoperative prognostic nutritional index in pathological stage I non-small cell lung cancer. Lung Cancer (Amsterdam, Netherlands) 98:15–21. doi: 10.1016/j.lungcan.2016.05.010 CrossRefGoogle Scholar
  28. Sun K, Chen S, Xu J, Li G, He Y (2014) The prognostic significance of the prognostic nutritional index in cancer: a systematic review and meta-analysis. J Cancer Res Clin Oncol 140:1537–1549 doi: 10.1007/s00432-014-1714-3 CrossRefPubMedGoogle Scholar
  29. Tokunaga R et al (2015) Prognostic nutritional index predicts severe complications, recurrence, and poor prognosis in patients with colorectal cancer undergoing primary tumor resection. Dis Colon Rectum 58:1048–1057CrossRefPubMedGoogle Scholar
  30. Watanabe M, Iwatsuki M, Iwagami S, Ishimoto T, Baba Y, Baba H (2012) Prognostic nutritional index predicts outcomes of gastrectomy in the elderly. World J Surg 36:1632–1639CrossRefPubMedGoogle Scholar
  31. Winawer S et al (2003) Colorectal cancer screening and surveillance: clinical guidelines and rationale—update based on new evidence. Gastroenterology 124:544–560CrossRefPubMedGoogle Scholar
  32. Yang Z, Zhang B, Hou L, Xie Y, Cao X (2014) Pre-operative prognostic nutritional index predicts the outcomes for triple-negative breast cancer. Tumour Biol J Int Soc Oncodev Biol Med 35:12165–12171. doi: 10.1007/s13277-014-2524-6 CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  • Gyoung Tae Noh
    • 1
  • Jeonghee Han
    • 1
  • Min Soo Cho
    • 1
  • Hyuk Hur
    • 1
  • Byung Soh Min
    • 1
  • Kang Young Lee
    • 1
  • Nam Kyu Kim
    • 1
  1. 1.Department of Surgery, Severance HospitalYonsei University College of MedicineSeoulKorea

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