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Significance of Preoperative Prognostic Nutritional Index in the Perioperative Management of Gastric Cancer

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

Malnutrition leads to accelerated tumor progression through the suppression of tumor immunity. The present study examined the significance of the preoperative prognostic nutritional index (PNI) for predicting postoperative survival outcomes in gastric cancer (GC).

Methods

A total of 447 patients who underwent curative gastrectomy for GC were included in the present study. PNI was calculated as 10 × serum albumin (g/dl) + 0.005 × total lymphocyte counts (per mm3). The prognostic impact of preoperative PNI was examined using two multivariate analysis models.

Results

The optimal cutoff value of preoperative PNI for predicting overall survival (OS) was 48 based on a receiver operating characteristic curve. The 5-year OS rate was 59.5% in the PNI<48 group and 91.3% in the PNI≥48 group (p<0.001). In the first multivariate survival analysis where all explanatory variables were composed of preoperative factors alone, a PNI<48 (hazard ratio [HR] 3.33; 95% confidence interval [CI] 2.01–5.56, p<0.001), upper-third GC and cT2–T4 were identified as independent indicators of a poor OS. In the second survival analysis where explanatory variables were composed of preoperative, intraoperative, and pathological factors, a PNI<48 (HR 2.80; 95% CI 1.65–4.78, p<0.001), hypertension, open gastrectomy, intraoperative blood loss≥100g, pT2–T4, and pN+ were independent prognostic factors.

Conclusion

Preoperative PNI may be a useful predictor of postoperative survival outcomes both before and immediately after surgery in GC. Appropriate perioperative interventions and the meticulous surveillance of GC relapse are necessary for patients with PNI<48.

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Authors and Affiliations

  1. Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan

    Tomoki Konishi, Toshiyuki Kosuga, Hiroyuki Inoue, Hirotaka Konishi, Atsushi Shiozaki, Takeshi Kubota, Kazuma Okamoto, Hitoshi Fujiwara & Eigo Otsuji

  2. Department of Surgery, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, Japan

    Tomoki Konishi

  3. Department of Surgery, Saiseikai Shiga Hospital, Shiga, Japan

    Toshiyuki Kosuga

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  1. Tomoki Konishi
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Correspondence to Toshiyuki Kosuga.

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Supplementary Information

Supplemental figure S1.

Cancer-specific survival curves of patients stratified by preoperative PNI (A) All patients, (B) patients with pStage I GC, and (C) patients with pStage II-III GC (PNG 19784 kb)

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Konishi, T., Kosuga, T., Inoue, H. et al. Significance of Preoperative Prognostic Nutritional Index in the Perioperative Management of Gastric Cancer. J Gastrointest Surg 26, 558–569 (2022). https://doi.org/10.1007/s11605-021-05168-x

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  • DOI: https://doi.org/10.1007/s11605-021-05168-x

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