Skip to main content

Advertisement

SpringerLink
Log in

Is the Prognostic Nutritional Index a Prognostic Marker for the Survival of Patients with Lymph-Node Positive Stage II-III Gastric Cancer Who Receive Adjuvant Chemotherapy?

  • Research
  • Published:
Journal of Gastrointestinal Cancer Aims and scope Submit manuscript

Abstract

Purpose

The prognostic nutritional index (PNI), like other systemic inflammatory markers, has been shown to be a prognostic factor in various cancer patients. In this study, we aimed to show whether PNI calculated before adjuvant chemotherapy is a prognostic factor for overall survival (OS) and disease-free survival (DFS) in patients with lymph node-positive stage II-III gastric cancer.

Methods

The PNI was calculated using the albumin and lymphocyte count. The PNI cut-off value was found to be 39.5. They were divided into two groups as being ≤ 39.5 (PNI low group) and > 39.5 (PNI high group).

Results

Our study included 168 patients with lymph node-positive stage II-III gastric cancer who received adjuvant chemotherapy. Of the patients, 116 (69.0%) were 65 years or younger, and 52 (31.0%) were over 65 years old. Of the patients, 117 (69.6%) were pT3, 51 (30.4%) were pT4. Seventy-three (43.4%) patients had pN1-2 disease and 95 (56.6%) patients had pN3 disease. The number of stage II patients was 73 (43.5%) and the number of stage III patients was 95 (56.5%). There were 73 patients with PNI ≤ 39.5 and 95 patients with PNI > 39.5. The mOS of the patients with low PNI group was 39.5 months, while the OS of the patients with high PNI group was 96.8 months (p = 0.002). In the group of patients with PNI low group, mDFS 24.4 months was significantly higher than those with PNI high group was 50.7 months (p = 0.021). The PNI score was statistically significant in univariate and multivariate analyzes for both DFS and OS.

Conclusion

PNI can be used as an independent prognostic factor for both OS and DFS in patients lymph node-positive, stage II-III gastric cancer who will receive adjuvant chemotherapy.

Key Points

  1. 1.

    Prognostic nutritional index, an inflammatory marker, has been shown to be a prognostic factor in cancer patients.

  2. 2.

    The prognostic nutritional index is an independent predictor of both disease-free survival and overall survival in patients with lymph node-positive gastric cancer receiving adjuvant chemotherapy.

  3. 3.

    The prognosis is worse in those with a low prognostic nutritional index. Both overall survival and disease-free survival times are significantly longer in those with a high prognostic nutritional index.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Data Availability

The data presented in this study can be obtained from the corresponding author.

References

  1. Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and Mortality Worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71(3):209–49.

    Article  PubMed  Google Scholar 

  2. Songun I, Putter H, Kranenbarg EM, Sasako M, van de Velde CJ. Surgical treatment of gastric cancer: 15-year follow-up results of the randomised nationwide dutch D1D2 trial. Lancet Oncol. 2010;11(5):439–49.

    Article  PubMed  Google Scholar 

  3. Macdonald JS, Smalley SR, Benedetti J, et al. Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction. N Engl J Med. 2001;345(10):725–30.

    Article  CAS  PubMed  Google Scholar 

  4. Ronellenfitsch U, Schwarzbach M, Hofheinz R, GE Adenocarcinoma Meta-analysis Group. ;. Perioperative chemo(radio)therapy versus primary surgery for resectable adenocarcinoma of the stomach, gastroesophageal junction, and lower esophagus. Cochrane Database Syst Rev. 2013;(5):CD008107.

  5. Diaz-Nieto R, Orti-Rodríguez R, Winslet M. Post-surgical chemotherapy versus surgery alone for resectable gastric cancer. Cochrane Database Syst Rev. 2013;9. CD008415.

  6. Oba K, Paoletti X, Alberts S, GASTRIC group, et al. Disease-free survival as a surrogate for overall survival in adjuvant trials of gastric cancer: a meta-analysis. J Natl Cancer Inst. 2013;105(21):1600–7.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Gokce A. Prognostic significance of Extracapsular Invasion in Gastric Cancer. Selcuk Med J. 2021;37(4):307–12.

    Google Scholar 

  8. Kowalewska M, Nowak R, Chechlinska M. Implications of cancer-associated systemic inflammation for biomarker studies. Biochim Biophys Acta. 2010;1806(2):163–71.

    CAS  PubMed  Google Scholar 

  9. Gabay C, Kushner I. Acute-phase proteins and other systemic responses to inflammation. N Engl J Med. 1999;340(6):448–54.

    Article  CAS  PubMed  Google Scholar 

  10. McMillan DC, Watson WS, O’Gorman P, Preston T, Scott HR, McArdle CS. Albumin concentrations are primarily determined by the body cell mass and the systemic inflammatory response in cancer patients with weight loss. Nutr Cancer. 2001;39(2):210–3.

    Article  CAS  PubMed  Google Scholar 

  11. Wolfson M, Strong CJ, Minturn D, Gray DK, Kopple JD. Nutritional status and lymphocyte function in maintenance hemodialysis patients. Am J Clin Nutr. 1984;39(4):547–55.

    Article  CAS  PubMed  Google Scholar 

  12. Buzby GP, Mullen JL, Matthews DC, Hobbs CL, Rosato EF. Prognostic nutritional index in gastrointestinal surgery. Am J Surg. 1980;139(1):160–7.

    Article  CAS  PubMed  Google Scholar 

  13. Zhang Q, Bao J, Zhu ZY, Jin MX. Prognostic nutritional index as a prognostic factor in lung cancer patients receiving chemotherapy: a systematic review and meta-analysis. Eur Rev Med Pharmacol Sci. 2021;25(18):5636–52.

    CAS  PubMed  Google Scholar 

  14. Xishan Z, Ye Z, Feiyan M, Liang X, Shikai W. The role of prognostic nutritional index for clinical outcomes of gastric cancer after total gastrectomy. Sci Rep. 2020;10(1):17373.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Nozoe T, Ninomiya M, Maeda T, Matsukuma A, Nakashima H, Ezaki T. Prognostic nutritional index: a tool to predict the biological aggressiveness of gastric carcinoma. Surg Today. 2010;40(5):440–3.

    Article  PubMed  Google Scholar 

  16. Migita K, Takayama T, Saeki K, et al. The prognostic nutritional index predicts long-term outcomes of gastric cancer patients independent of tumor stage. Ann Surg Oncol. 2013;20(8):2647–54.

    Article  PubMed  Google Scholar 

  17. Yang Y, Gao P, Song Y, et al. The prognostic nutritional index is a predictive indicator of prognosis and postoperative complications in gastric cancer: a meta-analysis. Eur J Surg Oncol. 2016;42(8):1176–82.

    Article  CAS  PubMed  Google Scholar 

  18. Takahashi T, Kaneoka Y, Maeda A, Takayama Y, Fukami Y, Uji M. The preoperative prognostic nutrition index is a prognostic indicator for survival in elderly gastric cancer patients after gastrectomy: a propensity score-matched analysis. Updates Surg. 2020;72(2):483–91.

    Article  PubMed  Google Scholar 

  19. Li QQ, Lu ZH, Yang L, et al. Neutrophil count and the inflammation-based glasgow prognostic score predict survival in patients with advanced gastric cancer receiving first-line chemotherapy. Asian Pac J Cancer Prev. 2014;15(2):945–50.

    Article  PubMed  Google Scholar 

  20. Alwarawrah Y, Kiernan K, MacIver NJ. Changes in Nutritional Status Impact Immune Cell metabolism and function. Front Immunol. 2018;9:1055.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Ding P, Guo H, Sun C, et al. Combined systemic immune-inflammatory index (SII) and prognostic nutritional index (PNI) predicts chemotherapy response and prognosis in locally advanced gastric cancer patients receiving neoadjuvant chemotherapy with PD-1 antibody sintilimab and XELOX: a prospective study. BMC Gastroenterol. 2022;22(1):121.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Funding

None.

Author information

Authors and Affiliations

  1. Department of Medical Oncology, Necmettin Erbakan University School of Medicine, Akyokuş, Konya, 42080, Turkey

    Mustafa Korkmaz, Melek Karakurt Eryılmaz, Muhammed Muhiddin Er, Mehmet Zahid Koçak, Aykut Demirkıran, Mustafa Karaağaç, Murat Araz, Mehmet Artaç & Zahid Mehmet Koçak

Authors
  1. Mustafa Korkmaz
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Melek Karakurt Eryılmaz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Muhammed Muhiddin Er
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mehmet Zahid Koçak
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Aykut Demirkıran
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Mustafa Karaağaç
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Murat Araz
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Mehmet Artaç
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Zahid Mehmet Koçak
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Author Contributions: MK, design and the conduct of the study. MK, MME, AD; data colection. MK; wrote manuscript text. MZK, MK; Performed statistical analysis. MA, MA, MKE; Performed final review and correction. All authors reviewed the manuscript.

Corresponding author

Correspondence to Mustafa Korkmaz.

Ethics declarations

Ethics Approval

This study was conducted retrospectively from data obtained for clinical purposes and was in line with the 1964 Declaration of Helsinki. This study was approved by Necmettin Erbakan University Research Ethics Committee (Approval number:2022/3974).

Consent to Participate

Written informed consent was not obtained as the study was a retrospective study.

Competing interests

The authors report there are no competing interests to declare.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Korkmaz, M., Eryılmaz, M.K., Er, M.M. et al. Is the Prognostic Nutritional Index a Prognostic Marker for the Survival of Patients with Lymph-Node Positive Stage II-III Gastric Cancer Who Receive Adjuvant Chemotherapy?. J Gastrointest Canc 54, 962–969 (2023). https://doi.org/10.1007/s12029-023-00972-x

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12029-023-00972-x

Keywords

Search

Navigation