Annals of Surgical Oncology

, Volume 25, Issue 5, pp 1254–1261 | Cite as

Risk Stratification According to the Prognostic Nutritional Index for Predicting Postoperative Complications After Lung Cancer Surgery

  • Satoru Okada
  • Junichi Shimada
  • Satoshi Teramukai
  • Daishiro Kato
  • Hiroaki Tsunezuka
  • Naoko Miyata
  • Shunta Ishihara
  • Tatsuo Furuya
  • Chiaki Nakazono
  • Narumi Ishikawa
  • Masayoshi InoueEmail author
Thoracic Oncology



The prognostic nutritional index (PNI), an immune nutritional marker based on serum albumin levels and total lymphocyte count, predicts postoperative complications in various types of malignancies. However, the clinical significance of the PNI for postoperative complications following lung cancer surgery is uncertain.


Patients with resected non-small cell lung cancer (n = 515) were retrospectively analyzed and the relationship between the preoperative PNI and postoperative complications was evaluated.


Multivariate logistic regression analysis revealed that a preoperative low PNI was a significant independent predictor of postoperative complications of Clavien–Dindo Grade ≥ II (odds ratio: 1.06 per unit decrease, 95.0% confidence interval 1.01–1.11). Patients were divided into three groups according to the preoperative PNI: normal (≥ 50; n = 324), mildly low (< 50, ≥ 45; n = 134), and severely low (< 45; n = 57). The incidence of postoperative complications of Grade ≥ II and Grade ≥ III in the normal, mildly low, and severely low PNI groups was 22.2, 39.6, and 42.1% and 7.1, 16.4, and 22.8%, respectively. The incidence of postoperative complications of Grade ≥ II and Grade ≥ III was significantly higher in the mildly low and severely low PNI groups than in the normal PNI group (p < 0.001 and p < 0.001, respectively). The incidence of air leak, pneumonia, and extrapulmonary infection, but not arrhythmia, was significantly higher in the mildly low and severely low PNI groups than in the normal PNI group.


The PNI could be a useful marker to predict the risk of postoperative complications after lung cancer surgery.



The authors thank Editage ( for English language editing.




The authors declare that there are no conflicts of interest to disclose.


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Copyright information

© Society of Surgical Oncology 2018

Authors and Affiliations

  • Satoru Okada
    • 1
  • Junichi Shimada
    • 1
  • Satoshi Teramukai
    • 2
  • Daishiro Kato
    • 1
  • Hiroaki Tsunezuka
    • 1
  • Naoko Miyata
    • 1
  • Shunta Ishihara
    • 1
  • Tatsuo Furuya
    • 1
  • Chiaki Nakazono
    • 1
  • Narumi Ishikawa
    • 1
  • Masayoshi Inoue
    • 1
    Email author
  1. 1.Division of Thoracic Surgery, Department of Surgery, Graduate School of Medical ScienceKyoto Prefectural University of MedicineKyotoJapan
  2. 2.Department of Biostatistics, Graduate School of Medical ScienceKyoto Prefectural University of MedicineKyotoJapan

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