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The optimal cut-off value of the preoperative prognostic nutritional index for the survival differs according to the TNM stage in hepatocellular carcinoma

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Abstract

Purpose

To establish the optimal cut-off value of the preoperative prognostic nutritional index (PNI) for prognosis according to the Tumor Node Metastasis (TNM) stage of hepatocellular carcinoma (HCC) after curative resection.

Methods

This retrospective study reviewed the records of 375 patients. The optimal cut-off value of the PNI was established according to the TNM stage, and overall survival was compared between the low and high PNI groups.

Results

The optimal cut-off value of the PNI decreased with increasing TNM stage, with 52, 47, and 43 patients having stage I, II, and III HCC, respectively. A low preoperative PNI predicted a poorer overall survival than did a high PNI for stage I (P < 0.001) and II (P = 0.002), but not stage III disease (P = 0.052). Multivariate analysis revealed that the preoperative PNI was an independent predictor of overall survival for stage I and II HCC (hazard ratios: 6.96 and 3.57, P = 0.001 and P = 0.001, respectively).

Conclusions

The findings of this study show that the optimal cut-off value for the PNI for prognosis differs among the TNM stages and that the preoperative PNI is a favorable prognostic factor for stage I HCC.

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References

  1. Huitzil-Melendez FD, Capanu M, O’Reilly EM, Duffy A, Gansukh B, Saltz LL, et al. Advanced hepatocellular carcinoma: which staging system best predict prognosis? J Clin Oncol. 2010;28:2889–95.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Llovet JM, Burroughs A, Bruix J. Hepatocellular carcinoma. Lancet. 2003;362:1907–17.

    Article  PubMed  Google Scholar 

  3. Zhou L, Rui JA, Wang SB, Chen SG, Qu Q. LCSGJ-T classification, 6th or 5th edition TNM staging did not independently predict the long-term prognosis of HBV-related hepatocellular carcinoma after radical hepatectomy. J Surg Res. 2010;159:538–44.

    Article  PubMed  Google Scholar 

  4. Merli M, Riggio O, Dally L. Policentrica Italiana Nutrizione Cirrosi. Does malnutrition affect survival in cirrhosis? Hepatology. 1996;23:1041–6.

    Article  CAS  PubMed  Google Scholar 

  5. Alberino F, Gatta A, Amodio P, Merkel C, Di Pascoli L, Boffo G, et al. Nutrition and survival in patients with liver cirrhosis. Nutrition. 2001;17:445–50.

    Article  CAS  PubMed  Google Scholar 

  6. Asari S, Matsumoto I, Toyama H, Shinzeki M, Goto T, Ishida J, et al. Preoperative independent prognostic factors in patients with borderline resectable pancreatic ductal adenocarcinoma following curative resection: the neutrophil-lymphocyte and platelet-lymphocyte ratios. Surg Today. 2016;46:583–92.

    Article  PubMed  Google Scholar 

  7. Onodera T, Goseki N, Kosaki G. Prognostic nutritional index in gastrointestinal surgery of malnourished cancer patients. Nippon Geka Gakkai Zasshi. 1984;85:1001–5. (Japanese).

    CAS  PubMed  Google Scholar 

  8. Okamura Y, Ashida R, Ito T, Sugiura T, Mori K, Uesaka K. Preoperative neutrophil to lymphocyte ratio and prognostic nutritional index predict overall survival after hepatectomy for hepatocellular carcinoma. World J Surg. 2015;39:1501–9.

    Article  PubMed  Google Scholar 

  9. Pinato DJ, Stebbing J, Ishizuka M, Khan SA, Wasan HS, North BV, et al. A novel and validated prognostic index in hepatocellular carcinoma: The inflammation based index (IBI). J Hepatol. 2012;57:1013–20.

    Article  PubMed  Google Scholar 

  10. Kinoshita A, Onoda H, Imai N, Iwaku A, Oishi M, Fushiya N, et al. Comparison of the prognostic value of inflammation-based prognostic scores in patients with hepatocellular carcinoma. Br J Cancer. 2012;107:988–93.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Sobin LH, Gospodarowicz MK, Wittekind CH, editors. TNM Classification of Malignant Tumours. 7th ed. New York: Wiley-Liss; 2009.

    Google Scholar 

  12. Bruix J, Sherman M. Management of hepatocellular carcinoma. Hepatology. 2005;42:1208–36.

    Article  PubMed  Google Scholar 

  13. Pugh RN, Murray-Lyon IM, Dawson JL, Pietroni MC, Williams R. Transection of the esophagus for bleeding oesophageal varices. Br J Surg. 1973;60:646–9.

    Article  CAS  PubMed  Google Scholar 

  14. Dindo D, Demartines N, Clavien P. Classification of surgical complications of surgery with evaluation in a cohort of 6366 patients and results of a survey. Ann Surg. 2004;240:205–13.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Katayama H, Kurokawa Y, Nakamura K, Ito H, Kanemitsu Y, Masuda N, et al. Extended Clavien-Dindo classification of surgical complications: Japan Clinical Oncology Group postoperative complications criteria. Surg Today. 2016;46:668–85.

    Article  PubMed  Google Scholar 

  16. Okamura Y, Ito T, Sugiura T, Mori K, Uesaka K. Anatomic versus nonanatomic hepatectomy for a solitary hepatocellular carcinoma: a case-controlled study with propensity score matching. J Gastrointest Surg. 2014;18:1994–2002.

    Article  PubMed  Google Scholar 

  17. Migita K, Takayama T, Saeki K, Matsumoto S, Wakatsuki K, Enomoto K, et al. The prognostic nutritional index predicts long-term outcomes of gastric cancer patients independent of tumor stage. Ann Surg Oncol. 2013;20:2649–54.

    Article  Google Scholar 

  18. Mohri Y, Inoue Y, Tanaka K, Hiro J, Uchida K, Kusunoki M. Prognostic nutritional index predicts postoperative outcome in colorectal cancer. World J Surg. 2013;37:2688–92.

    Article  PubMed  Google Scholar 

  19. Kanda M, Fujii T, Kodera Y, Nagai S, Takeda S, Nakao A. Nutritional predictors of postoperative outcome in pancreatic cancer. Br J Surg. 2011;98:268–74.

    Article  CAS  PubMed  Google Scholar 

  20. Nagahashi M, Matsuda Y, Moro K, Tsuchida J, Soma D, Hirose Y, et al. DNA damage response and sphingolipid signaling in liver diseases. Surg Today. 2016;46:995–1005.

    Article  CAS  PubMed  Google Scholar 

  21. Peng W, Li C, Wen TF, Yan LN, Li B, Wang WT, et al. Postoperative prognostic nutritional index change is an independent predictor of survival in patients with small hepatocellular carcinoma. Am J Surg. 2015;212:122–7.

    Article  PubMed  Google Scholar 

  22. Okabayashi T, Nishimori I, Sugimoto T, Maeda H, Dabanaka K, Onishi S, et al. Effects of branched-chain amino acids-enriched nutrient support for patients undergoing liver resection for hepatocellular carcinoma. J Gastroenterol Hepatol. 2008;23:1869–73.

    Article  PubMed  Google Scholar 

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Correspondence to Yukiyasu Okamura.

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We have no conflicts of interest to declare and we received no funding support for this study.

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Okamura, Y., Sugiura, T., Ito, T. et al. The optimal cut-off value of the preoperative prognostic nutritional index for the survival differs according to the TNM stage in hepatocellular carcinoma. Surg Today 47, 986–993 (2017). https://doi.org/10.1007/s00595-017-1491-0

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  • DOI: https://doi.org/10.1007/s00595-017-1491-0

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