Evaluation of Prognostic Nutritional Index in Patients Undergoing Radical Surgery with Nonsmall Cell Lung Cancer

Abstract

The prognostic nutritional index (PNI) has been reported to be a prognostic indicator in some malignant tumors. However, its prognostic value in nonsmall cell lung cancer (NSCLC) has not been fully investigated. A retrospective review of 1416 patients with NSCLC who underwent radical surgery between January 2006 and December 2011 was conducted. To obtain optimal cutoff levels of PNI, running log-rank statistics was applied. Survival was calculated by the Kaplan-Meier method. The prognostic significance of PNI, together with various clinicopathological factors, was evaluated by multivariate analysis. The optimal cutoff point for PNI was 52. The 1-, 3-, and 5-yr survival rates in patients with PNI of less than 52 were 80.0%, 61.3%, and 50.4%, respectively, and were significantly more unfavorable than those in patients with PNI 52 or higher (84.7%, 71.5%, and 60.3%, respectively, P < 0.001). Multivariate analysis suggested that gender (P = 0.026), age (P < 0.001), PNI (P = 0.005), differentiation (P = 0.024), pathology T category (P = 0.003), and pathology N category (P < 0.001) were revealed to be independent prognostic factors. Our results indicate that PNI is an independent predictor of survival for patients undergoing radical surgery with NSCLC.

Clinical Significance of Prognostic Nutritional Index After Surgical Treatment in Lung Cancer

“…As for the predictive impact of PNI, reported HRs of PNI for OS range from 1.33 to 2.40 for surgically resected stage I-IIIA NSCLC [16][17][18]. In the present study, the corrected HR for OS was 2.18, corresponding well with previous reports.…”

“…In the present study, low PNI was significantly associated with elevated CRP levels, indicating latent inflammation. Previous studies regarding resectable NSCLC did not assess preoperative inflammation [16][17][18][19]. Chronic obstructive pulmonary disease also represents a possible cause of inflammation in patients with NSCLC, but PNI score was not associated with smoking or the prevalence of chronic obstructive pulmonary disease in the present study.…”

“…The PNI may thus represent a strong prognostic factor in patients with resectable NSCLC. Previous retrospective studies [16][17][18][19] and our own findings agree that PNI represents an independent prognostic factor and that the prognostic impact of PNI is almost as strong as pathologic stage among patients with resectable NSCLC. However, those reports did not undertake detailed analyses for cause of death according to PNI status.…”

“…To date, low PNI status has been reported as a predictor of both postoperative complications and poor prognosis in various types of malignancies [9][10][11][12][13][14][15]. However, few studies have been performed with respect to NSCLC [16][17][18][19], and the clinical significance of PNI remains uncertain.…”

Clinical impact of pretreatment prognostic nutritional index (PNI) in small cell lung cancer patients treated with platinum‐based chemotherapy

“…Immunonutritional status and risks in gastrointestinal surgery patients . In recent years, increasing evidence shows that pretreatment PNI are closely correlated with the prognosis of some solid tumors . However, its role in SCLC remains to be explored.…”