The prognostic nutritional index predicts prognosis after liver resection in elderly patients with early-stage hepatocellular carcinoma

Abstract

Aims We aimed to determine the value of the preoperative prognostic nutritional index (PNI) and establish new nomograms to predict recurrence-free and overall survival (RFS and OS) in elderly patients with early-stage hepatocellular carcinoma (HCC). Methods Elderly patients (≥ 60 years of age) with very early-stage HCC (CNLC IA-IIA) after curative surgical resection were identified. PNI was calculated by [10 × serum albumin level (gr/dL)] + [0.005 × total lymphocyte count (per mm3)]. Univariate and multivariate Cox analysis was used to screen the variables and construct the nomogram model. ROC and calibration curves were used for model evaluation. Results The PNI-high was defined as ≥ 49.5 and ≥ 49.05 for RFS and OS, respectively. The 5-year-RFS rate was 34.1% in the PNI-low group versus 57.4% in the PNI-high group (P = 0.014). The 5-year OS rate in the PNI-low group was significantly lower than that in the PNI-high groups (68.2% vs. 84.4%, P = 0.033). The nomogram prediction models for patients’ RFS and OS were built by incorporating the same three independent survival predictors, including PNI-low, tumor presence of vascular invasion, and low differentiation. These two prediction models demonstrated good calibration and discrimination, with all C‑indexes greater than 0.72. The calibration plots basically coincide with the diagonal, indicating that the observed RFS and OS were close to the predicted outcomes. Conclusions The PNI-low, tumor presence of vascular invasion, and low differentiation can be adopted as a decision aid to predict the long-term RFS and OS for elderly patients with resected HCC.