The Significance of the Prognostic Nutritional Index in Patients with Completely Resected Non-Small Cell Lung Cancer

Abstract

ObjectivesImmunological parameters and nutritional status influence the outcome of patients with malignant tumors. A prognostic nutritional index, calculated using serum albumin levels and peripheral lymphocyte count, has been used to assess prognosis for various cancers. This study aimed to investigate whether this prognostic nutritional index affects overall survival and the incidence of postoperative complications in patients with completely resected non-small cell lung cancer.MethodsWe retrospectively reviewed the medical records of 409 patients with non-small cell lung cancer who underwent complete resection between 2005 and 2007 at the Aichi Cancer Center.ResultsThe 5-year survival rates of patients with high (≥50) and low (<50) prognostic nutritional indices were 84.4% and 70.7%, respectively (p = 0.0011). Univariate analysis showed that gender, histology, pathological stage, smoking history, serum carcinoembryonic antigen levels, and prognostic nutritional index were significant prognostic factors. Multivariate analysis identified pathological stage and the prognostic nutritional index as independent prognostic factors. The frequency of postoperative complications tended to be higher in patients with a low prognostic nutritional index.ConclusionsThe prognostic nutritional index is an independent prognostic factor for survival of patients with completely resected non-small cell lung cancer.

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

“…In fact, the prognosis of patients with locally advanced NSCLC was significantly poorer for the low-PNI group. The association between low PNI and old age was consistent with that described in an earlier report [17]. Tumor progression causes systemic inflammation and leads to impaired nutritional status [25].…”

“…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.…”

“…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.…”

“…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.…”

Prognostic effects of preoperative obstructive pneumonitis or atelectasis and comparison with tumor size in non-small cell lung cancer

“…Inflammatory cells interacted with cell matrix to make up tumor microenvironment, which could influence the occurrence and development of neoplasm (3,4). Several hematological markers, which could reflect the status of host inflammation, immunity, and hemostasis, have been reported to have prognostic utility in many cancers (5), such as C-reactive protein (CRP), neutrophils, platelets, lymphocytes, Glasgow prognostic score, prognostic nutrition index (PNI), neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR) and lymphocyte to monocyte ratio (LMR) (6)(7)(8)(9)(10)(11)(12). So we assumed that presence of obstructive pneumonitis or atelectasis might be associated with these inflammation indicators and predicted poor survival.…”