Is the Prognostic Nutritional Index a Prognostic Marker for the Survival of Patients with Lymph-Node Positive Stage II-III Gastric Cancer Who Receive Adjuvant Chemotherapy?

• Published in: Journal of gastrointestinal cancer Vol. 54; no. 3; pp. 962 - 969
• Main Authors: Korkmaz, Mustafa, Eryılmaz, Melek Karakurt, Er, Muhammed Muhiddin, Koçak, Mehmet Zahid, Demirkıran, Aykut, Karaağaç, Mustafa, Araz, Murat, Artaç, Mehmet, Koçak, Zahid Mehmet
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.09.2023
• Subjects: Aged; Cancer Research; Chemotherapy, Adjuvant; Gastroenterology; Humans; Internal Medicine; Medicine; Medicine & Public Health; Nutrition Assessment; Nutritional Status; Oncology; Prognosis; Radiotherapy; Retrospective Studies; Stomach Neoplasms - drug therapy; Adjuvant chemotherapy; Prognostic nutritional index; Gastric cancer; Survival
• ISSN: 1941-6628; 1941-6636; 1941-6636
• DOI: 10.1007/s12029-023-00972-x

Purpose The prognostic nutritional index (PNI), like other systemic inflammatory markers, has been shown to be a prognostic factor in various cancer patients. In this study, we aimed to show whether PNI calculated before adjuvant chemotherapy is a prognostic factor for overall survival (OS) and disease-free survival (DFS) in patients with lymph node-positive stage II-III gastric cancer. Methods The PNI was calculated using the albumin and lymphocyte count. The PNI cut-off value was found to be 39.5. They were divided into two groups as being ≤ 39.5 (PNI low group) and > 39.5 (PNI high group). Results Our study included 168 patients with lymph node-positive stage II-III gastric cancer who received adjuvant chemotherapy. Of the patients, 116 (69.0%) were 65 years or younger, and 52 (31.0%) were over 65 years old. Of the patients, 117 (69.6%) were pT3, 51 (30.4%) were pT4. Seventy-three (43.4%) patients had pN1-2 disease and 95 (56.6%) patients had pN3 disease. The number of stage II patients was 73 (43.5%) and the number of stage III patients was 95 (56.5%). There were 73 patients with PNI ≤ 39.5 and 95 patients with PNI > 39.5. The mOS of the patients with low PNI group was 39.5 months, while the OS of the patients with high PNI group was 96.8 months (p = 0.002). In the group of patients with PNI low group, mDFS 24.4 months was significantly higher than those with PNI high group was 50.7 months (p = 0.021). The PNI score was statistically significant in univariate and multivariate analyzes for both DFS and OS. Conclusion PNI can be used as an independent prognostic factor for both OS and DFS in patients lymph node-positive, stage II-III gastric cancer who will receive adjuvant chemotherapy. Key Points Prognostic nutritional index, an inflammatory marker, has been shown to be a prognostic factor in cancer patients. The prognostic nutritional index is an independent predictor of both disease-free survival and overall survival in patients with lymph node-positive gastric cancer receiving adjuvant chemotherapy. The prognosis is worse in those with a low prognostic nutritional index. Both overall survival and disease-free survival times are significantly longer in those with a high prognostic nutritional index.