Prognostic nutritional index predicts outcomes of gastrectomy in the elderly

Abstract

Background: Owing to the increased life expectancy, elderly patients with gastric cancer is also increasing. Onodera's prognostic nutritional index (PNI) is an assessment tool for nutritional status of surgical patients and possibly predicts prognosis of the patients. The aim of the present study is to clarify the predictive and prognostic significance of PNI in elderly patients who underwent gastrectomy for gastric cancer.

Methods: Two hundred ninety-five patients, including 196 nonelderly patients under 75 years old (group NE) and 99 elderly patients (group E), were eligible. We collected the data on nutritional status and the outcome of gastrectomy, including morbidity, mortality, and survival of these patients. A Cox proportional hazards model was used to evaluate the prognostic significance.

Results: The PNI was significantly lower in group E than in group NE. Both morbidity and mortality rates after gastrectomy were similar between the groups. Although PNI could not predict the postoperative events in group NE, low PNI might be a risk of mortality and morbidity in the elderly. Although survival after gastrectomy was similar among groups divided by the median PNI value (49.2) in group NE, the prognosis of PNI-L (<44.7) was significantly poorer than PNI-H (PNI ≧ 44.7) in group E. Multivariate analysis demonstrated that PNI-L was an independent prognostic factor in the elderly.

Conclusions: The PNI predicts both short-term and long-term outcomes after gastrectomy in the elderly.