Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Oct 31;20(1):261.
doi: 10.1186/s12893-020-00917-2.

Onodera's prognostic nutritional index is a strong prognostic indicator for patients with hepatocellular carcinoma after initial hepatectomy, especially patients with preserved liver function

Akihiro Tanemura  1 , Shugo Mizuno  2 , Aoi Hayasaki  2 , Kazuyuki Gyoten  2 , Takehiro Fujii  2 , Yusuke Iizawa  2 , Hiroyuki Kato  2 , Yasuhiro Murata  2 , Naohisa Kuriyama  2 , Masashi Kishiwada  2 , Hiroyuki Sakurai  2 , Shuji Isaji  3
Affiliations

Onodera's prognostic nutritional index is a strong prognostic indicator for patients with hepatocellular carcinoma after initial hepatectomy, especially patients with preserved liver function

Akihiro Tanemura et al. BMC Surg. .

Abstract

Background: Several inflammation-based scores are used to assess the surgical outcomes of hepatocellular carcinoma (HCC). The aim of the present study was to elucidate the prognostic value of the prognostic nutritional index (PNI) in HCC patients who underwent hepatectomy with special attention to preoperative liver functional reserve.

Methods: Preoperative demographic and tumor-related factors were analyzed in 189 patients with HCC undergoing initial hepatectomy from August 2005 to May 2016 to identify significant prognostic factors.

Results: Multivariate analysis for overall survival (OS) revealed that female sex (p = 0.005), tumor size (p < 0.001) and PNI (p = 0.001) were independent prognostic factors. Compared to the High PNI group (PNI ≥ 37, n = 172), the Low PNI group (PNI < 37, n = 17) had impaired liver function and significantly poorer OS (13% vs. 67% in 5-year OS, p = 0.001) and recurrence-free survival (RFS) (8 vs. 25 months in median PFS time, p = 0.002). In the subgroup of patients with a preserved liver function of LHL15 ≥ 0.9, PNI was also independent prognostic factor, and OS (21% vs. 70% in 5-year OS, p = 0.008) and RFS (8 vs. 28 months in median PFS time, p = 0.018) were significantly poorer in the Low PNI group than the High PNI group.

Conclusions: PNI was an independent prognostic factor for HCC patients who underwent hepatectomy. Patients with PNI lower than 37 were at high risk for early recurrence and poor patient survival, especially in the patients with preserved liver function of LHL ≥ 0.9.

Keywords: ALBI grade; GPS; Hepatectomy; Hepatocellular carcinoma; LHL15; Liver functional reserve; NLR; PLR; PNI; Technetium-99 m-diethylenetriaminepentaacetic acid-galactosyl-human serum albumin (99mTc-GSA) liver scintigraphy.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Overall survival (OS) at each PNI cut-off value of 35 to 50
Fig. 2
Fig. 2
Overall (OS) and progression free survivals (PFS) according to PNI cut-off value of 37
Fig. 3
Fig. 3
Overall (OS) and progression free survivals (PFS) according to PNI cut-off value of 37 in subgroup according to liver functional reserve using LHL15
See this image and copyright information in PMC

References

    1. Walsh SR, Cook EJ, Goulder F, Justin TA, Keeling NJ. Neutrophil-lymphocyte ratio as a prognostic factor in colorectal cancer. J Surg Oncol. 2005;91:181–184. doi: 10.1002/jso.20329. - DOI - PubMed
    1. Smith RA, Bosonnet L, Ghaneh P, Sutton R, Evans J, Healey P, et al. The platelet-lymphocyte ratio improves the predictive value of serum CA19-9 levels in determining patient selection for staging laparoscopy in suspected periampullary cancer. Surgery. 2008;143:658–666. doi: 10.1016/j.surg.2007.12.014. - DOI - PubMed
    1. Forrest LM, McMillan DC, McArdle CS, Angerson WJ, Dunlop DJ. Evaluation of cumulative prognostic scores based on the systemic inflammatory response in patients with inoperable non-small-cell lung cancer. Br J Cancer. 2003;89:1028–1030. doi: 10.1038/sj.bjc.6601242. - DOI - PMC - PubMed
    1. Onodera T, Goseki N, Kosaki G. Prognostic nutritional index in gastrointestinal surgery of malnourished cancer patients. Nippon Geka Gakkai Zasshi. 1984;85:1001–1005. - PubMed
    1. Buzby GP, Mullen JL, Matthews DC, Hobbs CL, Rosato EF. Prognostic nutritional index in gastrointestinal surgery. Am J Surg. 1980;139:160–167. doi: 10.1016/0002-9610(80)90246-9. - DOI - PubMed