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. 2021 Jul 2:13:5263-5273.
doi: 10.2147/CMAR.S316437. eCollection 2021.

Preoperative Prognostic Nutrition Index as a Prognostic Indicator of Survival in Elderly Patients Undergoing Gastric Cancer Surgery

Xiaonan Zhang #  1 , Huimin Fang #  1 , Zhigang Zeng  1 , Kaijun Zhang  1 , Zhanyi Lin  1   2 , Gang Deng  1 , Weiping Deng  1 , Lichang Guan  1 , Xuebiao Wei  1 , Xinyi Li  2 , Lei Jiang  1   2   3 , Lishu Xu  1   2   3
Affiliations

Preoperative Prognostic Nutrition Index as a Prognostic Indicator of Survival in Elderly Patients Undergoing Gastric Cancer Surgery

Xiaonan Zhang et al. Cancer Manag Res. .

Abstract

Purpose: Gastric cancer is a common tumor type associated with nutritional and immune status. The aim of the current study was to investigate the prognostic value of a preoperative prognostic nutritional index (PNI), composed of nutritional factors and immune factors in elderly patients undergoing gastric cancer surgery.

Patients and methods: A total of 454 patients undergoing gastric cancer surgery were divided into two groups based on preoperative PNI scores: ≤45.1 (n = 307) and >45.1 (n = 147). Survival analysis was performed using the Kaplan-Meier method and Log rank tests. Univariate and multivariate analyses were conducted to identify independent prognostic factors using a Cox proportional hazards model.

Results: According to the X-tile program, the optimal cutoff value for predicting overall survival (OS) with the PNI was 45.1. The receiver operating characteristic analysis revealed that PNI exhibited 70.6% sensitivity and 56.5% specificity for predicting death during long-term follow-up. The cumulative incidence of postoperative 4-year mortality indicated that the risk of death increased significantly for PNI ≤45.1. In multivariate analysis, preoperative PNI was a significant independent predictor of mortality. In the age-stratified subgroup analysis, preoperative PNI was more sensitive for the old elderly subgroup than for the young elderly subgroup.

Conclusion: Preoperative PNI is a sensitive and specific prognostic predictor among elderly patients undergoing gastric cancer surgery.

Keywords: elderly patients; gastric cancer; prognostic nutritional index; radical gastrectomy.

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Conflict of interest statement

The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Flow diagram of the included population. A total of 467 elderly gastric cancer patients were screened, of which 13 lacked preoperative PNI-related data and were excluded from the cohort. The remaining 454 patients were enrolled in the study.
Figure 2
Figure 2
The optimal cutoff value of PNI. The optimal cutoff value of PNI was determined by X-tile software (Yale University, New Haven, CT), using overall survival as the primary outcome in patients from the training cohort. (A, D, and G) The coloring of the plot represents the strength of the association, ranging from low (dark, black) to high (green or red). Indirect associations between factor expression and survival are colored red, whereas positive associations are colored green. (B, E, and H) The histogram shows the optimal cutoff point for the whole group, the young elderly subgroup, and the old elderly subgroup. (C, F, and I) Kaplan–Meier curve corresponding to the cutoff point for the whole group, the young elderly subgroup, and the old elderly subgroup.
Figure 3
Figure 3
Survival analysis based on PNI level. ROC curves for postoperative survival and Kaplan–Meier curves of postoperative survival based on PNI levels. (A and B) represent the whole group. (C and D) represent the young elderly subgroup (60 years ≥ age >74 years). (E and F) represent the old elderly subgroup (age ≥75 years).
See this image and copyright information in PMC

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