title: Prognostic nutritional index predicts postoperative complications and long-term outcomes of gastric cancer.
abstract: OBJECTIVE
  To investigate the impact of prognostic nutritional index (PNI) on the postoperative complications and long-term outcomes in gastric cancer patients undergoing total gastrectomy.
  
  
  METHODS
  The data for 386 patients with gastric cancer were extracted and analyzed between January 2003 and December 2008 in our center. The patients were divided into two groups according to the cutoff value of the PNI: those with a PNI ≥ 46 and those with a PNI < 46. Clinicopathological features were compared between the two groups and potential prognostic factors were analyzed. The relationship between postoperative complications and PNI was analyzed by logistic regression. The univariate and multivariate hazard ratios were calculated using the Cox proportional hazard model.
  
  
  RESULTS
  The optimal cutoff value of the PNI was set at 46, and patients with a PNI ≥ 46 and those with a PNI < 46 were classified into PNI-high and PNI-low groups, respectively. Patients in the PNI-low group were more likely to have advanced tumor (T), node (N), and TNM stages than patients in the PNI-high group. The low PNI is an independent risk factor for the incidence of postoperative complications (OR = 2.223). The 5-year overall survival (OS) rates were 54.1% and 21.1% for patients with a PNI ≥ 46 and those with a PNI < 46, respectively. The OS rates were significantly lower in the PNI-low group than in the PNI-high group among patients with stages II (P = 0.001) and III (P < 0.001) disease.
  
  
  CONCLUSIONS
  The PNI is a simple and useful marker not only to identify patients at increased risk for postoperative complications, but also to predict long-term survival after total gastrectomy. The PNI should be included in the routine assessment of advanced gastric cancer patients.
authors.affiliation: Nan Jiang, Jing-Yu Deng, Xue-Wei Ding, Bin Ke, Ning Liu, Ru-Peng Zhang, Han Liang, Key Laboratory of Cancer Prevention and Therapy, Department of Gastrointestinal Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin 300060, China.
authors.forename: Nan
authors.initials: N
authors.lastname: Jiang
authors.affiliation: Nan Jiang, Jing-Yu Deng, Xue-Wei Ding, Bin Ke, Ning Liu, Ru-Peng Zhang, Han Liang, Key Laboratory of Cancer Prevention and Therapy, Department of Gastrointestinal Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin 300060, China.
authors.forename: Jing-Yu
authors.initials: JY
authors.lastname: Deng
authors.affiliation: Nan Jiang, Jing-Yu Deng, Xue-Wei Ding, Bin Ke, Ning Liu, Ru-Peng Zhang, Han Liang, Key Laboratory of Cancer Prevention and Therapy, Department of Gastrointestinal Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin 300060, China.
authors.forename: Xue-Wei
authors.initials: XW
authors.lastname: Ding
authors.affiliation: Nan Jiang, Jing-Yu Deng, Xue-Wei Ding, Bin Ke, Ning Liu, Ru-Peng Zhang, Han Liang, Key Laboratory of Cancer Prevention and Therapy, Department of Gastrointestinal Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin 300060, China.
authors.forename: Bin
authors.initials: B
authors.lastname: Ke
authors.affiliation: Nan Jiang, Jing-Yu Deng, Xue-Wei Ding, Bin Ke, Ning Liu, Ru-Peng Zhang, Han Liang, Key Laboratory of Cancer Prevention and Therapy, Department of Gastrointestinal Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin 300060, China.
authors.forename: Ning
authors.initials: N
authors.lastname: Liu
authors.affiliation: Nan Jiang, Jing-Yu Deng, Xue-Wei Ding, Bin Ke, Ning Liu, Ru-Peng Zhang, Han Liang, Key Laboratory of Cancer Prevention and Therapy, Department of Gastrointestinal Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin 300060, China.
authors.forename: Ru-Peng
authors.initials: RP
authors.lastname: Zhang
authors.affiliation: Nan Jiang, Jing-Yu Deng, Xue-Wei Ding, Bin Ke, Ning Liu, Ru-Peng Zhang, Han Liang, Key Laboratory of Cancer Prevention and Therapy, Department of Gastrointestinal Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin 300060, China.
authors.forename: Han
authors.initials: H
authors.lastname: Liang
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects* / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D015596:Nutrition Assessment; D009752:Nutritional Status; D016017:Odds Ratio; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome
keywords: Gastric cancer; Postoperative complications; Prognosis; Prognostic nutritional index; Total gastrectomy