Prognostic nutritional index predicts survival and correlates with systemic inflammatory response in advanced pancreatic cancer.
BACKGROUND
Recent studies have implied a prognostic value of the prognostic nutritional index (PNI) in certain types of human cancers. However, the value of PNI for predicting survival in patients with pancreatic cancer remains unknown. The goal of this study was to investigate the predictive significance of PNI in patients with advanced pancreatic cancer.


METHODS
A total of 321 consecutive patients with pathologically-confirmed locally advanced or metastatic pancreatic ductal adenocarcinoma (PDAC) were retrospectively recruited between January 2011 and August 2013. The patients were divided into a test set (n = 110) and a validation set (n = 211). We evaluated the association between PNI and overall survival (OS). The relationship between PNI and systemic inflammatory response markers, including the neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and lymphocyte/monocyte ratio (LMR) was also assessed. In addition, the associations between PNI and the TNF-α were analyzed.


RESULTS
Kaplan-Meier analyses showed that a low PNI correlated significantly with a shorter OS in patients with advanced pancreatic cancer (190 days for patients with a low PNI vs. 290 days for patients with a high PNI, log-rank = 12.566, P < 0.001). Multivariate analysis identified PNI as an independent prognostic factor for OS (hazard ratio [HR]: 0.627, 95% confidence interval [CI]: 0.453-0.868, P = 0.003). PNI also correlated positively with NLR and PLR and negatively with LMR. Additionally, patients with a low PNI exhibited high levels of TNF-α.


CONCLUSIONS
Our results confirm that PNI is associated with the systemic inflammatory response and can be used to predict survival in advanced pancreatic cancer.
Department of Integrative Oncology, Fudan University Shanghai Cancer Center, 270 Dong An Road, Shanghai 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, 130 Dong An Road, Shanghai 200032, China.
Y
Y
Geng
Department of Integrative Oncology, Fudan University Shanghai Cancer Center, 270 Dong An Road, Shanghai 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, 130 Dong An Road, Shanghai 200032, China.
Q
Q
Qi
Department of Pathology, Fudan University Shanghai Cancer Center, 270 Dong An Road, Shanghai 200032, China.
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M
Sun
Department of Integrative Oncology, Fudan University Shanghai Cancer Center, 270 Dong An Road, Shanghai 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, 130 Dong An Road, Shanghai 200032, China.
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H
Chen
Department of Integrative Oncology, Fudan University Shanghai Cancer Center, 270 Dong An Road, Shanghai 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, 130 Dong An Road, Shanghai 200032, China. Electronic address: wangp413@163.com.
P
P
Wang
Department of Integrative Oncology, Fudan University Shanghai Cancer Center, 270 Dong An Road, Shanghai 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, 130 Dong An Road, Shanghai 200032, China. Electronic address: zchenzl@fudan.edu.com.
Z
Z
Chen
D021441:Carcinoma, Pancreatic Ductal / Q000175:diagnosis / Q000401:mortality / Q000556:secondary*; D002681:China / Q000453:epidemiology; D049448:Cholangiopancreatography, Magnetic Resonance; D005260:Female; D006801:Humans; D007249:Inflammation / Q000175:diagnosis* / Q000401:mortality; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D015596:Nutrition Assessment; D009752:Nutritional Status; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology*; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D014057:Tomography, X-Ray Computed
Pancreatic cancer; Prognosis; Prognostic nutritional index; Systemic inflammatory response