title: Clinical Significance of the Prognostic Nutritional Index for Predicting Short- and Long-Term Surgical Outcomes After Gastrectomy: A Retrospective Analysis of 7781 Gastric Cancer Patients.
abstract: To evaluate the predictive and prognostic significance of the prognostic nutritional index (PNI) in a large cohort of gastric cancer patients who underwent gastrectomy.Assessing a patient's immune and nutritional status, PNI has been reported as a predictive marker for surgical outcomes in various types of cancer.We retrospectively reviewed data from a prospectively maintained database of 7781 gastric cancer patients who underwent gastrectomy from January 2001 to December 2010 at a single center. From this data, we analyzed clinicopathologic characteristics, PNI, and short- and long-term surgical outcomes for each patient. We used the PNI value for the 10th percentile (46.70) of the study cohort as a cut-off for dividing patients into low and high PNI groups.Regarding short-term outcomes, multivariate analysis showed a low PNI (odds ratio [OR] = 1.505, 95% CI = 1.212-1.869, P <0.001), old age, male sex, high body mass index, medical comorbidity, total gastrectomy, and combined resection to be independent predictors of postoperative complications. Among these, only low PNI (OR = 4.279, 95% CI = 1.760-10.404, P = 0.001) and medical comorbidity were independent predictors of postoperative mortality. For long-term outcomes, low PNI was a poor prognostic factor for overall survival, but not recurrence (overall survival: hazard ratio [HR] = 1.383, 95% CI = 1.221-1.568, P < 0.001; recurrence-free survival: HR = 1.142, 95% CI = 0.985-1.325, P = 0.078).PNI can be used to predict patients at increased risk of postoperative morbidity and mortality. Although PNI was an independent prognostic factor for overall survival, the index was not associated with cancer recurrence.
authors.affiliation: From the Department of Surgery (JYL, HIK, YNK, JYA, JHC, WJH, SHN, CBK), Yonsei University College of Medicine; Open NBI Convergence Technology Research Laboratory (HIK), Severance Hospital; Biostatistics Collaboration Unit (JHH), Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea; Department of Surgery (SA), King Fahd Hospital of the University Khobar, Khobar, Saudi Arabia; Brain Korea 21 Project for Medical Science (WJH, SHN), Yonsei University College of Medicine; and Robot and Minimally Invasive Surgery Center (WJH), Yonsei University Health System, Seoul, Korea.
authors.forename: Jee Youn
authors.initials: JY
authors.lastname: Lee
authors.forename: Hyoung-Il
authors.initials: HI
authors.lastname: Kim
authors.forename: You-Na
authors.initials: YN
authors.lastname: Kim
authors.forename: Jung Hwa
authors.initials: JH
authors.lastname: Hong
authors.forename: Saeed
authors.initials: S
authors.lastname: Alshomimi
authors.forename: Ji Yeong
authors.initials: JY
authors.lastname: An
authors.forename: Jae-Ho
authors.initials: JH
authors.lastname: Cheong
authors.forename: Woo Jin
authors.initials: WJ
authors.lastname: Hyung
authors.forename: Sung Hoon
authors.initials: SH
authors.lastname: Noh
authors.forename: Choong-Bai
authors.initials: CB
authors.lastname: Kim
mesh_terms: D005260:Female; D005743:Gastrectomy / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D053208:Kaplan-Meier Estimate; D000069451:Long Term Adverse Effects / Q000175:diagnosis / Q000209:etiology; D008297:Male; D008875:Middle Aged; D015596:Nutrition Assessment; D009752:Nutritional Status; D011183:Postoperative Complications / Q000175:diagnosis*; D011237:Predictive Value of Tests; D011379:Prognosis; D056910:Republic of Korea; D012189:Retrospective Studies; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000175:diagnosis / Q000601:surgery