title: Impact of the prognostic nutritional index on the recovery and long-term oncologic outcome of patients with colorectal cancer.
abstract: OBJECTIVE
  The prognostic nutritional index (PNI) has been reported to be a predictive marker for surgical outcomes and prognosis in gastrointestinal malignancies. In this study, we aimed to identify the impact of preoperative PNI on the recovery and long-term oncologic outcome of patients with colorectal cancer (CRC).
  
  
  METHODS
  A total of 3569 patients who underwent curative resection for CRC were enrolled, and their medical records were analyzed retrospectively. Preoperative PNI was calculated as 10× serum albumin concentration (g/dL) + 0.005 × total lymphocyte count (/mm3). The occurrence of postoperative complications, duration of hospital stay, disease-free survival, and overall survival were analyzed according to the preoperative PNI. In addition, PNI was compared according to the status of pathologic factors.
  
  
  RESULTS
  The postoperative complication rate and postoperative duration of hospital stay increased significantly as PNI increased. Patients with a lower PNI showed a worse survival outcome. Increased depth of tumor invasion, presence of distant metastasis, and poorer histologic grade were associated with a lower PNI. The cut-point of preoperative PNI was calculated as 50, and patients with PNI > 50 showed a markedly better survival outcome. Furthermore, patients with PNI > 50 showed better results in postoperative complication rate and postoperative duration of hospital stay.
  
  
  CONCLUSIONS
  Preoperative PNI is a simple and efficient indicator (cut-point 50) for estimating the recovery and oncologic outcome of patients. A low PNI was associated with increased occurrence of postoperative complications, prolonged hospital stay, poor oncologic outcome, and aggressive tumor phenotypes.
authors.affiliation: Department of Surgery, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea.
authors.forename: Gyoung Tae
authors.initials: GT
authors.lastname: Noh
authors.affiliation: Department of Surgery, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea.
authors.forename: Jeonghee
authors.initials: J
authors.lastname: Han
authors.affiliation: Department of Surgery, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea.
authors.forename: Min Soo
authors.initials: MS
authors.lastname: Cho
authors.affiliation: Department of Surgery, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea.
authors.forename: Hyuk
authors.initials: H
authors.lastname: Hur
authors.affiliation: Department of Surgery, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea.
authors.forename: Byung Soh
authors.initials: BS
authors.lastname: Min
authors.affiliation: Department of Surgery, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea.
authors.forename: Kang Young
authors.initials: KY
authors.lastname: Lee
authors.affiliation: Department of Surgery, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea. namkyuk@yuhs.ac.
authors.forename: Nam Kyu
authors.initials: NK
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D015179:Colorectal Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D005743:Gastrectomy; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015596:Nutrition Assessment; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: Colorectal cancer; Oncologic outcome; tumor phenotype; Postoperative complication; Prognostic nutritional index