title: A decrease in the prognostic nutritional index is associated with a worse long-term outcome in gastric cancer patients undergoing neoadjuvant chemotherapy.
abstract: OBJECTIVE
  The aim of this study was to evaluate the prognostic impact of the prognostic nutritional index (PNI) in gastric cancer patients undergoing neoadjuvant chemotherapy (NAC).
  
  
  METHODS
  This study reviewed 54 patients with gastric cancer who underwent NAC and a subsequent R0 gastrectomy. The PNI before starting NAC and before gastrectomy were calculated using the following formula: 10 × serum albumin (g/dl) + 0.005 × total lymphocyte count (per mm3). A multivariate analysis was performed to identify the predictors of overall survival (OS).
  
  
  RESULTS
  The mean pre-NAC and preoperative PNI were 48.3 ± 5.1 and 48.2 ± 4.7, respectively (p = 0.934). The PNI decreased after NAC in 31 patients (57.4%). The pre-NAC PNI and preoperative PNI were not significantly associated with the OS rate. The 3-year OS rate in patients with the decreased PNI values was significantly lower than that in the patients whose PNI values were either maintained or increased (41 vs. 76.4%, p = 0.003). A multivariate analysis revealed that a decreased PNI value was an independent predictor of a poor OS (p = 0.006).
  
  
  CONCLUSIONS
  Decreased PNI values were associated with worse long-term outcomes in gastric cancer patients undergoing NAC.
authors.affiliation: Department of Surgery, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan. kmigita@naramed-u.ac.jp.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Migita
authors.affiliation: Department of Surgery, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan.
authors.forename: Sohei
authors.initials: S
authors.lastname: Matsumoto
authors.affiliation: Department of Surgery, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan.
authors.forename: Kohei
authors.initials: K
authors.lastname: Wakatsuki
authors.affiliation: Department of Surgery, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Ito
authors.affiliation: Department of Surgery, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan.
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Kunishige
authors.affiliation: Department of Surgery, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nakade
authors.affiliation: Department of Surgery, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan.
authors.forename: Mutsuko
authors.initials: M
authors.lastname: Kitano
authors.affiliation: Department of Surgery, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan.
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Nakatani
authors.affiliation: Department of Surgery, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan.
authors.forename: Hiromichi
authors.initials: H
authors.lastname: Kanehiro
mesh_terms: D000368:Aged; D017024:Chemotherapy, Adjuvant / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020360:Neoadjuvant Therapy / Q000401:mortality; D015596:Nutrition Assessment; D011237:Predictive Value of Tests; D057234:Preoperative Period; D011379:Prognosis; D013274:Stomach Neoplasms / Q000401:mortality* / Q000628:therapy*; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome
keywords: Gastric cancer; Neoadjuvant chemotherapy; Prognostic nutritional index