The Relationship Between Prognostic Nutritional Index(PNI) And Prognosis In Patients With Hepatocellular Carcinoma After Radical Resection

Objective: The goal of this study was to investigate the relationship between prognostic nutritional index(PNI)and prognosis in patients with hepatocellular carcinoma after radical resection.Method: Between January 1,2008 and January 1,2013,186 HCC patients meeting Milan Criteria that received radical resection in the Second Affiliated Hospital of Dalian Medical University were collected.Totally,128 HCC patients were enrolled in this study due to our criteria.The PNI was calculated according to the following formula: serum albumin(g/L)+ 5×total lymphocyte count(109/L).Among the 128 patients enrolled in the study,we divided them into two groups according to the PNI<45 or PNI?45.Student's t test and Chi-square test were used to analyze the clinical data and Fisher probabilities was used if necessary between two groups.Kaplane-Meier method was used to compare OS in two groups and the log-rank test was applied to estimate differences in survival.Univariate and multivariate analysis were accomplished using the Cox proportional hazards regression model in the Statistical Package for Social Sciences version 21.0(SPSS).P<0.05 was considered statistically significant.Result: In 128 patients enrolled in the study,119 patients had successful follow up and 9 patients lost follow up.The follow-up rate was 92.96%.Male patients account for 85.2%(109/128)and the female patients occupied 14.8%(19/128).78.1%(100/128)patients' age is less than 65 and 21.9%(28/128)patients' age is over 65.Among the 128 patients,we divided them into two groups according to the PNI<45 or PNI?45.In the two groups,gender(male/female),age(<65/?65),tumor diameter(<3cm/?3cm),tumor differentiation(well-medium/medium/medium-poor-poor),AFP(<400ng/m L/?400ng/m L),ALB(<35g/L/?35g/L),A/G(<1.5/?1.5),ALT(<40U/L/?40U/L),AST(<40U/L/?40U/L),ALP(<130U/L/?130U/L),GGT(<50U/L/?50U/L)and PLR(0/1)had no statistical differences(P>0.05).Child-Pugh score(A/B),BCLC(0/A),tumor number(1/2-3),vascular invasion(present/absent)and NLR(0/1)had statistical differences(P<0.05).Of all the 128 patients,6 patients lost follow up and 19 patients died in the 3-year OS.Therefore 3-year OS was 85.2%.In the group(PNI<45)3-year OS was 74.2%,while in the group(PNI?45)3-year OS was 88.7%.According to the Kaplane-Meier method,3-year OS had differences(log rank,P=0.038)between the two groups(PNI<45/ PNI?45).Univariate analysis using Cox proportional hazards regression model showed that gender(male/female),age(< 65/?65),tumor diameter(< 3cm/?3cm),tumor differentiation(well-medium/medium/medium-poor),AFP(<400ng/m L/?400ng/m L),ALB(<35g/L/?35g/L),A/G(<1.5/?1.5),Child-Pugh score(A/B),tumor number(1/2-3),NLR(0/1)and PLR(0/1)made no difference to 3-year OS.On the contrary,vascular invasion(present/absent),BCLC(0/A),PNI(0/1)made a difference to 3-year OS and each hazard ratio(HR)was 1.819,1.703 and 1.923.Multivariate analysis using Cox proportional hazards regression model showed that vascular invasion(present/absent),BCLC(0/A)and PNI(0/1)made a difference to 3-year OS and each HR(95% CI)was 1.145-2.364,1.236-2.446 and 1.328-2.518.Consequently this study confirmed PNI as an effective prognostic predictor for 3-year OS.Of all the 128 patients,56 patients had recurrence during the 3-year follow up.The rate of recurrence free survival was 56.3%.3-year recurrence free survival was 51.6% in the group of PNI<45,while 3-year recurrence free survival was 57.7% in the other group.Based on Kaplane-Meier method,there were no differences on 3-year recurrence free survival between group of PNI<45 and PNI?45(log-rank,P=0.387).Univariate analysis using Cox proportional hazards regression model implied gender(male/female),age(< 65/?65),tumor diameter(< 3cm/?3cm),tumor differentiation(well-medium/medium/medium-poor-poor),AFP(<400ng/m L/?400ng/m L),ALB(<35g/L/?35g/L),A/G(<1.5/?1.5),Child-Pugh score(A/B),tumor number(1/2-3),NLR(0/1),PLR(0/1)and PNI(0/1)made no difference to 3-year recurrence free survival.However vascular invasion(present/absent)and BCLC(0/A)made a difference to 3-year recurrence free survival and each HR was 1.254 and 1.614.Multivariate analysis indicated that BCLC(0/A)made a difference to 3-year recurrence free survival and HR(95% CI)was 1.116-2.637.Therefore PNI could not be acted as an effective prognostic indicator for 3-year recurrence free survivalConclusion: In this study,vascular invasion(present/absent),BCLC(0/A)and PNI(0/1)made a difference to 3-year OS of HCC patients and could be used as effective predictors for 3-year OS.Besides vascular invasion(present/absent),BCLC(0/A)made a difference to 3-year recurrence free survival of HCC patients while only BCLC(0/A)could be acted as an effective prognostic predictor.At last PNI(0/1)was an effective prognostic predictor for 3 year OS other than 3 year recurrence free survival.