Relationship Between Prognostic Nutritional Index And Long-term Prognosis Of Patients With Resectable Gastrointestinal Cancer

?Objective?:To investigate the correlation between the prognostic nutritional index(PNI)and long-term prognosis and clinicopathological features of patients with gastric and colorectal cancer.?Methods?:The clinicopathological data of 168 gastric and colorectal cancer cancer patients received by the second department of gener al surgery of Qingdao Municipal Hospital from January 2010 to December 2014 was analyzed,retrospectively.All the patients were received radical surgery and confirmed gastric or colorectal cancer by pathological examination after surgery.The preoperative and postoperative PNI values were calculated according to the results of routine and biochemical blood test 1 week before and 3 months after operation,respectively.The PNI value was calculated by serumalbumin(g/L)+5×lymphocyte count(×10~9/L).The receiver operating characteristic(ROC)curve and Youden index with best sensitivity and specificity was used to determine the cut-off value of the PNI.Then patients were divided as follows:group A,patients with pre-PNILow and post-PNILow;group B,patients with either pre-PNIHigh and post-PNILow or pre-PNILow and post-PNIHigh;and group C,patients with pre-PNIHigh and post-PNIHigh.Survival curves were described by the Kaplan-Meier method and compared by the Log-rank test.The univariate and multivariate analyses were performed with the Cox proportional hazard model to identify the prognostic factors.The difference was defined statistically significant when P(27)0.05.?Results?:There were 103 gastric cancer and 65 colorectal cancer patients in this study.The mean preoperative PNI was 46.44±7.44.When the PNI value was51.08,the Youden index was maxinal,with a sensitivity of 28.1%and specificity of90.9%.So we took 51.08 as the preoperative cut-off value.The five-year survival rates of pre-PNIlow group and pre-PNIhigh group were 83.2%and 95.3%,respectively.The mean postoperative PNI was 49.83±6.26.When the PNI value was49.34,the Youden index was maxinal,with a sensitivity of 65.8%and specificity of68.2%.So we took 49.34 as the postoperative cut-off value.The five-year survival rates of post-PNIlow group and post-PNIhigh group were 75.4%and 93.2%,respectively.The five-year survival rates were 73.7%,90.8%,and 97.1%for groups A,B,and C,respectively.Obvious correlation between preoperative an d postoperative PNI was observed(r=0.328,P<0.05).The mean age in pre-PNIHigh group was significantly lower than in pre-PNILow group(c~2=11.501,P=0.001).Tumor infiltration depth in pre-PNIHigh group was less than in pre-PNILow group(c~2=5.409,P=0.020).The TNM stage in pre-PNIHigh group was earlier than in pre-PNILow group(c~2=4.918,P=0.027).The proportion lymph node metastasis in post-PNIHigh group was significantly lower than in post-PNILow group(c~2=5.646,P=0.017).So were the Borrmann type(c~2=7.282,P=0.007),differentiated degree(c~2=4.818,P=0.028),tumor infiltration depth(c~2=13.175,P=0.000),TNM stage(c~2=168.000,P=0.000),and the nodules(c~2=6.346,P=0.012).Significant differences of the TNM stage and lymphovascular invasion were observed between pre-PNIHigh and post-PNIHigh group and the others.Patients with high pre-and postoperative PNI have the best prognosis.The univariate and multivariate analyses indicated that the lymphovascular invasion(OR,0.355;95%CI,0.154-0.817;P=0.015)and combination of pre-and postoperative PNI(OR,12.933;95%CI,1.675-99.868;P=0.014)were independent factors for predicting overall survival rate.?Conclusions?:PNI can not only reflect the tumor characteristics,but also validly predict the long-term outcomes of patients with gastrointestinal cancer.Moreover,the combination of pre-and postoperative PNI can effectively predict the prognosis of patients with gastrointestinal cancer and was better than any one of them.