# Postoperative Prognostic Nutritional Index as a Useful Prognostic Factor in Patients With Gastric Cancer

## TL;DR

This study shows that the postoperative prognostic nutritional index (PNI) can predict outcomes for gastric cancer patients after surgery.

## Contribution

The study demonstrates that postoperative PNI is an independent and useful prognostic factor for gastric cancer patients.

## Key findings

- PNI on postoperative Day 1 had the highest predictive accuracy (AUC of 0.699) for recurrence.
- Low PNI on Day 1 was significantly linked to worse overall and recurrence-free survival.
- PNI on Day 1 was an independent prognostic factor in multivariate analysis.

## Abstract

To verify whether postoperative prognostic nutritional index is a useful prognostic factor in patients with gastric cancer.

This study included 1738 consecutive patients with gastric cancer who underwent radical gastrectomy at our institution from January 2004 to December 2018. The sensitivity and specificity of white blood cell, neutrophil, lymphocyte, monocyte, and platelet counts, C‐reactive protein, hemoglobin, and albumin levels, neutrophil‐to‐lymphocyte ratio, lymphocyte‐to‐monocyte ratio, C‐reactive protein‐to‐albumin ratio, platelet‐to‐lymphocyte ratio, and prognostic nutritional index on postoperative Days 1 and 3 in predicting recurrence were evaluated using receiver operating characteristic curves. Recurrence‐free survival and overall survival were compared between the normal and high fibrinogen groups.

After applying the inclusion criteria, 1635 eligible patients were included in the analysis. The prognostic nutritional index on postoperative Day 1 attained the highest area under the curve (0.699). Overall survival and recurrence‐free survival in the low prognostic nutritional index on postoperative Day 1 group were significantly poorer than those in the high prognostic nutritional index on postoperative Day 1 group (log‐rank test, both p < 0.001). Multivariate Cox analysis revealed that prognostic nutritional index on postoperative Day 1 was a significantly independent prognostic factor for overall survival and recurrence‐free survival (p = 0.002 and p < 0.001, respectively).

Postoperative prognostic nutritional index was a useful prognostic factor in patients with gastric cancer.

In patients after gastric cancer surgery, low postoperative PNI values, considering nutritional status, surgical stress, and postoperative inflammatory response, were significantly associated with poor prognosis in terms of both RFS and OS.