Prognostic nutrition index for evaluation of surgical risk and prognosis in elderly patients with gastric cancer / 中华全科医师杂志

ABSTRACT

Objective To assess the application of preoperative prognostic nutritional index (PNI) in evaluation the surgical risk and long-term prognosis for elderly patients with gastric cancer.Methods The clinical data of 205 patients aged ≥ 75 years with gastric cancer undergoing radical resection from January 2004 to December 2016 were analyzed retrospectively.The PNI value was calculated by serum albumin (g/L) +5 x lymphocyte count (x 109/L).The receiver operating characteristic (ROC) curve and Youden's index was used to determine the value of PNI in surgical risk and prognosis of patients.Patients were divided into low PNI group and high PNI group based on the cut-off value,the clinicopathological characteristics,postoperative complications and long-term survival were compared between two groups.Results The average PNI value of 205 patients was 47.3 ± 5.5.When 44.9 was set as the cut-off value with the maximal Youden's index,the sensitivity and specificity of PNI were 0.86 and 0.47,respectively.There were statistically significant differences between the two groups of patients in age(t =-2.16,P =0.032),BMI (t =4.88,P =0.000),Charlson comorbidity score (x2 =7.77,P =0.005),gastric resection range (x2 =8.63,P =0.003),postoperative complications (x2 =9.46,P =0.002).The incidence of complications in the high PNI group was 24.8％ (33/133),which was lower than that in the low PNI group (45.8％,33/72;x2 =9.46,P =0.002).Multivariate logistic analysis showed that age (P =0.032),Charlson coplications scal (CCS) (P =0.042) and PNI ＜ 44.9 (P =0.027) were independent risk factors for postoperative complications;PNI ＜ 44.9 (P =0.001),gastrectomy (P =0.011),lymph node dissection (P =0.000),tumor differentiation (P =0.001) and TNM stage (P =0.000) were independent prognostic factors for elderly patients with gastric cancer.Conclusions Prognostic nutritional index is a valuable clinical marker in evaluation of surgical risk and prognosis for elderly patients with gastric cancer.