Masahiro Sasahara1,2, Mitsuro Kanda3, Seiji Ito4, Yoshinari Mochizuki2, Hitoshi Teramoto1, Kiyoshi Ishigure5, Toshifumi Murai6, Takahiro Asada7, Akiharu Ishiyama8, Hidenobu Matsushita9, Chie Tanaka2, Daisuke Kobayashi2, Michitaka Fujiwara2, Kenta Murotani10, Yasuhiro Kodera2. 1. Department of Surgery, Yokkaichi Municipal Hospital, Yokkaichi, Japan. 2. Department of Surgery, Komaki Municipal Hospital, Komaki, Japan. 3. Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya, Japan, m-kanda@med.nagoya-u.ac.jp. 4. Department of Gastroenterological Surgery, Aichi Cancer Center, Nagoya, Japan. 5. Department of Surgery, Konan Kosei Hospital, Konan, Japan. 6. Department of Surgery, Ichinomiya Municipal Hospital, Ichinomiya, Japan. 7. Department of Surgery, Gifu Prefectural Tajimi Hospital, Tajimi, Japan. 8. Department of Surgery, Okazaki City HospitalKoryuji-cho, Okazaki, Japan. 9. Department of Surgery, Tosei General Hospital, Seto, Japan. 10. Biostatistics Center, Graduate School of Medicine, Kurume University, Kurume, Japan.
Abstract
BACKGROUND/AIMS: Identification of nutritional indicators to predict short-term and long-term outcomes is necessary to provide appropriate treatment to patients with gastric cancer. METHODS: We designed an analysis of a multicenter dataset of patients with gastric cancer who underwent gastrectomy between 2010 and 2014. We enrolled 842 eligible patients who had stage II/III gastric cancer. The area under the curve (AUC) values were compared among prognostic nutritional index (PNI), calculated as 10 × albumin g/dL + 0.005 × total lymphocyte count/mm3, and its constituents, and the predictive value of preoperative PNI for postoperative short-term and long-term outcomes was evaluated. RESULTS: Preoperative PNI exhibited higher AUC values (0.719) for 1-year survival than its constituents, and the optimal cutoff value was 47. The disease-free and overall survival of patients in the PNI-low group were significantly shorter compared with those in the PNI-high group. The prognostic difference between the PNI-high and PNI-low groups was significantly greater in the subgroup of patients who underwent total gastrectomy. Clinically relevant postoperative complications were more frequently observed in the PNI-low group. CONCLUSIONS: The preoperative PNI is a useful predictor reflecting the incidence of complications after gastrectomy and the prognosis of patients with stage II/III gastric cancer.
BACKGROUND/AIMS: Identification of nutritional indicators to predict short-term and long-term outcomes is necessary to provide appropriate treatment to patients with gastric cancer. METHODS: We designed an analysis of a multicenter dataset of patients with gastric cancer who underwent gastrectomy between 2010 and 2014. We enrolled 842 eligible patients who had stage II/III gastric cancer. The area under the curve (AUC) values were compared among prognostic nutritional index (PNI), calculated as 10 × albumin g/dL + 0.005 × total lymphocyte count/mm3, and its constituents, and the predictive value of preoperative PNI for postoperative short-term and long-term outcomes was evaluated. RESULTS: Preoperative PNI exhibited higher AUC values (0.719) for 1-year survival than its constituents, and the optimal cutoff value was 47. The disease-free and overall survival of patients in the PNI-low group were significantly shorter compared with those in the PNI-high group. The prognostic difference between the PNI-high and PNI-low groups was significantly greater in the subgroup of patients who underwent total gastrectomy. Clinically relevant postoperative complications were more frequently observed in the PNI-low group. CONCLUSIONS: The preoperative PNI is a useful predictor reflecting the incidence of complications after gastrectomy and the prognosis of patients with stage II/III gastric cancer.