Abstract
BackgroundThe systemic inflammatory response and nutritional status of patients with malignant tumors are related to postoperative results. We examined the usefulness of the prognostic nutritional index (PNI) as a prognostic tool in patients with oral squamous cell carcinoma who underwent radical surgery.MethodsFrom 2008 to 2019, 102 patients (73 males, 29 females; age, 65.6 ± 9.8 years) who visited our hospital and underwent surgical therapy were included in this study. The endpoint was the total survival period, and the evaluation markers included the lymphocyte count and albumin level in peripheral blood obtained 4 weeks preoperatively, age, sex, alcohol consumption, smoking history, site of the tumor, pathological stage, and surgery status. The PNI was calculated using serum albumin levels and the peripheral blood lymphocyte count. The relationship between the PNI and patient characteristics were analyzed using Fisher's exact test. The Kaplan–Meier method was used to evaluate the survival rate. The survival periods were compared using the log-rank method. We evaluated the prognostic factors for overall survival (OS) and disease-free survival (DFS) in a logistic regression model.ResultsThe tumor sites included the maxilla (n = 12), buccal mucosa (n = 11), mandible (n = 17), floor of the mouth (n = 9), and tongue (n = 53). The number of patients with stage I, II, III, and IV oral cancers was 28 (27.5%), 34 (27.5%), 26 (33.3%), and 14 (13.7%), respectively. During the observation period, 21 patients died of head and neck cancer. The optimal cut-off PNI value was 42.9, according to the receiver operating characteristic analysis. The proportion of patients with a short OS was lower in those with PNI higher than 42.9, and the 5-year OS in patients with PNI higher and lower than the cut-off value was 62.3% and 86.0%, respectively (P = 0.0105).ConclusionsThe OS of patients with PNI < 42.9 was lower than that of patients with PNI ≥ 42.9. The PNI, which is a preoperative head-to-foot inflammatory marker, can help in estimating the prognosis of oral cancer.
Highlights
The systemic inflammatory response and nutritional status of patients with malignant tumors are related to postoperative results
We used a receiver operating characteristic (ROC) curve analysis to evaluate whether the prognostic nutritional index (PNI) could predict disease-free survival (DFS) or overall survival (OS)
ROC analyses showed that the optimal PNI was 42.9 (OS: sensitivity- 69.2, specificity- 0.583; area under the curve (AUC) = 0.62; DFS: sensitivity- 75.8, specificity- 0.575; AUC = 0.66) (Figs. 1, 2)
Summary
The systemic inflammatory response and nutritional status of patients with malignant tumors are related to postoperative results. We examined the usefulness of the prognostic nutritional index (PNI) as a prognostic tool in patients with oral squamous cell carcinoma who underwent radical surgery. The prognostic factors for patients with oral cancer include tumor depth, vascular and neural invasion, cervical. A previous report has examined the systemic inflammatory response and the effect of the nutritional status in patients with oral cancer receiving radiation or chemotherapy; there are few reports on patients having undergone surgical therapy [10, 23]. The prognostic nutritional index (PNI) is evaluated using the serum albumin level and the lymphocyte count. PNI reflects the nutritional status and immunological state of the patient
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