Abstract
BackgroundAn ideal tumor marker should be capable of being detected at any stage of the disease. However, gastric cancer patients do not always have elevated serum carcinoembryonic antigen (CEA) levels, even in advanced cases. Recently, several studies have investigated the associations between preoperative PNI and postoperative long-term outcomes. In this study, we focused on the significance of the prognostic nutritional index (PNI) as a potential predictor of survival in resectable gastric cancer patients with normal preoperative serum CEA levels.MethodsWe retrospectively conducted cohort study to evaluate the PNI as a predictor of survival in 368 resectable gastric cancer patients who underwent potentially curative gastrectomy at our institute between January 2010 and December 2016. We selected 218 patients by propensity score matching to reduce biases due to the different distributions of co-variables among the comparable groups.ResultsIn the multivariate analysis, pStage (hazard ratio [HR]: 14.003, 95% confidence interval [CI]: 5.033–44.487; p < 0.001), PNI (HR: 2.794, 95% CI: 1.352–6.039; p < 0.001) were identified as independent prognostic factors of CSS in 218 propensity matched gastric cancer patients. The Kaplan-Meier analysis demonstrated that low PNI patients had a significantly poorer cancer specific survival (CSS) than high PNI patients (p = 0.008).Among 166 propensity matched gastric cancer patients with normal preoperative serum CEA levels, multivariate analysis demonstrated that pStage (HR: 7.803, 95% CI: 3.015–24.041; p < 0.001) and PNI (HR: 3.078, 95% CI: 1.232–8.707; p = 0.016) were identified as independent prognostic factors of CSS. And Kaplan-Meier analysis demonstrated that low PNI had a significantly poorer CSS than high PNI value (p = 0.011).ConclusionsThis study demonstrates that a low preoperative PNI value is a potential independent risk factor for poorer CSS in patients with gastric cancer, even in those with normal serum CEA levels.
Highlights
An ideal tumor marker should be capable of being detected at any stage of the disease
Among 166 propensity matched gastric cancer patients with normal preoperative serum carcinoembryonic antigen (CEA) levels, multivariate analysis demonstrated that pStage (HR: 7.803, 95% CI: 3.015–24.041; p < 0.001) and prognostic nutritional index (PNI) (HR: 3.078, 95% CI: 1.232–8.707; p = 0.016) were identified as independent prognostic factors of cancer specific survival (CSS)
This study demonstrates that a low preoperative PNI value is a potential independent risk factor for poorer CSS in patients with gastric cancer, even in those with normal serum CEA levels
Summary
An ideal tumor marker should be capable of being detected at any stage of the disease. Several studies have investigated the associations between preoperative PNI and postoperative long-term outcomes. We focused on the significance of the prognostic nutritional index (PNI) as a potential predictor of survival in resectable gastric cancer patients with normal preoperative serum CEA levels. There has been increasing concern regarding the association between the systemic inflammatory response and survival in patients with various types of cancer [1,2,3]. The systemic inflammatory response has attracted considerable attention as a unique prognostic factor independent of conventional tumor markers [4, 5]. Systemic inflammation involves biochemical reactions in response to cancer cell secreted inflammatory cytokines [6]. Several studies have investigated the associations between preoperative nutritional status, cancer-related inflammation, and postoperative long-term outcomes Cancer-related inflammatory changes induced by hypercytokinemia can be indirectly evaluated using multiple assessment tools (e.g., Glasgow prognostic scores, neutrophil-to-lymphocyte ratios, and lymphocyte-to-monocyte ratios) [7, 8].
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