Abstract
BackgroundThe prognostic nutritional index (PNI) reflects immunonutritional status. We evaluated the effects of postoperative PNI and perioperative changes in the PNI on overall survival (OS) in glioblastoma (GBM) patients.MethodsDemographic, laboratory, and clinical data were retrospectively collected from 335 GBM patients. Preoperative and postoperative PNIs were calculated from serum albumin concentration and lymphocyte count, which were measured within 3 weeks before surgery and 1 month after surgery. Patients were classified into high (n = 206) or low (n = 129) postoperative PNI groups according to the postoperative PNI cutoff value and further classified into four groups according to the cutoff values of the preoperative and postoperative PNIs, as follows: Group HH (both high PNIs, n = 92), Group HL (high preoperative and low postoperative PNI, n = 70), Group LH (low preoperative and high postoperative PNI, n = 37), and Group LL (both low PNIs, n = 136).ResultsThe median OS was significantly longer in the high postoperative PNI (PNI ≥ 50.2) group than the low postoperative PNI (PNI < 50.2) group (24.0 vs. 15.0 months, p < 0.001). In multivariate analysis, high postoperative PNI was a significant predictor of OS. OS was significantly longer in Group HH than in Group LL and seemed longer in Group HH than in Group HL and in Group LH than in Group LL. OS was not different between Groups HH and LH or between Groups HL and LL.ConclusionsHigh postoperative PNI was associated with improved OS and perioperative changes in PNI may provide additional important information for prognostic prediction in GBM patients.
Highlights
The prognostic nutritional index (PNI) reflects immunonutritional status
A few studies focusing on the prognostic role of postoperative PNI have reported that it is predictive of prognosis in patients with hepatocellular carcinoma and lung cancer and a high postoperative PNI is associated with a good prognosis in such patients [23, 24]
Data collection We retrospectively reviewed the electronic medical records of subjects to collect data categorized into four parts: preoperative data, including demographic information, comorbidities, daily activities, represented by the Karnofsky performance status (KPS) score, preoperative laboratory findings; intraoperative data, including surgical time and intraoperative transfusions; postoperative data, including postoperative laboratory findings, KPS score at hospital discharge, the extent of surgical resection, which was radiographically confirmed and classified into gross total resection, near-total resection, subtotal resection, partial resection, and biopsy, and postoperative adjuvant therapy; and gene expression profiles, including O6-methylguanine-DNA methyltransferase (MGMT) methylation, epidermal growth factor receptor amplification, and the Isocitrate dehydrogenase (IDH) mutation
Summary
The prognostic nutritional index (PNI) reflects immunonutritional status. We evaluated the effects of postoperative PNI and perioperative changes in the PNI on overall survival (OS) in glioblastoma (GBM) patients. A few studies focusing on the prognostic role of postoperative PNI have reported that it is predictive of prognosis in patients with hepatocellular carcinoma and lung cancer and a high postoperative PNI is associated with a good prognosis in such patients [23, 24]. These studies indicate that the postoperative PNI rather than preoperative PNI can better reflect postoperative general conditions in patients undergoing hepatic and pulmonary tumor surgeries. Previous studies demonstrated that postoperative complications had a negative relationship with the postoperative PNI [23, 25]
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