Abstract
The preoperative nutritional and immunological statuses have an important impact in predicting the survival outcome of patients with various types of malignant tumors. Our study aimed to explore the clinical significance and predictive prognostic potential of Onodera’s prognostic nutritional index (PNI) in patients with colorectal carcinoma. This retrospective study included a total of 1321 patients who were diagnosed with colorectal cancer and who had been surgically treated between January 1994 and December 2007. The PNI level was determined according the following formula: 10 × serum albumin (g/dL) + 0.005 × total lymphocyte count (per mm3). The impact of PNI on clinicopathological features and overall survival (OS) was determined. The optimal cutoff value of PNI was set at 45. Patients in the low-PNI group had a greater potential to have aggressive histological features, advanced tumors (T), nodal involvement (N), metastasis (M), and TNM stage than those in the high-PNI group. The low-PNI group had a worse OS than the high-PNI group (5-year survival rate 56.1 vs 64.8 %, respectively; P < 0.05). Furthermore, the PNI value was an independent prognostic factor for colorectal cancer in this study. The OS was significantly lower in the low-PNI group than in the high-PNI group in patients with TNM stage II and III diseases. Preoperative PNI is a simple and useful marker to predict clinicopathological features and long-term survival outcome in patients with colorectal carcinoma. PNI analysis should be included in the routine assessment of patients with locally advanced colorectal cancer.
Highlights
According to GLOBOCAN 2012 database, there were 253, 000 new cases of colorectal cancer and 139,000 cases of death due to colorectal cancer; these accounted for 18.6 and 20.0 % of cancers and cancer deaths worldwide, respectively
Multivariate analysis revealed that only the low prognostic nutritional index (PNI) value, infiltrative gross type, advanced T stage, lymph node involvement, and distant metastasis were independent prognostic factors for adverse overall survival (OS) of colorectal cancer patients in this study
Low PNI was first found to be a predictor of a high risk of short-term postoperative complications in the gastrointestinal tract
Summary
According to GLOBOCAN 2012 database, there were 253, 000 new cases of colorectal cancer and 139,000 cases of death due to colorectal cancer; these accounted for 18.6 and 20.0 % of cancers and cancer deaths worldwide, respectively. It is important to determine preoperative predictive prognostic markers for patients with colorectal cancer who undergo surgical treatment. The PNI was originally used to evaluate the risk of postoperative complications and mortality [8] in gastrointestinal tract surgery, and it has become a powerful prognostic parameter for various types of cancer, such as colorectal cancer [9], gastric cancer [10], pancreatic cancer [11], Tumor Biol. Few studies have evaluated the clinical importance of PNI in patients with colorectal cancer in China, and most of the related studies have had a small sample size. We performed a retrospective analysis to study the clinical importance and prognostic effect of PNI in a large cohort of Chinese patients with colorectal cancer
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