Prognostic value of perioperative changes in the prognostic nutritional index in patients with surgically resected non-small cell lung cancer

• Published in: Surgery today (Tokyo, Japan) Japan), 2024-09, Vol.54 (9), p.1031-1040
• Main Authors: Hayasaka, Kazuki, Notsuda, Hirotsugu, Onodera, Ken, Watanabe, Tatsuaki, Watanabe, Yui, Suzuki, Takaya, Hirama, Takashi, Oishi, Hisashi, Niikawa, Hiromichi, Okada, Yoshinori
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Carcinoma, Non-Small-Cell Lung - mortality; Carcinoma, Non-Small-Cell Lung - pathology; Carcinoma, Non-Small-Cell Lung - surgery; Cohort Studies; Female; Humans; Lung Neoplasms - mortality; Lung Neoplasms - surgery; Male; Medicine; Medicine & Public Health; Middle Aged; Nutrition Assessment; Original Article; Perioperative Period; Pneumonectomy; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Prognosis; Retrospective Studies; Risk; Surgery; Surgical Oncology; Survival Rate
• ISSN: 0941-1291; 1436-2813; 1436-2813
• DOI: 10.1007/s00595-024-02847-5

Purpose This single-institution retrospective cohort study was conducted to assess the prognostic significance of perioperative changes in the prognostic nutritional index (PNI) in patients who underwent surgery for non-small cell lung cancer (NSCLC). Methods Clinicopathological data were collected from 441 patients who underwent lobectomy for NSCLC between 2010 and 2016.The PNI ratio (postoperative PNI/preoperative PNI) was used as an indicator of perioperative PNI changes. Prognostic differences were investigated based on PNI ratios. Results The optimal cut-off value of the PNI ratio for overall survival (OS) was set at 0.88 using a receiver operating characteristic curve. The PNI ratio was inversely related to a high smoking index, interstitial lung disease, and postoperative pulmonary complications. The 5-year OS rates for the high vs. low PNI ratio groups were 88.2% vs. 68.5%, respectively (hazard ratio [HR]: 3.04, 95% confidence interval [CI]: 1.90–4.86). Multivariable analysis revealed that a low PNI ratio was significantly associated with poor prognosis (HR: 2.94, 95% CI: 1.77–4.87). The PNI ratio was a more sensitive indicator than postoperative PNI status alone for identifying patients at high risk of mortality, particularly those with non-lung cancer causes. Conclusion The perioperative PNI change is a significant prognostic factor for patients with NSCLC.