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Prognostic value of the preoperative prognostic nutritional index in oldest-old patients with colorectal cancer

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Abstract

Background

The prognostic nutritional index (PNI), which is calculated using serum albumin and the peripheral lymphocyte count, is a simple and useful score for predicting the prognosis in patients with various cancers. The correlation between the preoperative PNI and long-term outcomes is unclear in oldest-old patients with colorectal cancer.

Methods

A total of 84 consecutive patients ≥ 85 years old who underwent resection for primary colon adenocarcinoma at our institution between April 2008 and March 2017 were retrospectively reviewed. The cut-off value of the PNI for predicting the relapse-free survival (RFS) was 42.4 on a receiver operating characteristic curve analysis. The clinical characteristics and markers of systemic inflammation were then compared between patients with a low PNI (PNI < 42.4, n = 33) and a high PNI (PNI ≥ 42.4, n = 51).

Results

A low PNI was associated with systemic inflammation marker levels, including a low neutrophil-to-lymphocyte ratio (p = 0.048), a low platelet-to-lymphocyte ratio (p = 0.006), and a high lymphocyte-to-monocyte ratio (p < 0.001). The median follow-up period of this cohort was 34 months (1–151 months). The 5-year RFS, overall survival (OS), and cancer-specific survival were significantly worse in the low-PNI group than in the high-PNI group (p = 0.032, p = 0.004, p = 0.049, respectively). In the multivariate analysis, a low PNI was an independent predictor for both the RFS (HR 3.188, p = 0.041) and OS (HR 3.953, p = 0.027).

Conclusions

A low-preoperative PNI was significantly associated with a poor prognosis in oldest-old colorectal cancer patients. Perioperative nutritional support may be important for prolonging the survival.

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Authors and Affiliations

  1. Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan

    Tetsuro Tominaga, Takashi Nonaka, Makoto Hisanaga, Akiko Fukuda, Yukinori Tanoue, Takafumi Yoshimoto, Shigekazu Hidaka & Takeshi Nagayasu

  2. Department of Cardiopulmonary Rehabilitation Science, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan

    Terumitsu Sawai

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  1. Tetsuro Tominaga
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Contributions

Tetsuro Tominaga and Takashi Nonaka were the main designers of the study. Tetsuro Tominaga analyzed the data. All co-authors contributed substantially to this study and fulfilled the requirements for authorship as per the guidelines of the International Committee of Medical Journal Editors. All authors have read and approved the final version of the manuscript.

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Correspondence to Tetsuro Tominaga.

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Tominaga, T., Nonaka, T., Hisanaga, M. et al. Prognostic value of the preoperative prognostic nutritional index in oldest-old patients with colorectal cancer. Surg Today 50, 449–459 (2020). https://doi.org/10.1007/s00595-019-01910-w

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