Retrospective Cohort Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. May 27, 2024; 16(5): 1291-1300
Published online May 27, 2024. doi: 10.4240/wjgs.v16.i5.1291
Preoperative prognostic nutritional index predicts long-term outcomes of patients with ampullary adenocarcinoma after curative pancreatoduodenectomy
Chong-Yuan Sun, Xiao-Jie Zhang, Zheng Li, He Fei, Ze-Feng Li, Dong-Bing Zhao
Chong-Yuan Sun, Xiao-Jie Zhang, Zheng Li, He Fei, Ze-Feng Li, Dong-Bing Zhao, Department of Pancreatic and Gastric Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Co-first authors: Chong-Yuan Sun and Xiao-Jie Zhang.
Author contributions: Sun SC and Zhang XJ contributed equally to this work; Zhao DB designed the research study, who is the corresponding authors of this paper; Sun SC and Zhang XJ analyzed the data; and all authors wrote the manuscript and have approved the final manuscript.
Supported by the CAMS Innovation Fund for Medical Sciences (CIFMS), No. 2021-I2M-C&T-A-014.
Institutional review board statement: This study was reviewed and approved by the National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Ethics Committee.
Informed consent statement: Ethical review and approval were not required for the study on human participants in accordance the local legislation and institutional requirements.
Conflict-of-interest statement: All the Authors have no conflict of interest related to the manuscript.
Data sharing statement: The original anonymous dataset is available on reasonable request from the corresponding author at dbzhao@cicams.ac.cn.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Dong-Bing Zhao, MD, Doctor, Department of Pancreatic and Gastric Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 PanjiayuanNanli, Chaoyang District, Beijing 100021, China. dbzhao@cicams.ac.cn
Received: January 1, 2024
Revised: April 10, 2024
Accepted: April 24, 2024
Published online: May 27, 2024
Processing time: 142 Days and 17.6 Hours
Abstract
BACKGROUND

The prognostic nutritional index (PNI), a marker of immune-nutrition balance, has predictive value for the survival and prognosis of patients with various cancers.

AIM

To explore the clinical significance of the preoperative PNI on the prognosis of ampullary adenocarcinoma (AC) patients who underwent curative pancreaticoduodenectomy.

METHODS

The data concerning 233 patients diagnosed with ACs were extracted and analyzed at our institution from January 1998 to December 2020. All patients were categorized into low and high PNI groups based on the cutoff value determined by receiver operating characteristic curve analysis. We compared disease-free survival (DFS) and overall survival (OS) between these groups and assessed prognostic factors through univariate and multivariate analyses.

RESULTS

The optimal cutoff value for the PNI was established at 45.3. Patients with a PNI ≥ 45.3 were categorized into the PNI-high group, while those with a PNI < 45.3 were assigned to the PNI-low group. Patients within the PNI-low group tended to be of advanced age and exhibited higher levels of aspartate transaminase and total bilirubin and a lower creatinine level than were those in the PNI-high group. The 5-year OS rates for patients with a PNI ≥ 45.3 and a PNI < 45.3 were 61.8% and 43.4%, respectively, while the 5-year DFS rates were 53.5% and 38.3%, respectively. Patients in the PNI- low group had shorter OS (P = 0.006) and DFS (P = 0.012). In addition, multivariate analysis revealed that the PNI, pathological T stage and pathological N stage were found to be independent prognostic factors for both OS and DFS.

CONCLUSION

The PNI is a straightforward and valuable marker for predicting long-term survival after pancreatoduodenectomy. The PNI should be incorporated into the standard assessment of patients with AC.

Keywords: Ampullary carcinoma, Prognostic nutritional index, Prognosis, Pancreaticoduodenectomy

Core Tip: In light of emerging evidence that has substantiated the correlation between malnutrition and immune suppression with poor prognosis across various cancer types, we examined the prognostic significance of the preoperative prognostic nutritional index (PNI) in patients with ampullary adenocarcinoma (AC) who underwent curative pancreaticoduodenectomy (PD). Our findings revealed that the PNI, pathological T stage and pathological N stage were independent prognostic factors for both overall survival and disease-free survival in AC patients who underwent curative PD.