Published online May 27, 2024. doi: 10.4240/wjgs.v16.i5.1291
Revised: April 10, 2024
Accepted: April 24, 2024
Published online: May 27, 2024
Processing time: 142 Days and 17.6 Hours
The prognostic nutritional index (PNI), a marker of immune-nutrition balance, has predictive value for the survival and prognosis of patients with various cancers.
To explore the clinical significance of the preoperative PNI on the prognosis of ampullary adenocarcinoma (AC) patients who underwent curative pancreaticoduodenectomy.
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.
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.
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.
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.