Department of Anesthesia & Critical Care, Memorial Sloan Kettering Cancer Center, NY, New York, USA.
Geriatrics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, NY, New York, USA.
J Geriatr Oncol. 2020 Jun;11(5):880-884. doi: 10.1016/j.jgo.2020.03.013. Epub 2020 Apr 4.
Prognostic Nutritional Index (PNI) is associated with disease and overall survival in patients with cancer. We aimed to assess the relationship between PNI, frailty, and six-month postoperative survival in older patients with cancer.
In this retrospective study, patients with cancer aged ≥75 who underwent geriatric preoperative evaluation and then proceeded with elective surgery with hospital length of stay of ≥1 day and had six-month follow-up were included. PNI is measured by preoperative [10 × albumin(gr/dl)] + [0.005 × absolute lymphocyte count (per mm)]. Higher PNI is suggestive of better nutritional status. Frailty was assessed by geriatric assessment. PNI among patients with and without each age-related impairment was evaluated. Pearson correlation coefficient was used to assess the correlation between the number of age-related impairments and PNI. Multivariable regression analysis was used to assess the relationship between six-month mortality and PNI.
PNI ranged from 19 to 49 (average 40) among 1025 patients (average age 80). Patients with impairment in Karnofsky Performance Status, falls in the past year, prolonged timed up and go test, limited social activity, significant weight loss, polypharmacy, polycomorbid conditions, depression, and dependent for basic and instrumental activities of daily living had lower PNI than fit patients. The correlation coefficient between PNI and number of aging impairments was -0.28 (p < .001). Each unit increase in PNI was associated with 10% reduction in 6-month mortality (OR = 0.90, p < .001).
PNI independent of frailty, age, American Society of Anesthesiologist Performance Scale (ASA-PS), and metastatic disease is associated with six-month postoperative mortality. Future studies should assess the interventions aimed at improving PNI and its impact on surgical outcomes.
预后营养指数（PNI）与癌症患者的疾病和总生存相关。我们旨在评估 PNI、衰弱与癌症老年患者术后 6 个月生存的关系。
在这项回顾性研究中，纳入了年龄≥75 岁、接受了老年术前评估、随后接受了择期手术且住院时间≥1 天、并进行了 6 个月随访的癌症患者。PNI 通过术前[10×白蛋白（g/dl）]+[0.005×绝对淋巴细胞计数（每 mm）]来测量。较高的 PNI 提示更好的营养状态。衰弱通过老年综合评估来评估。评估了有和无每个与年龄相关的功能障碍的患者的 PNI。Pearson 相关系数用于评估与年龄相关的功能障碍数量和 PNI 之间的相关性。多变量回归分析用于评估术后 6 个月死亡率与 PNI 之间的关系。
在 1025 名患者中（平均年龄 80 岁），PNI 范围为 19 至 49（平均 40）。卡氏功能状态评分、过去 1 年跌倒、计时起立行走测试时间延长、社交活动受限、明显体重减轻、多药治疗、合并多种疾病、抑郁和基本及工具性日常生活活动依赖的患者比健康患者的 PNI 低。PNI 与年龄相关的功能障碍数量之间的相关系数为-0.28（p<0.001）。PNI 每增加一个单位，术后 6 个月死亡率降低 10%（OR=0.90，p<0.001）。
独立于衰弱、年龄、美国麻醉医师协会身体状况评分（ASA-PS）和转移性疾病，PNI 与术后 6 个月死亡率相关。未来的研究应评估旨在改善 PNI 及其对手术结果影响的干预措施。
