Department of Thoracic Surgery, Kyoto Katsura Hospital, 17 Yamada Hirao, Nishikyo, Kyoto, 615-8256, Japan.
Department of Clinical Research, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, 710-8602, Japan.
Surg Today. 2023 Jun;53(6):681-691. doi: 10.1007/s00595-023-02650-8. Epub 2023 Jan 31.
Objective nutritional scoring systems using preoperative blood samples have shown the potential to predict the postoperative outcomes of patients with non-small cell lung cancer (NSCLC). However, it remains unclear whether the prognostic impact depends on age and comorbid burdens. We conducted this study to validate the impact of preoperative nutritional status, stratified with age and comorbidity.
We reviewed the preoperative prognostic nutritional index (PNI) and postoperative outcomes of 713 consecutive patients with completely resected NSCLC.
We identified the optimal cutoff values of the PNI as 46. Significantly higher postoperative complication rates and worse survival rates were observed in the low PNI (≤ 46) group, regardless of age/comorbidity burdens. Multivariate analysis showed that a low PNI (≤ 46) was an independent prognostic factor for poor overall survival (hazard ratio: 2.5). A matched-pair analysis gave consistent results, showing that a low PNI (≤ 46) was an independent prognostic factor for poor overall survival (OS; hazard ratio: 1.8) and recurrence-free survival (RFS; hazard ratio: 1.6).
Nutritional status, indexed by the PNI, is a strong prognostic factor for the postoperative outcomes of patients undergoing curative resection for NSCL, regardless of age/comorbidity burdens.
使用术前血样的客观营养评分系统已显示出预测非小细胞肺癌（NSCLC）患者术后结局的潜力。然而，其预后影响是否取决于年龄和合并症负担仍不清楚。我们进行了这项研究，以验证术前营养状况的预后影响，并进行了年龄和合并症分层。
我们回顾了 713 例完全切除的 NSCLC 患者的术前预后营养指数（PNI）和术后结局。
我们确定了 PNI 的最佳截断值为 46。无论年龄/合并症负担如何，PNI（≤46）较低的患者术后并发症发生率和生存率均显著降低。多变量分析显示，低 PNI（≤46）是总生存期（OS）不良的独立预后因素（风险比：2.5）。配对分析得出了一致的结果，表明低 PNI（≤46）是 OS（风险比：1.8）和无复发生存期（RFS；风险比：1.6）不良的独立预后因素。
PNI 指数所反映的营养状况是非小细胞肺癌患者根治性切除术后的一个强大预后因素，无论年龄/合并症负担如何。
