Postoperative Prognostic Nutritional Index as a Useful Prognostic Factor in Patients With Gastric Cancer

Aim To verify whether postoperative prognostic nutritional index is a useful prognostic factor in patients with gastric cancer. Methods This study included 1738 consecutive patients with gastric cancer who underwent radical gastrectomy at our institution from January 2004 to December 2018. The sensitivity and specificity of white blood cell, neutrophil, lymphocyte, monocyte, and platelet counts, C-reactive protein, hemoglobin, and albumin levels, neutrophil-to-lymphocyte ratio, lymphocyte-to-monocyte ratio, C-reactive protein-to-albumin ratio, platelet-to-lymphocyte ratio, and prognostic nutritional index on postoperative Days 1 and 3 in predicting recurrence were evaluated using receiver operating characteristic curves. Recurrence-free survival and overall survival were compared between the normal and high fibrinogen groups. Results After applying the inclusion criteria, 1635 eligible patients were included in the analysis. The prognostic nutritional index on postoperative Day 1 attained the highest area under the curve (0.699). Overall survival and recurrence-free survival in the low prognostic nutritional index on postoperative Day 1 group were significantly poorer than those in the high prognostic nutritional index on postoperative Day 1 group (log-rank test, both p < 0.001). Multivariate Cox analysis revealed that prognostic nutritional index on postoperative Day 1 was a significantly independent prognostic factor for overall survival and recurrence-free survival (p = 0.002 and p < 0.001, respectively). Conclusion Postoperative prognostic nutritional index was a useful prognostic factor in patients with gastric cancer.