Predictive impact for postoperative recurrence using the preoperative prognostic nutritional index in pathological stage I non-small cell lung cancer

Background: The most effective treatment for early-stage non-small cell lung cancer (NSCLC) is surgical resection. Nevertheless, up to 20% of patients, even those with stage I NSCLC, relapse after surgery and die. The prognostic nutritional index (PNI) is used to assess immunonutritional conditions or is a predictor of postoperative recurrence in patients with digestive malignancies. However, the usefulness of the PNI for lung cancer is still unknown. We retrospectively analyzed clinicopathological features of stage I NSCLC patients to identify predictors of recurrence and to investigate effects of preoperative PNI levels. Methods: We selected 141 consecutive stage I NSCLC patients who were treated from August 2005 to August 2010. We measured their preoperative PNI levels in uni- and multivariate Cox regression analyses of recurrence-free survival. Results: A low PNI was significantly associated with sex (P = 0.0117), preoperative serum carcino embryonic antigen levels (P = 0.0228), and postoperative recurrence (P < 0.0001). In multivariate analysis, PNI (RR: 9.243; 95% CI: 3.662-25.823; P<0.0001), pleural invasion (RR: 8.664; 95% CI: 2.510-38.056; P = 0.0005), and intratumoral blood vessel invasion (RR: 3.151; 95% CI: 1.259-7.681; P = 0.0152) were independent prognostic factors. The low-PNI group had a significantly shorter recurrence-free survival than the high-PNI group, regardless of pathological T factors (T1a, P = 0.0422; T1b, P < 0.0001; T2a, P = 0.0098). Conclusions: The preoperative PNI level is a simple and novel predictor of recurrence in stage I NSCLC patients, and might help identify patients who will need multimodality therapy such as induction or adjuvant therapy. (C) 2016 Elsevier Ireland Ltd. All rights reserved.