Clinical significance of prognostic nutritional index in patients with glioblastomas

Preoperative prognostic nutritional index (PNI) has been proven to be associated with clinical outcomes in patients with malignancies. However, data regarding the role of PNI in human glioblastomas (GBMs) is lacking. We, therefore, aimed to investigate the association between PNI and clinical parameters and survival in GBM patients. This retrospective analysis included 300 GBM patients who were surgically treated at our institute from 2008 to 2017. PNI was calculated as albumin (g/L)+5 x total lymphocyte count (10(9)/L). SPSS 22.0, GraphPad Prism 5, and X tile were the primary tools used for data analysis, figuring drawing, and calculating optimal cutoffs, respectively. Mean albumin value, lymphocyte count, and PNI were 42.13 +/- 4.43 g/L, 1.73 +/- 0.71 x 10(9)/L, and 50.80 +/- 6.01, respectively. PNI was increased in patients aged <= 60 years and in men. Moreover, PNI >= 44 was associated with improved overall survival in younger patients and women. PNI was not associated with isocitric dehydrogenase (IDH)-1(R132H) mutations or predicted survival in GBM patients without such mutations. Univariate analysis showed that a high preoperative Karnofsky performance score, gross total resection, completed chemoradiotherapy, IDH-1(R132H) mutations, and higher PNI levels were associated with favorable outcomes. Multivariate analysis showed that only completed chemoradiotherapy and IDH-1(R132H) mutations were independent prognostic factors. Our results indicated that PNI is associated with age and sex in GBM patients but fails to provide independent prognostic values.