Prognostic nutritional index predicts survival and correlates with systemic inflammatory response in advanced pancreatic cancer

Background: Recent studies have implied a prognostic value of the prognostic nutritional index (PM) in certain types of human cancers. However, the value of PM for predicting survival in patients with pancreatic cancer remains unknown. The goal of this study was to investigate the predictive significance of PM in patients with advanced pancreatic cancer. Methods: A total of 321 consecutive patients with pathologically-confirmed locally advanced or metastatic pancreatic ductal adenocarcinoma (PDAC) were retrospectively recruited between January 2011 and August 2013. The patients were divided into a test set (n = 110) and a validation set (n = 211). We evaluated the association between PNI and overall survival (OS). The relationship between PM and systemic inflammatory response markers, including the neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and lymphocyte/monocyte ratio (LMR) was also assessed. In addition, the associations between PM and the TNF-alpha were analyzed. Results: Kaplan-Meier analyses showed that a low PM correlated significantly with a shorter OS in patients with advanced pancreatic cancer (190 days for patients with a low PM vs. 290 days for patients with a high PM, log-rank = 12.566, P < 0.001). Multivariate analysis identified PM as an independent prognostic factor for OS (hazard ratio [HR]: 0.627, 95% confidence interval [CI]: 0.453-0.868, P = 0.003). PM also correlated positively with NLR and PLR and negatively with LMR. Additionally, patients with a low PM exhibited high levels of TNF-alpha. Conclusions: Our results confirm that PM is associated with the systemic inflammatory response and can be used to predict survival in advanced pancreatic cancer. (C) 2015 Elsevier Ltd. All rights reserved.