The prognostic value of preoperative pre-albumin and PNI for overall survival in gastric cancer patients

Background: The presence of malnutrition and systematic inflammatory response can cause a shorter survival and higher possible complications in patients with malignancy. Routine peripheral blood tests and liver function tests reflecting immune and nutritional status, were reported to be the predictors of overall survival (OS) in some tumor patients. Aims: This retrospective study aimed to assess the prognostic value of preoperative prealbumin, albumin, hemoglobin and prognostic nutritional index (PNI) for OS in gastric cancer (GC) patients. Methods: A total of 368 patients who were diagnosed with GC and underwent surgery between December 2010 and December 2012 were followed-up until October 2016. Receiver operating characteristic (ROC) curve analysis was used to determine the cutoff values of pre-albumin, albumin and PNI. Then, a score system including pre-albumin and PNI was constructed. Kaplan-Meier curves and Cox regression analyses were used to calculate OS characteristics. Results: The cutoff values of pre-albumin, albumin and PNI were 192.5 mg/L, 42 g/L and 48.37, respectively by ROC curve analysis. The Kaplan-Meier survival curves revealed that GC patients with hemoglobin >= 120 g/L (P = 0.006), albumin >= 42 g/L (P = 0.034), pre-albumin >= 192.5 mg/L (P = 0.000), tumor size < 5 cm (P = 0.000), PNI >= 48.37 (P = 0.001) and well differentiation grade (P = 0.026) had longer OS. Additionally, pre albumin, PNI and TNM stage were demonstrated to be independent risk factors for the overall survival, and the area under the ROC curve of the new score model was 0.637 (95% confidence interval: 0.581-0.694), showing a reliable ability to evaluate the prognostic value of GC patients. Conclusions: Preoperative pre-albumin and PNI were independent prognostic factors and the new score model in our study may serve as a reliable index to predict the prognosis of GC patients.