The prognostic nutritional index predicts long-term outcomes of gastric cancer patients independent of tumor stage

Ann Surg Oncol. 2013 Aug;20(8):2647-54. doi: 10.1245/s10434-013-2926-5. Epub 2013 Mar 6.


Purpose: The aim of this study was to investigate the impact of the prognostic nutritional index (PNI) on the long-term outcomes in gastric cancer patients.

Methods: This study reviewed the medical records of 548 patients with gastric cancer who underwent gastrectomy. The PNI was calculated as 10 × serum albumin (g/dl) + 0.005 × total lymphocyte count (per mm(3)). The receiver operating characteristic (ROC) curve analysis was performed to determine the cutoff value of the PNI. The multivariate analysis was performed to identify the prognostic factors.

Results: The mean PNI was significantly lower in patients with T3-T4 tumors (P < 0.001) and lymph node metastasis (P < 0.001) than in those without such factors. Patients who had a postoperative complication had a lower mean PNI than those without (P = 0.023). When the ROC curve analysis was performed, the optimal cutoff value of the PNI for predicting the 5-year survival was 48. In the multivariate analysis, a low PNI was an independent predictor for poor overall survival (P < 0.001). In the subgroup analysis, the overall and relapse-free survival rates were significantly lower in the PNI-low group than in the PNI-high group among patients with stage I and stage III disease.

Conclusions: The PNI is a simple and useful marker for predicting the long-term outcomes of gastric cancer patients independent of the tumor stage. Based on our results, we suggest that the PNI should be included in the routine assessment of gastric cancer patients.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Antineoplastic Combined Chemotherapy Protocols / administration & dosage
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
  • Carcinoembryonic Antigen / blood
  • Chemotherapy, Adjuvant
  • Cisplatin / administration & dosage
  • Deoxycytidine / administration & dosage
  • Deoxycytidine / analogs & derivatives
  • Disease-Free Survival
  • Drug Combinations
  • Female
  • Fluorouracil / administration & dosage
  • Gastrectomy / adverse effects
  • Humans
  • Lymphatic Metastasis
  • Lymphocyte Count
  • Male
  • Middle Aged
  • Nutritional Status
  • Oxonic Acid / administration & dosage
  • Predictive Value of Tests
  • Retrospective Studies
  • Serum Albumin / metabolism*
  • Stomach Neoplasms / blood*
  • Stomach Neoplasms / pathology
  • Stomach Neoplasms / therapy*
  • Tegafur / administration & dosage
  • Time Factors
  • Uracil / administration & dosage
  • Young Adult


  • Carcinoembryonic Antigen
  • Drug Combinations
  • Serum Albumin
  • Deoxycytidine
  • S 1 (combination)
  • Tegafur
  • Uracil
  • Oxonic Acid
  • 5'-deoxy-5-fluorocytidine
  • Cisplatin
  • Fluorouracil

Supplementary concepts

  • 1-UFT protocol