The preoperative prognostic nutritional index is a predictive and prognostic factor of high-grade serous ovarian cancer

BMC Cancer. 2018 Sep 10;18(1):883. doi: 10.1186/s12885-018-4732-8.


Background: The aim of our study was to investigate whether an inflammation-based prognostic score, the prognostic nutritional index (PNI), was associated with clinical characteristics and prognosis in patients with high-grade serous ovarian cancer (HGSC).

Methods: We retrospectively investigated 875 patients who underwent primary staging or debulking surgery for HGSC between April 2005 and June 2013 at our institution. None of these patients received neoadjuvant chemotherapy. Preoperative PNI was calculated as serum albumin (g/L) + 0.005 × lymphocyte count (per mm3). The optimal PNI cutoff value for overall survival (OS) was identified using the online tool "Cutoff Finder". Clinical characteristics and PNI were compared with chi-square or Fisher's exact tests, as appropriate. The impact of PNI on OS was analyzed using the Kaplan-Meier method and Cox proportional hazards model.

Results: The median (range) PNI was 46.2 (29.2-67.7). The 45.45 cutoff value discriminated patients into the high-PNI and low-PNI groups. A low preoperative PNI was associated with an advanced FIGO stage, increased CA125 level, more extensive ascites, residual disease and platinum resistance. For univariate analyses, a high PNI was associated with increased OS (p < 0.001). In multivariate analyses, the PNI remained an independent predictor of OS as a continuous variable (p = 0.021) but not as dichotomized groups (p = 0.346).

Conclusion: Our study demonstrated that the PNI could be a predictive and prognostic parameter for HGSC.

Keywords: Ovarian cancer; Overall survival; Platinum sensitivity; Prognostic nutritional index; Residual disease.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Cystadenocarcinoma, Serous / epidemiology*
  • Cystadenocarcinoma, Serous / mortality
  • Cystadenocarcinoma, Serous / pathology
  • Cystadenocarcinoma, Serous / therapy
  • Female
  • Humans
  • Kaplan-Meier Estimate
  • Middle Aged
  • Neoplasm Grading
  • Neoplasm Staging
  • Nutrition Assessment
  • Nutritional Status*
  • Ovarian Neoplasms / epidemiology*
  • Ovarian Neoplasms / mortality
  • Ovarian Neoplasms / pathology
  • Ovarian Neoplasms / surgery
  • Preoperative Period
  • Prognosis
  • Proportional Hazards Models