The pretreatment nutritional and immunological status play indispensable roles in predicting the outcome of patients with various types of malignancies. The aim of the study was to investigate whether preoperative prognostic nutritional index (PNI), which simply accounts for nutritional and immunological status, was associated with overall survival (OS) in patients with gallbladder carcinoma (GBC). The retrospective study included a total of 315 GBC patients after surgery between 2002 and 2012. PNI was calculated according to the following formula: 10× serum albumin (g/dl) +0.005× total lymphocyte count (per mm3). A receiver operating characteristic (ROC) curve for survival prediction was plotted to verify the optimal cutoff value for LMR, which was set at 46.14. According the value, patients were categorized into two different groups, namely high-PNI group (n = 133) and low-PNI group (n = 182). The univariate and multivariate Cox regression models were used to identify the independent prognostic factors. The results showed that low pretreatment PNI value was significantly associated with elderly age, partial surgery procedure, and advanced tumor status such as tumor stage, node stage, and tumor-node-metastasis stage (P < 0.05). The low-PNI group had a worse OS compare with the high-PNI group (P < 0.05). Via univariate and multivariate analyses, pretreatment PNI was identified as an independent prognostic factor for OS [HR: 0.613; 95%CI: 0.448–0.838; P < 0.001]. Subgroup analyses further revealed that PNI was significantly associated with postoperative OS independent of tumor node metastasis stage and surgical procedure. In conclusion, pretreatment PNI might serve as an effective predictor to evaluate prognosis of GBC patients after surgery. Based on the findings, PNI, characterized with accessibility, objectivity and noninvasiveness, should be included in the routine assessment of GBC.
Prognostic nutritional index Gallbladder carcinoma Overall survival Albumin Lymphocyte count
This is a preview of subscription content, log in to check access
The study was supported by the Clinical Research Award of the First Affiliated Hospital of Xi’an Jiaotong University, China (No. XJTU1AF-CRF-2015-003).
Compliance with ethical standards
Conflicts of interest
Source of funding
Supported by the Clinical Research Award of the First Affiliated Hospital of Xi’an Jiaotong University, China (No. XJTU1AF-CRF-2015-003).
Poojary SS, Mishra G, Gupta S, Shrivastav BR, Tiwari PK. Dysfunction of subtelomeric methylation and telomere length in gallstone disease and gallbladder cancer patients of North Central India. J Hepatobiliary Pancreat Sci. 2016. doi:10.1002/jhbp.332.PubMedGoogle Scholar
Schwegler I, von Holzen A, Gutzwiller JP, Schlumpf R, Muhlebach S, Stanga Z. Nutritional risk is a clinical predictor of postoperative mortality and morbidity in surgery for colorectal cancer. Br J Surg. 2010;97(1):92–7. doi:10.1002/bjs.6805.
Geng Y, Qi Q, Sun M, Chen H, Wang P, Chen Z. Prognostic nutritional index predicts survival and correlates with systemic inflammatory response in advanced pancreatic cancer. Eur J Surg Oncol. 2015;41(11):1508–14. doi:10.1016/j.ejso.2015.07.022.CrossRefPubMedGoogle Scholar
Shimizu K, Okita R, Saisho S, Maeda A, Nojima Y, Nakata M. Preoperative neutrophil/lymphocyte ratio and prognostic nutritional index predict survival in patients with non-small cell lung cancer. World Journal of Surgical Oncology. 2015;13(1). doi:10.1186/s12957-015-0710-7.
Chen KL, Liu YH, Li WY, Chen J, YK G, Geng QR, et al. The prognostic nutritional index predicts survival for patients with extranodal natural killer/T cell lymphoma, nasal type. Ann Hematol. 2015;94(8):1389–400. doi:10.1007/s00277-015-2361-8.CrossRefPubMedGoogle Scholar
Murakami Y, Uemura K, Sudo T, Hashimoto Y, Nakashima A, Kondo N, et al. Prognostic factors of patients with advanced gallbladder carcinoma following aggressive surgical resection. J Gastrointest Surg. 2011;15(6):1007–16. doi:10.1007/s11605-011-1479-9.CrossRefPubMedGoogle Scholar
D’Hondt M, Lapointe R, Benamira Z, Pottel H, Plasse M, Letourneau R, et al. Carcinoma of the gallbladder: patterns of presentation, prognostic factors and survival rate—an 11-year single centre experience. Eur J Surg Oncol. 2013;39(6):548–53. doi:10.1016/j.ejso.2013.02.010.CrossRefPubMedGoogle Scholar
Bo Y, Yao M, Zhang L, Bekalo W, Lu W, Preoperative Nutritional LQ. Risk Index to predict postoperative survival time in primary liver cancer patients. Asia Pac J Clin Nutr. 2015;24(4):591–7. doi:10.6133/apjcn.2015.24.4.26.PubMedGoogle Scholar
Mehrazin R, Uzzo RG, Kutikov A, Ruth K, Tomaszewski JJ, Dulaimi E, et al. Lymphopenia is an independent predictor of inferior outcome in papillary renal cell carcinoma. Urol Oncol. 2015;33(9):388 e19–25. doi:10.1016/j.urolonc.2014.06.004.CrossRefGoogle Scholar
Gao Y, Zhou S, Jiang W, Huang M, Dai X. Effects of ganopoly (a Ganoderma lucidum polysaccharide extract) on the immune functions in advanced-stage cancer patients. Immunol Investig. 2003;32(3):201–15.CrossRefGoogle Scholar
Suzana S, Boon PC, Chan PP, Normah CD. Malnutrition risk and its association with appetite, functional and psychosocial status among elderly Malays in an agricultural settlement. Malays J Nutr. 2013;19(1):65–75.PubMedGoogle Scholar
Yamashita K, Ushiku H, Katada N, Hosoda K, Moriya H, Mieno H, et al. Reduced preoperative serum albumin and absence of peritoneal dissemination may be predictive factors for long-term survival with advanced gastric cancer with positive cytology test. Eur J Surg Oncol. 2015;41(10):1324–32. doi:10.1016/j.ejso.2015.05.021.CrossRefPubMedGoogle Scholar
Laursen I, Briand P, Lykkesfeldt AE. Serum albumin as a modulator on growth of the human breast cancer cell line, MCF-7. Anticancer Res. 1990;10(2 A):343–51.PubMedGoogle Scholar
Sonnenschein C, Soto AM, Michaelson CL. Human serum albumin shares the properties of estrocolyone-I, the inhibitor of the proliferation of estrogen-target cells. J Steroid Biochem Mol Biol. 1996;59(2):147–54.CrossRefPubMedGoogle Scholar