Prediction Efficacy for Clinical Outcome of Prognostic Nutritional Index in Patients with Resectable Biliary Tract Cancer Depends on Sex and Obstructive Jaundice Status

Abstract

Background

The Prognostic Nutritional Index (PNI), a marker of nutritional status and systemic inflammation, is a proven prognostic biomarker in some cancers. The predictive value of PNI in biliary tract cancer (BTC) has not been established.

Objective

The aim of this study was to determine the relationship between the PNI and outcomes of resectable BTC.

Methods

In total, 430 patients with stage I–III resectable BTC [gallbladder cancer (GBC), n = 212; cholangiocarcinoma (CHO), n = 218] who had attended Fudan University Zhongshan Hospital were enrolled. The relationship between the PNI and clinical outcomes was evaluated both in the whole cohort and in selected subgroups.

Results

Eligible patients were classified into PNI-low (PNI < 45) and PNI-high (PNI ≥ 45) groups. The PNI-low group had significantly worse overall survival (OS) in both the whole cohort (p = 0.002) and in the GBC subgroup (p = 0.001), but had similar OS as the PNI-high group in the CHO subgroup (p = 0.328). Multivariate analysis revealed that low PNI is an independent risk factor for worse survival in GBC (hazard ratio 1.623, 95% confidence interval 1.063–2.480, p = 0.026). PNI was found to predict clinical outcome in women (p < 0.001) and patients without obstructive jaundice (p = 0.017) with GBC, but was not a prognostic factor in any subgroup with CHO. The estimated area under the time-dependent receiver operating characteristic curve was significantly greater when TNM stage was combined with PNI in women with GBC.

Conclusions

PNI is an independent predictor of OS in GBC, but not in CHO. It has no prognostic value in men with GBC or patients with obstructive jaundice.

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Acknowledgment

This study was funded by Grants from the National Natural Science Foundation of China (81872352, 81803091), JianFeng Project of XuHui Provincial Commission of Health and Family Planning (SHXH201703) and the Shanghai Medical Discipline of Key Programs for General Surgery (2017ZZ02007) and Clinical Study of Zhongshan Hospital (2018ZSLC24). All study sponsors had no roles in the study design, and in the collection, analysis, and interpretation of data. All authors have contributed significantly to the content of this article.

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Correspondence to Houbao Liu PhD, MD or Yueqi Wang MD.

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Jie Wang, Xiaobo Bo, Min Li, Lingxi Nan, Changcheng Wang, Zhihui Gao, Tao Suo, Xiaoling Ni, Han Liu, Jun Han, Pinxiang Lu, Houbao Liu, and Yueqi Wang declare no potential conflicts of interest.

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Wang, J., Bo, X., Li, M. et al. Prediction Efficacy for Clinical Outcome of Prognostic Nutritional Index in Patients with Resectable Biliary Tract Cancer Depends on Sex and Obstructive Jaundice Status. Ann Surg Oncol (2020). https://doi.org/10.1245/s10434-020-08728-8

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