Low PNI, incomplete adjuvant chemotherapy worsens survival after gastric cancer resection

Low preoperative prognostic nutritional index (PNI) has a significant impact on the completion of planned adjuvant chemotherapy (AC) following curative resection of stage II/III gastric cancer, a study has shown. Low PNI and incomplete AC confer an additive effect and lead to worse outcomes.

The investigators retrospectively reviewed medical records of 1,288 consecutive patients with stage II/III gastric cancer who underwent curative resection and planned to receive AC between November 2010 and December 2017.

X-tile was used to determine the optimal cutoff value of PNI for cancer-specific survival. Univariate and multivariate analyses were performed to identify the independent predictive factors for incomplete AC. Finally, the investigators conducted Cox regression analyses to examine the relationship of low PNI, incomplete AC and cancer-specific survival.

Four hundred six (31.5 percent) of the 1,288 patients completed at least six cycles of AC within 6 months after initial AC (complete AC). Low PNI (<43.9; n=386) was independently associated with incomplete AC (less than six cycles). Moreover, poor cancer-specific survival was independently predicted by low PNI (hazard ratio [HR], 1.287, 95 percent confidence interval [CI], 1.058–1.565) and incomplete AC (HR, 1.667, 95 percent CI, 1.342–2.071).

On further analysis, both low PNI and incomplete AC had an additive effect, resulting in an even worse cancer-specific survival.

“Further prospective studies are needed to clarify whether perioperative nutrition intervention could improve completion of AC and improve prognosis of gastric cancer patients,” the investigators said.