Predictive value of preoperative prognostic nutritional index in patients with distal cholangiocarci-noma after radical resection / 中华肝胆外科杂志

ABSTRACT

Objective:To evaluate the predictive value of prognostic nutritional index (PNI) for survival after radical resection in patients with distal cholangiocarcinoma.Methods:The clinical data of 160 patients with distal cholangiocarcinoma undergoing radical pancreatoduodenectomy in Beijing Chaoyang Hospital Affiliated to Capital Medical University from September 2011 to March 2022 were retrospectively analyzed, including 97 males and 63 females, aged (65.58±9.22) years old. The optimal cut-off value of PNI for predicting postoperative survival was 42.275 determined by the receiver operating characteristic curve. Patients were divided into the low PNI group ( n=79, PNI<42.275) and high PNI group ( n=81, PNI≥42.275). The survival status of patients were followed up by outpatient clinic or telephone review. Survival analysis was performed using the Kaplan-Meier method and the log-rank test. Factors with P<0.1 in the univariate analysis were included in the Cox proportional hazards model for multivariate analysis to screen the prognostic factors. Results:There were statistically significant differences in the preoperative albumin, total bilirubin, lymphocytes counts between the two group (all P<0.05). The postoperative median survival time of the low PNI group was 17 months, with cumulative 1, 3 and 5-year survival rates of 62.0%, 25.0% and 16.2%, respectively. The postoperative median survival time of the high PNI group was 23 months, with cumulative 1, 3 and 5-year survival rates of 84.0%, 46.4% and 40.4%, respectively. There was a significant difference between the two groups ( P<0.001). PNI score<42.275 ( HR=1.040, 95% CI 1.011-1.071, P=0.008), CA19-9>37 U/ml ( HR=1.620, 95% CI 1.046-2.509, P=0.031), venous invasion ( HR=1.809, 95% CI 1.013-3.230, P=0.045), lymph node metastasis ( HR=1.956, 95% CI 1.300-2.969, P=0.001), tumor diameter >2 cm ( HR=1.534, 95% CI 1.011-2.328, P=0.044), without postoperative adjuvant chemotherapy ( HR=2.828, 95% CI 1.291-6.195, P=0.009) had a greater risk of poor survival after radical resection. Conclusion:PNI score could be an influencing factor and serve as a predicting tool for the survival after radical resection in patients with distal cholangiocarci-noma.