Low PNI Tied to Higher Mortality Risk in Gastric Cancer

TOPLINE:

Prognostic nutritional index (PNI) was a valuable predictor for oncological outcomes and morbidity among European patients with gastric cancer undergoing multimodal curative-intent treatment. A low PNI was associated with decreased odds of achieving Textbook Outcome (TO) and an increased risk for 90-day mortality.

METHODOLOGY:

• Researchers used data from the European Gastric Cancer Association GASTRODATA registry between 2017 and 2022 to analyse 721 patients with gastric cancer who underwent multimodal treatment.
• The primary outcome was TO achievement; the secondary outcome was 90-day mortality, defined as death within 90 days after surgery.
• The PNI was calculated using a cutoff value of 45.5 on the basis of the receiver operating characteristic curve analysis.
• The majority of patients had advanced tumours (cT3-4, 75.2%) and metastatic lymph nodes (57.7%). Overall, 70% of patients had a high PNI, with a median of 49.5.

TAKEAWAY:

• The PNI demonstrated a sensitivity of 76% and a specificity of 39.9% to predict TO and a sensitivity of 72% and a specificity of 74% to predict 90-day mortality.
• A low PNI was significantly associated with decreased odds of achieving TO (odds ratio [OR], 0.57; 95% CI, 0.37-0.89) and an increased risk for 90-day mortality (OR, 4.99; 95% CI, 2.32-10.73).
• Moreover, a low PNI was associated with increased risks for postoperative complications (OR, 1.79), unplanned intensive care unit admissions (OR, 3.44), and longer hospital stays (OR, 1.91).
• The PNI was strongly correlated with both pathological nodal and tumour stages (correlation coefficient [rho], −0.189; P < .0001 and rho, −0.163; P < .0001, respectively).

IN PRACTICE:

“PNI was a valuable predictor for oncological outcomes and morbidity among European GC [gastric cancer] patients undergoing multimodal curative-intent treatment,” the authors wrote. “While low PNI was associated with decreased odds of TO achievement and increased risk of 90-day mortality, further prospective large-scale and nutritional intervention studies are warranted to standardize the PNI threshold and improve its clinical applicability as well as surgical outcomes following oncologic surgery,” they concluded.

SOURCE:

This study was led by Zuzanna Pelc, Department of Surgical Oncology, Medical University of Lublin, Lublin, Poland. It was published online on May 28, 2025, in the International Journal of Cancer.

LIMITATIONS:

The retrospective design limited the ability to reassess the PNI after surgery to evaluate trends during multimodal treatment. The studied cohort’s heterogeneity, with half of the patients omitting neoadjuvant chemotherapy, may have affected result interpretation. The PNI cutoff of 45.5 showed moderate discriminative ability for predicting TO, suggesting that it should be interpreted within a broader clinical context rather than as a standalone predictor.

DISCLOSURES:

No funding information was provided for this study. One author reported being a consultant for J&J, Medicaroid, and Olympus, outside of this study. The other authors reported having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.