Value of postoperative prognostic nutritional index in prognosis of patients with hepatocellular carcinoma

Objective To explore the value of postoperative prognostic nutritional index (post-PNI) in the prognosis of patients with hepatocellular carcinoma (HCC) after hepatectomy. Methods Clinical data of 316 patients receiving HCC hepatectomy in the Third Affiliated Hospital of Sun Yat-sen University between January 2009 and December 2014 was analyzed retrospectively. There were 289 males and 27 females, with a mean age of (50±12) years. The informed consents of all patients were obtained and the local ethical committee approval was received. Post-PNI was calculated using value of ALB and lymphocyte count of the first examination after operation. The optimum cut-off value of post-PNI was defined according to receivers' operating characteristic (ROC) curve, and the patients were divided into high post-PNI group and low post-PNI group. Survival analysis of two groups was conducted using Kaplan-Meier method and Log-rank test, and the influencing factors for survival and prognosis were analyzed by Cox proportional hazard model. Results The optimum cut-off value of post-PNI was 36.4 by ROC curve. There were 165 cases in high post-PNI group, and 151 cases in low post-PNI group. The 1-, 3- and 5-year recurrence-free survival rate and overall survival rate of the high post-PNI group were respectively 74.4%, 55.5%, 50.3% and 93.8%, 85.9%, 78.7%, and were respectively 60.9%, 32.5%, 27.1% and 91.3%, 72.0% and 62.9% in low post-PNI group were, where significant differences were observed (χ2=16.939, 8.428; P<0.05). Multiple-factor analysis showed that post-PNI≤36.4 was the independent risk factor for the recurrence-free survival and overall survival of HCC hepatectomy patients (HR=1.705, 1.771; P<0.05). Conclusions Post-PNI is an influencing factor for the recurrence-free survival and overall survival of HCC hepatectomy patients. Low post-PNI patients have worse prognosis. Key words: Carcinoma, hepatocellular; Hepatectomy; Prognostic nutritional index; Prognosis