Prognostic Nutrition Index and Its Significance in Advanced Ovarian Cancer

Objective The prognostic nutrition index (PNI) had been shown to be prognostic in various gastrointestinal and head neck malignancies. The aim of this study was to investigate the significance of PNI in advanced ovarian cancer with respect to clinical characteristics, treatment-related morbidity and response to platin-based chemotherapy. Methods We prospectively investigated 286 patients who underwent primary or interval debulking surgery for advanced epithelial ovarian cancer between August 2017 and September 2019. All patients received 6 cycles adjuvant or neoadjuvant chemotherapy with carboplatin and paclitaxel. Pretreatment PNI was calculated as serum albumin (g/L) + 0.005 x lymphocyte count (per mm(3)). Optimal PNI cutoff value for disease-free survival (DFS) was identified using ROC curves. Comparisons between categorical variables were performed using Chi-square or Fisher's exact tests, Cox regression analysis used for multivariate analyses and impact of PNI on DFS analyzed by Kaplan-Meier method and Cox proportional hazards model. Results The 47.85 cutoff value divided patients into high PNI and low PNI groups. No significant correlation was found between pretreatment PNI and age of patient, FIGO stage, residual disease after surgery, chemotoxicity or platinum resistance. However, low PNI was associated with high CA-125 levels (p < 0.001) and increased rate of postoperative complications (p = 0.036). In univariate analysis, PNI was not found to be associated with DFS (p = 0.103) but in multivariate analysis, PNI was independently associated with DFS (HR = 0.960,p = 0.013). Conclusion Low PNI was significantly associated with increased CA-125 levels, increased rate of postoperative complications and low DFS.