Preoperative prognostic nutritional index predicts overall survival in surgically resected small cell lung cancer: A single-institution experience.

PURPOSE: Surgical lung resection, followed by chemotherapy and radiation therapy, is recommended for patients with early stage small cell lung cancer (SCLC). Combined SCLC, defined by the presence of non-SCLC, is associated with poorer survival than pure SCLC; however, reliable prognostic markers in surgically treated SCLC remain unclear. We aimed to investigate the prognostic factors for all SCLC subtypes undergoing surgery. METHODS: We retrospectively evaluated patients with SCLC who underwent lung resection at our institute between 2000 and 2022. The clinical characteristics and surgical outcomes were analyzed. RESULTS: Among the 2,309 cases, 23 pure SCLC (1.00%) and 26 combined SCLC (1.12%) were identified. The patient characteristics were comparable between the groups. The 5-year overall survival rates were 46.0% for pure SCLC and 36.5% for combined SCLC, respectively (P = 0.89), while the recurrence-free survival rates were 27.7% and 30.0%, respectively (P = 0.76). A Multivariate Cox regression analysis revealed that the prognostic nutritional index (PNI) was an independent prognostic factor. Although a literature-based PNI cutoff of 45.0 was not significantly associated with survival differences (P = 0.162), our exploratory cohort-specific cutoff of 47.0 demonstrated a significant survival difference (P = 0.008), with a higher PNI associated with a better survival. CONCLUSIONS: The preoperative nutritional status may be a useful predictive marker of postoperative survival in patients with SCLC undergoing curative surgery.