Predictive significance of preoperative prognostic nutritional index after surgery for clinical T4 lung cancer.

PURPOSE: This study explored the clinical and prognostic value of the preoperative prognostic nutritional index (PNI) in patients undergoing surgery for clinical (c)T4 lung cancer, focusing on postoperative morbidity, recurrence, and the survival. METHODS: Data from 120 patients who underwent resection for cT4 lung cancer (July 2008 and December 2015) were retrospectively reviewed. The patients were divided into low- (≤ 45, n = 63) and high- (> 45, n = 57) PNI groups. The primary outcomes included complication rate, recurrence-free survival (RFS), and overall survival (OS). RESULTS: The median age of the patients was 68 years (82% male). Pneumonectomy was performed in 30% of patients, and R0 resection was achieved in 88%. Thirty-day mortality was 3.3%. A low PNI was associated with more severe complications (P = 0.024), reoperation (P = 0.032), non-infectious complications (P = 0.041), and longer hospital stay (P = 0.009). The 5-year RFS and OS rates were lower in the low-PNI group (RFS: 29.2% vs. 48.1%, P = 0.033; OS: 38.5% vs. 55.4%, P = 0.012). A low PNI independently predicted poorer OS (hazard ratio [HR], 1.69; 95% confidence interval [CI], 1.02-2.79; P = 0.040). Non-lung cancer-related mortality was higher in the low-PNI group than in the high-PNI group (27.5% vs. 11.5%, P = 0.041), mainly due to respiratory complications. CONCLUSIONS: The preoperative PNI predicts postoperative morbidity and long-term outcomes in patients with cT4 lung cancer, aiding risk stratification and management.