Impact of Postoperative Prognostic Nutritional Index on Post-gastrectomy Outcomes in Older Adults With Gastric Cancer

BACKGROUND/AIM: This study aimed to clarify the impact of preoperative and postoperative inflammation and nutritional markers on post-gastrectomy outcomes in older adult patients with gastric cancer (GC) using data from multiple institutions. PATIENTS AND METHODS: We enrolled 273 patients aged ≥75 years who were diagnosed with GC and underwent gastrectomy. The prognostic impact of six preoperative and postoperative inflammation and nutritional markers was compared. RESULTS: Comparison of the area under the receiver operating characteristic curve (AUC) among the six markers revealed that the prognostic nutritional index (PNI) demonstrated the highest AUC in both preoperative and postoperative values, indicating that preoperative and postoperative PNIs had the highest predictive value. Considering the utility of preoperative and postoperative PNIs and their combined value as overall survival (OS) predictors in older adult patients with GC, preoperative PNI and the combined value were identified as valuable OS predictors across all patients and in those with early GC but not in those with advanced GC. Conversely, postoperative PNI alone accurately predicted the prognosis in the overall analysis and stage-specific analyses. Further analysis revealed that higher postoperative PNI was associated with a higher laparoscopic surgery proportion and a lower postoperative complication incidence. Multivariate analysis indicated that a postoperative PNI of