Nutritional and Immune State of Gastric Cancer Patients Deteriorate During the Preoperative Period

Gastric cancer (GC) patients are vulnerable to malnutrition due to abdominal discomfort, nausea, vomiting, and anorexia. The Prognostic Nutritional Index (PNI), which combines serum albumin and total lymphocyte count (TLC), has prognostic value for numerous malignancies including GC. GC patients who are malnourished have a higher incidence of surgical complications and worse long-term prognosis. Although the link between PNI and prognosis is well established, whether the PNI decreases while GC patients await surgery is unknown. The primary objective of this study of 124 GC patients was to determine whether the nutritional and immune status decreased during the preoperative period. Here we demonstrate that the PNI decreased due to reductions in both serum albumin and TLC (P < 0.001); the effects were greater in advanced vs. early-stage GC. Corresponding decreases in BMI were found (P < 0.001). Significant reductions in PNI occurred over time regardless of tumor location. Tumor diameter was positively associated with the magnitude of PNI decline (P < 0.01). Reductions in preoperative PNI/day were associated with worsening of progression-free survival (PFS) and overall survival (OS). Collectively, these results provide a strong rationale for future nutritional support studies that aim to attenuate the preoperative decline in PNI and improve outcomes of GC patients.