Dynamics of prognostic nutritional index before and after surgery in head and neck cancer

To evaluate the relationship between changes in the prognostic nutritional index (PNI), which is an indicator of nutritional status, and outcomes in patients with head and neck cancer who underwent surgery at our hospital.

We retrospectively reviewed the medical records of 148 patients (128 men and 20 women) who underwent surgery from 2015 to 2022. The median age was 68.5 (range: 40-88) years. Overall survival (OS) was calculated using the Kaplan-Meier method. The PNI was calculated preoperatively and postoperatively. Based on changes in pre- and post-treatment, patients were categorized as having high PNI both before and after surgery (high-to-high [HTH]), low PNI before and high PNI after surgery (low-to-high [LTH]), high PNI before and low PNI after surgery (high-to-low [HTL]), and low PNI both preoperatively and postoperatively (low-to-low [LTL]).

The effects of pre- and post-treatment changes in the PNI on patient outcomes were determined using the Cox proportional hazards model.

The median PNI was 49 and 48 before and after surgery, respectively. In the multivariate analysis, preoperative PNI was an independent poor prognostic factor for disease-free survival (DFS) and OS (P=0.037 and P=0.039). The postoperative PNI was an independent poor prognostic factor for DFS and OS (P<0.01). In the univariate analysis, the HTL and LTL groups showed poorer patient outcomes when the HTH group was used as a reference.

Changes in PNI could be a useful indicator of postoperative outcomes in patients with head and neck cancer.