The Clinical Impact of Prognostic Nutritional Index at Recurrence of Pancreatic Cancer

Most patients with pancreatic cancer experience recurrence after curative surgical resection. Nutritional-related indicators have been evaluated to analyze prognosis in pancreatic cancer. However, it is unknown whether the cachexia index (CXI) or the prognostic nutritional index (PNI) is better for prediction of survival in patients with recurrence of pancreatic cancer. In this study, we compared the ability of the PNI to predict survival at 1 year after recurrence of pancreatic cancer with that of the CXI.

The study included 113 patients whom we retrospectively identified to have developed recurrence of pancreatic cancer as of September 2025 following pancreatectomy at our Institution between July 2005 and December 2022.

The 5-year post-recurrence overall survival rate was 5.8% and the median survival time was 378 days. The 1-year survival curve was significantly better for the high PNI group than the low PNI group and for the high CXI group than the low CXI group (p<0.001 for both comparisons). Analysis of receiver-operating characteristic curves showed that the discriminatory ability of the PNI was higher than that of the CXI for prediction of 1-year post-recurrence survival [area under the curve: 0.711 for PNI (p<0.001) vs. 0.670 for CXI (p=0.002)]. Multivariate analysis identified the PNI as an independent prognostic factor for 1-year survival in patients with recurrence of pancreatic cancer (p=0.006).

Patients with a low PNI at the time of recurrence of pancreatic cancer have poorer prognostic outcomes than those with a high PNI. Improvement of nutritional status after curative surgery might improve prognosis after recurrence of pancreatic cancer.