Preoperative prognostic nutritional index predicts overall survival in surgically resected small cell lung cancer: A...

Surgical lung resection, followed by chemotherapy and radiation therapy, is recommended for patients with early stage small cell lung cancer (SCLC). Combined SCLC, defined by the presence of non-SCLC, is associated with poorer survival than pure SCLC; however, reliable prognostic markers in surgically treated SCLC remain unclear. We aimed to investigate the prognostic factors for all SCLC subtypes undergoing surgery.

We retrospectively evaluated patients with SCLC who underwent lung resection at our institute between 2000 and 2022. The clinical characteristics and surgical outcomes were analyzed.

Among the 2,309 cases, 23 pure SCLC (1.00%) and 26 combined SCLC (1.12%) were identified. The patient characteristics were comparable between the groups. The 5-year overall survival rates were 46.0% for pure SCLC and 36.5% for combined SCLC, respectively (P = 0.89), while the recurrence-free survival rates were 27.7% and 30.0%, respectively (P = 0.76). A Multivariate Cox regression analysis revealed that the prognostic nutritional index (PNI) was an independent prognostic factor. Although a literature-based PNI cutoff of 45.0 was not significantly associated with survival differences (P = 0.162), our exploratory cohort-specific cutoff of 47.0 demonstrated a significant survival difference (P = 0.008), with a higher PNI associated with a better survival.

The preoperative nutritional status may be a useful predictive marker of postoperative survival in patients with SCLC undergoing curative surgery.