Impact of the Prognostic Nutritional Index on Outcomes in Resectable Gallbladder Cancer

Gallbladder cancer (GBC) is the most common malignancy of the biliary tract, with poor survival outcomes. This study was undertaken to assess whether the prognostic nutritional index (PNI) has any impact on survival outcomes for patients with resectable GBC.

A retrospective study analyzed patients who underwent radical resection for GBC at a tertiary care cancer center from 1 January 2010 to 31 December 2024. The PNI was calculated with serum albumin and absolute lymphocyte count at the time of diagnosis (before neoadjuvant or operative treatment) and was correlated with survival.

The study enrolled 1312 patients, with a median follow-up period of 39.9 months. The median overall survival (OS) for the entire cohort was 28.6 months. The mean PNI for the entire cohort was 51.84. The PNI was an independent predictor of OS in both the uni- and multivariate analyses. The PNI cutoff estimated with maximally distributed rank statistics for OS was 48. The log-rank test showed that patients with PNI of 48 or higher had significantly better survival, with a differential OS in the two PNI cutoff groups of 10% at 3 years and 13.2% at 5 years.

In resectable GBC, PNI correlates with OS. This highlights systemic effects of cancer-host interaction on the inflammatory and nutritional status of patients, with an impact on long-term outcomes. Strategies aimed at improving nutritional and immunologic status in tandem with the standard-of-care cancer treatment may have an impact on survival.