Preoperative prognostic nutritional index predicts long-term outcomes of patients with ampullary adenocarcinoma after curative pancreatoduodenectomy

Table 1 Comparison of the baseline characteristics of different groups of patients with ampullary adenocarcinoma, n (%)

Characteristic		Total (n = 233)	PNI-low (n = 100)	PNI-high (n = 133)	P value
Gender	Male	133 (57.1)	56 (56.0)	77 (57.9)	0.772
	Female	100 (42.9)	44 (44.0)	56 (41.1)
Age, yr	≤ 60	141 (60.5)	52 (52.0)	89 (66.9)	0.021
	> 60	92 (39.5)	48 (48.0)	44 (33.1)
Tumor size, cm	≤ 2	112 (48.1)	42 (42.0)	70 (52.6)	0.108
	> 2	121 (51.0)	58 (58.0)	63 (47.4)
Tumor differentiation	Poor differentiation	88 (37.8)	43 (43.0)	45 (33.8)	0.063
	Moderate differentiation	96 (41.2)	43 (43.0)	53 (39.8)
	Well differentiation	49 (21.0)	14 (14.0)	35 (26.4)
Lymph nodes resection	< 17	156 (67.0)	64 (41.0)	92 (59.0)	0.406
	≥ 17	77 (33.0)	36 (46.8)	41 (53.2)
Vascular invasion	No	182 (78.1)	74 (74.0)	108 (81.2)	0.188
	Yes	51 (21.9)	26 (26.0)	25 (18.8)
pT	T1	31 (13.3)	13 (13.0)	18 (13.5)	0.8291
	T2	86 (36.9)	34 (34.0)	52 (39.1)
	T3	110 (47.2)	50 (50.0)	60 (45.1)
	T4	6 (2.6)	3 (3.0)	3 (2.3)
pN	N0	162 (69.5)	64 (64.0)	98 (73.7)	0.193
	N1	58 (24.9)	28 (28.0)	30 (22.6)
	N2	13 (5.6)	8 (8.0)	5 (3.7)
TNM stage	I	97 (41.6)	36 (36.0)	61 (45.9)	0.213
	II	65 (27.9)	28 (28.0)	37 (27.8)
	III	71 (30.5)	36 (36.0)	35 (26.3)
Postoperative complication	No	142 (60.9)	40 (40.0)	51 (38.3)	0.798
	Yes	91 (39.1)	60 (60.0)	82 (61.6)
Postoperative adjuvant therapy	No	152 (65.2)	29 (29.0)	34 (25.6)	0.597
	Yes	63 (27.0)	64 (64.0)	88 (74.4)
	Unknow	18 (7.8)
CA199, U/mL	≤ 59.67	107 (45.9)	38 (38.0)	69 (51.9)	0.053
	> 59.67	107 (45.9)	52 (52.0)	55 (48.1)
	Unknow	19 (8.2)
ALT, U/L	≤ 52.0	118 (50.6)	47 (47.0)	71 (53.4)	0.335
	> 52.0	115 (49.4)	53 (53.0)	62 (46.6)
AST, U/L	≤ 55.0	122 (52.4)	44 (44.0)	78 (58.6)	0.027
	> 55.0	111 (47.6)	56 (56.0)	55 (41.4)
TBIL, μmol/L	≤ 51.3	117 (50.2)	42 (42.0)	75 (56.4)	0.030
	> 51.3	116 (49.8)	58 (58.0)	58 (43.6)
Cr, μmol/L	≤ 62.0	115 (49.4)	61 (61.0)	54 (40.6)	0.002
	> 62.0	118 (50.6)	39 (39.0)	79 (59.4)

¹Fisher exact test.

PNI: Prognostic nutritional index; CA199: Carbohydrate antigen 199; ALT: Alanine transaminase; AST: Aspartate transaminase; TBIL: Total bilirubin; Cr: Creatinine.

Table 2 Univariate and multivariate analysis of overall survival in patients with ampullary adenocarcinoma

Variate	Univariate analysis			Multivariate analysis
	HR	95%CI	P value	HR	95%CI	P value
Gender (male vs female)	0.882	0.593-1.313	0.537
age (≤ 60 vs > 60)	1.147	0.769-1.713	0.501
Tumor size (≤ 2 vs > 2)	1.142	0.773-1.689	0.504
Tumor differentiation (non-well vs well)	0.667	0.407-1.094	0.109
Lymph nodes resection (< 17 vs ≥ 17)	1.161	0.761-1.771	0.488
Vascular invasion (No vs Yes)	1.318	0.846-2.053	0.222
pT (T1, T2 vs T3, T4)	2.114	1.417-3.153	< 0.001	1.901	1.257-2.876	0.002
pN (N0 vs N1, N2)	2.197	1.454-3.319	< 0.001	1.851	1.209-2.834	0.005
Postoperative complication (No vs Yes)	1.043	0.695-1.567	0.838
Postoperative adjuvant therapy (No vs Yes)	1.432	0.934-2.195	0.100
PNI (< 45.3 vs ≥ 45.3)	0.584	0.393-0.866	0.007	0.569	0.383-0.846	0.005

PNI: Prognostic nutritional index; 95%CI: 95% confidence interval; HR: Hazard ratio.

Table 3 Univariate and multivariate analysis of disease-free survival in patients with ampullary adenocarcinoma

Variate	Univariate analysis			Multivariate analysis
	HR	95%CI	P value	HR	95%CI	P value
Gender (male vs female)	0.945	0.653-1.367	0.764
Age (≤ 60 vs > 60)	1.048	0.723-1.518	0.806
Tumor size (≤ 2 vs > 2)	1.213	0.844-1.745	0.297
Tumor differentiation (non-well vs well)	0.666	0.420-1.056	0.084
Lymph nodes resection (< 17 vs ≥ 17)	1.061	0.711-1.583	0.771
Vascular invasion (No vs Yes)	1.523	1.012-2.291	0.044	1.063	0.677-1.668	0.792
pT (T1, T2 vs T3, T4)	1.975	1.363-2.861	< 0.001	1.819	1.215-2.723	0.004
pN (N0 vs N1, N2)	2.113	1.440-3.101	< 0.001	1.793	1.130-2.846	0.013
Postoperative complication (No vs Yes)	1.022	0.701-1.491	0.909
Postoperative adjuvant therapy (No vs Yes)	1.591	1.072-2.360	0.021	0.958	0.590-1.557	0.863
PNI (< 45.3 vs ≥ 45.3)	0.631	0.438-0.909	0.013	0.674	0.464-0.980	0.039

PNI: Prognostic nutritional index; 95%CI: 95% confidence interval; HR: Hazard ratio.