Prognostic importance of prognostic nutritional index in high grade serous ovarian cancer and comparison with other prognostic factors

Aim: The aim of this study is to investigate the contribution of the prognostic nutritional index (PNI) to the prognosis in order to predict the prognosis of patients diagnosed with high-grade serous ovarian cancer in our clinic and to reveal its relationship with other prognostic factors. Materials and Methods: This retrospective study was conducted on 332 patients who were diagnosed with high grade serous ovarian cancer, treated and followed-up at Çukurova University Balcalı Hospital Gynecology and Obstetrics Clinic between 2010-2020. Age range, body mass index (BMI), menopausal status, parity status, presenting symptoms, presence of comorbidity, American Society of Anesthesiology (ASA) scores, laboratory findings and presence of preoperative acid which is thought to be effective in prognosis, Ca-125 (Cancer antigen-125), neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, Fagotti Score, disease stage, presence of recurrence, platin resistance status, whether optimal cytoreduction was achieved, and PNI values were recorded. The PNI value was calculated by using the patients' albumin and lymphocyte values. The relationship with other factors affecting the prognosis was analyzed by statistical methods. Results: The mean age of the patients was 54.6±12.1 years, and 65,4% of cases were in the postmenopausal period. 13.9% of the patients were nulliparous. The mean BMI was 29.9±6.1, and 38.9% had concomitant comorbid disease. The mean preoperative Ca-125 value was 764.7±1162.2. The mean follow-up period was 61.3±38.8 months. There was a 3-year survival of 68.1% and a 5-year survival of 48.5% of the patients. The mean PNI value was found to be 41.8±8.7. As a result of the analysis performed according to the mortality findings of the patients, it was determined that the cut-off value of the PNI value of 44.6 and below predicted mortality with a sensitivity of 96.84% and a specificity of 81.69% (p<0.001). 5-year survival rate is low in patients with low PNI; mortality rate was higher (p<0.001). PNI in postmenopausal patients, patients with tumor burden ≥ 1 cm after cytoreduction, advanced stage patients, positive cytology results, platin resistant patients, patients with acidity > 1 liter, patients with high Fagotti Score, recurrence, and low 5-year survival value was found to be significantly lower (respectively p=0.037, p<0.001, p<0.001, p=0.004, p<0.001, p=0.002, p=0.041, p<0.001, p<0.001). A weak inverse relationship was found between the PNI values of the patients and their Ca-125 values (p=0.026). The factors affecting the mean survival were advanced age, menopause, low PNI value, presence of ascites, presence of recurrence, and advanced stage of the patients (p=0013, p=002, p<0.001, p<0.001, p<0.001, p<0.001, respectively). It was determined that the PNI value of the patients being 44.46 and below had an effect on mortality 136.82 times (OR=136.821, 95% CI 54.6-342.4) (p<0.001). Conclusion: We revealed that PNI can be a potential marker in terms of mortality and prognosis in patients with high grade serous ovarian cancer. The prognostic potential of PNI should be supported by high evidence studies. Keywords: Ovarian Cancer, High Grade Serous Ovarian Cancer, Prognostic Nutritional Index