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Prognostic Nutritional Index Predicts Life Expectancy of Patients with End-Stage Oral Cancer

Accurate estimation of life expectancy in terminally ill patients with cancer is important from both the clinician’s and the patient’s perspectives. However, studies have revealed that clinicians do not accurately estimate the time to death, making it difficult for the patients and their families to prepare themselves. Although several indices and scores exist for evaluating the life expectancy, most of these include subjective components in the calculation, such as the presence of edema, anorexia, or delirium, which makes the objective assessment prone to inaccuracy.

In this paper, the authors aimed to evaluate the value of the Prognostic Nutritional Index (PNI) for accurately estimating the life expectancy of patients with end-stage oral cancer. A longitudinal section study was performed after obtaining ethical approval and in-formed consent. Fifteen patients (12 men; mean age: 71.7 years old) who died of oral cancer between 2005 and 2014 (the terminal group) were included. The mean PNI values at the initial visit and at 3, 2, and 1 months before the deaths were comparatively analyzed. The following data were collected from the patient medical records: sex, age, site of primary tumor, C-reactive protein (CRP) levels, serum albumin levels, and peripheral lymphocyte count measured at the initial visit and at various time points during the follow-up period.

The results indicated that the mean follow-up period was 133 days. At the initial examination, the PNI values were 49.1 ± 4.5 (p = 0.6723). The PNI value of the terminal group was 35.6 ± 5.1 at 2 months before death and 28.6 ± 3.0 at 1 month before death. The PNI values at 3, 2, and 1 months before death in the terminal group significantly differed from each other and from that at the initial visit and steadily decreased until death.

In conclusion, the findings suggest the utility of PNI as a prognostic index in patients with end-stage oral cancer patients. Considering the particular importance of appropriate nutritional management in these patients at the end stage of the disease, more research is necessary to investigate how the PNI value can be used in these patients to improve the quality of life near death.

Article by Atsushi Abe, et al, from Japan.

Full access: http://t.cn/E4x2GUV
Image by Ka-Ron Wade, from Flickr-cc. 

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