Impact of preoperative nutritional status on long-term survival in patients with locally advanced oral squamous cell carcinoma

Recently, nutritional status has been reported to be associated with the prognosis of various diseases. Methods to assess nutritional status using common blood-testing parameters include the prognostic nutritional index (PNI), hemoglobin-albumin-lymphocyte-platelet (HALP) score, and controlling nutritional status (CONUT) score. This study aimed to clarify the utility of these scores in patients with locally advanced oral cancer. A total of 106 patients with stage 3 or 4 oral squamous cell carcinoma, who underwent surgery between June 2007 and January 2020, were included. Preoperative PNI, HALP, and CONUT scores were calculated, and cut-off values were set using time-dependent receiver operating characteristic curves. The patients were divided into two arms. Cox proportional hazards analysis was used to identify the factors associated with disease-specific 5-year survival rates. Among the three preoperative scores (PNI, HALP, and CONUT), only PNI showed a significant difference between the preoperative score and disease-specific 5-year survival. The PNI score of 46.5 was set as the cut-off value, and the disease-specific 5-year survival rate was 62.0% in the PNI-low group and 76.0% in the PNI-high group (P = 0.027). In the Cox proportional hazards analysis with PNI-high/low and cancer cell differentiation as variables, the hazard ratio for PNI-high/low was 0.41 (95% confidence interval: 0.19-0.94, P = 0.034). The preoperative PNI score was correlated with disease-specific survival rates and was considered a prognostic factor in patients with locally advanced oral cancer. This suggests the usefulness of nutritional assessment using the PNI in patients with oral cancer.