Introduction The prognostic nutritional index (PNI) is a biomarker of nutritional and immunological status that has been validated as a prognostic factor in cancer. In ovarian cancer (OC) it has been studied in the Asian population. The aim of our study was to evaluate the association of PNI in Mexican patients with advanced ovarian cancer treated with neoadjuvant chemotherapy followed by debulking surgery.

Methods Retrospective cohort study of 220 patients with OC. PNI was calculated with de formula: albumin (g/L) + 0.005 X lymphocyte count (mm3). The cut-off point was obtained using ROC curves. Categorical variables were analyzed with Chi square and multivariate analysis with logistic regression. DFS was obtained with Kaplan Meier. P value 0.05 was considered significant.

Results The PNI cut-off values at diagnosis and post chemotherapy to predict complete and optimal surgery were 40.5 (AUC 0.62, OR: 1.07; p = 0.0023) and 44.5 (AUC 0.67, OR: 1.16; p = 0.00014), with significant association with high levels of PNI (p = 0.003 and p = 0.000), respectively. In logistic regression high levels of PNI were protective for residual disease (OR: 0.349, p = 0.005) and (OR: 0.168, p = 0.001). Median DFS was 15 (p = 0.054) and 13 (p = 0.640) months, respectively for cut-off points.

Conclusion/Implications In our study PNI behaves as an independent prognostic factor in advanced OC. High levels are associated with complete and optimal surgery and may be a predictor of DFS.