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Vaz J, Piver R, Brzezinska B, Suhner J, Sareddy S, Vuppala P, Vernon M, Xu H, Rungruang B, Johnson M, Higgins RV, Ghamande S, Richardson KP, McIndoe R, Purohit S, Mysona D. Nutrition's checkpoint inhibition: The impact of nutrition on immunotherapy outcomes. Gynecol Oncol 2024; 189:129-136. [PMID: 39116830 DOI: 10.1016/j.ygyno.2024.07.685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Accepted: 07/31/2024] [Indexed: 08/10/2024]
Abstract
OBJECTIVES To determine if nutritional status effects response to immunotherapy in women with gynecologic malignancies. METHODS A retrospective chart review was conducted on gynecologic cancer patients who received immunotherapy at a single institution between 2015 and 2022. Immunotherapy included checkpoint inhibitors and tumor vaccines. The prognostic nutritional index (PNI) was calculated from serum albumin levels and total lymphocyte count. PNI values were determined at the beginning of treatment for each patient and assessed for their association with immunotherapy response. Disease control response (DCR) as an outcome of immunotherapy was defined as complete response, partial response, or stable disease. RESULTS One hundred and ninety-eight patients received immunotherapy (IT) between 2015 and 2022. The gynecological cancers treated were uterine (38%), cervix (32%), ovarian (25%), and vulvar or vaginal (4%) cancers. The mean PNI for responders was higher than the non-responder group (p < 0.05). The AUC value for PNI as a predictor of response was 49. A PNI value of 49 was 43% sensitive and 85% specific for predicting a DCR. In Cox proportional hazards analysis, after adjusting for ECOG score and the number of prior chemotherapy lines, severe malnutrition was associated with progression-free survival (PFS) (HR = 1.85, p = 0.08) and overall survival (OS) (HR = 3.82, p < 0.001). Patients with PNI < 49 were at a higher risk of IT failure (HR = 2.24, p = 0.0001) and subsequent death (HR = 2.84, p = 9 × 10-5). CONCLUSIONS PNI can be a prognostic marker to predict response rates of patients with gynecologic cancers treated with immunotherapy. Additional studies needed to understand the mechanistic role of malnutrition in immunotherapy response.
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Affiliation(s)
- Jennifer Vaz
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Rachael Piver
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Bogna Brzezinska
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Jessa Suhner
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Sneha Sareddy
- Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Priyanka Vuppala
- Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Marlo Vernon
- Department of Biostatistics, Data Science and Epidemiology, School of Public Health, Augusta University, Augusta, GA, USA
| | - Hongyan Xu
- Department of Biostatistics, Data Science and Epidemiology, School of Public Health, Augusta University, Augusta, GA, USA
| | - Bunja Rungruang
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Marian Johnson
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Robert V Higgins
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Sharad Ghamande
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Katherine P Richardson
- Center for Biotechnology and Genomic Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Richard McIndoe
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Medical College of Georgia at Augusta University, Augusta, GA, USA; Center for Biotechnology and Genomic Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Sharad Purohit
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Medical College of Georgia at Augusta University, Augusta, GA, USA; Center for Biotechnology and Genomic Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA.
| | - David Mysona
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Medical College of Georgia at Augusta University, Augusta, GA, USA; Center for Biotechnology and Genomic Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA
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Fumagalli D, Sonik R, De Vitis LA, Rossi V, Bazzurini L, McGree ME, Fought AJ, Mariani A, Cliby WA, Kumar A. Evaluating nutrition in advanced ovarian cancer: which biomarker works best? Gynecol Oncol 2024; 188:97-102. [PMID: 38943693 DOI: 10.1016/j.ygyno.2024.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 06/12/2024] [Accepted: 06/24/2024] [Indexed: 07/01/2024]
Abstract
BACKGROUND Advanced epithelial ovarian cancer (OC) patients often present with malnutrition; however, the ideal nutritional evaluation tool is unclear. We aimed to evaluate the role of preoperative albumin, Prognostic Nutritional Index [PNI], neutrophil-to-lymphocyte ratio [NLR], and platelet-to-lymphocyte ratio [PLR] as independent predictors of severe postoperative complications and 90-day mortality in OC patients who underwent primary cytoreductive surgery to identify the ideal tool. METHODS OC patients who underwent surgery at Mayo Clinic (2003-2018) were included; biomarkers were retrospectively retrieved and established cut-offs were utilized. Outcomes included severe complications (Accordion grade ≥ 3) and 90-day mortality. Univariate and multivariable logistic regression models were performed. Biomarkers were evaluated in separate models adjusted for age and American Society of Anesthesiologists (ASA) score for 90-day mortality, and adjusted for age, ASA score, stage, and surgical complexity for severe complications. RESULTS Albumin <3.5 g/dL, PNI < 45, NLR > 6 and PLR ≥ 200 were univariately associated with 90-day mortality (all p < 0.05) in 627 patients that met inclusion criteria. Each marker remained significant in adjusted models with albumin having the highest OR: 6.04 [95% CI:2.80-13.03] and AUC (0.83). Univariately, PNI <45, NLR >6, and PLR ≥200 were significant predictors of severe complications(all p < 0.05), however failed to reach significance in adjusted models. Albumin was not associated with severe complications. CONCLUSION All biomarkers were associated with 90-day mortality in adjusted models, with albumin being the easiest predictor to attain clinically; none with severe complications. Future research should focus less on methods of nutritional assessment and more on strategies to improve nutrition during OC tumor-directed therapy.
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Affiliation(s)
- Diletta Fumagalli
- Division of Gynecologic Surgery, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA; Department of Medicine and Surgery, University of Milan-Bicocca, Milan, MI, Italy
| | - Roma Sonik
- Mayo Alix School of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Luigi A De Vitis
- Division of Gynecologic Surgery, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA; Department of Gynecology, European Institute of Oncology (IEO), Milan, MI, Italy
| | - Valentina Rossi
- Department of Medicine and Surgery, University of Milan-Bicocca, Milan, MI, Italy
| | - Luca Bazzurini
- Department of Obstetrics and Gynecology, Manerbio Hospital, ASST Garda, Brescia, BS, Italy
| | - Michaela E McGree
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Angela J Fought
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Andrea Mariani
- Division of Gynecologic Surgery, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA
| | - William A Cliby
- Division of Gynecologic Surgery, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA
| | - Amanika Kumar
- Division of Gynecologic Surgery, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA.
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Bacalbasa N, Petrea S, Gaspar B, Pop L, Varlas V, Hasegan A, Gorecki G, Martac C, Stoian M, Zgura A, Balescu I. The Influence of Inflammatory and Nutritional Status on the Long-Term Outcomes in Advanced Stage Ovarian Cancer. Cancers (Basel) 2024; 16:2504. [PMID: 39061143 PMCID: PMC11274520 DOI: 10.3390/cancers16142504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Revised: 06/23/2024] [Accepted: 07/06/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND Despite improving surgical techniques and achieving more often complete debulking procedures, certain patients with advanced-stage ovarian cancer still have a very poor prognosis. The aim of the current paper is to investigate whether inflammatory and nutritional status can predict the long-term outcomes of ovarian cancer patients. METHODS A retrospective analysis of 57 cases diagnosed with advanced-stage ovarian cancer submitted to surgery as first intent therapy was carried out. In all cases, the preoperative status was determined by calculating the CRP/albumin ratio, as well as the Glasgow score, the modified Glasgow score and the prognostic nutritional index. RESULTS Patients presenting higher values of the CRP/albumin ratio, with a higher Glasgow score, modified Glasgow score and prognostic nutritional index (PNI), were more frequently associated with incomplete debulking surgery, a higher peritoneal carcinomatosis index and poorer overall survival (20 months versus 9 months for the CRP/albumin ratio p = 0.011, 42 versus 27 versus 12 months for the Glasgow score p = 0.042, 50 versus 19 versus 12 months for the modified Glasgow score, p = 0.001, and 54 months versus 21 months, p = 0.011 for the prognostic nutritional index). CONCLUSIONS A strong relationship between the nutritional and inflammatory status in advanced-stage ovarian cancer seems to exist.
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Affiliation(s)
- Nicolae Bacalbasa
- Department of Visceral Surgery, Center of Excellence in Translational Medicine “Fundeni” Clinical Institute, 022328 Bucharest, Romania;
- Department of Surgery, “Carol Davila” University of Medicine and Pharmacy, 022328 Bucharest, Romania;
| | - Sorin Petrea
- Department of Surgery, “Carol Davila” University of Medicine and Pharmacy, 022328 Bucharest, Romania;
- Department of Surgery, “Ion Cantacuzino” Clinical Hospital, 022328 Bucharest, Romania
| | - Bogdan Gaspar
- Department of Surgery, “Carol Davila” University of Medicine and Pharmacy, 022328 Bucharest, Romania;
- Department of Visceral Surgery, “Floreasca” Clinical Emergency Hospital, 022328 Bucharest, Romania
| | - Lucian Pop
- Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, 022328 Bucharest, Romania; (L.P.); (V.V.)
- Department of Obstetrics and Gynecology, National Institute of Mother and Child Care Alessandrescu-Rusescu, 022328 Bucharest, Romania
| | - Valentin Varlas
- Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, 022328 Bucharest, Romania; (L.P.); (V.V.)
- Department of Obstetrics and Gynecology, “Filantropia” Clinical Hospital, 022328 Bucharest, Romania
| | - Adrian Hasegan
- Department of Urology, Sibiu Emergency Hospital, Faculty of Medicine, University of Sibiu, 550169 Sibiu, Romania;
| | - Gabriel Gorecki
- Department of Anesthesia and Intensive Care, CF 2 Clinical Hospital, 022328 Bucharest, Romania;
- Faculty of Medicine, Titu Maiorescu University, 022328 Bucharest, Romania
| | - Cristina Martac
- Department of Anesthesiology, Fundeni Clinical Hospital, 022328 Bucharest, Romania;
| | - Marilena Stoian
- Department of Internal Medicine, “Carol Davila” University of Medicine and Pharmacy, 022328 Bucharest, Romania;
- Department of Internal Medicine and Nephrology, Dr. Ion Cantacuzino Hospital, 022328 Bucharest, Romania
| | - Anca Zgura
- Department of Medical Oncology, Oncological Institute Prof. Dr. Al. Trestioreanu, 022328 Bucharest, Romania;
- Department of Medical Oncology, “Carol Davila” University of Medicine and Pharmacy, 022328 Bucharest, Romania
| | - Irina Balescu
- Department of Visceral Surgery, “Carol Davila” University of Medicine and Pharmacy, 022328 Bucharest, Romania;
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Pergialiotis V, Thomakos N, Papalios T, Lygizos V, Vlachos DE, Rodolakis A, Haidopoulos D. Prognostic Nutritional Index as a Predictive Biomarker of Post-Operative Infectious Morbidity in Gynecological Cancer Patients: A Prospective Cohort Study. Nutr Cancer 2024; 76:364-371. [PMID: 38369888 DOI: 10.1080/01635581.2024.2318827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 02/01/2024] [Accepted: 02/02/2024] [Indexed: 02/20/2024]
Abstract
Malnutrition significantly impacts the post-operative process of gynecological cancer patients. A prominent variable for determining perioperative morbidity is the Prognostic Nutritional Index (PNI). To investigate PNI's predictive value on the risk of post-operative infections, we conducted a prospective cohort study involving women who underwent surgery for gynecological malignancies. Out of the 208 patients enrolled, 28 (13.5%) were malnourished and post-operative infections occurred in 43 patients. Notably, there was a significant difference in PNI between patients who developed infections and those who did not (p = 0.027), as well as between malnourished patients and those with normal nutritional status (p = 0.043). Univariate analysis showed that preoperative PNI predicts the risk of post-operative infections better than post-operative white blood cell count (AUC of 0.562 vs 0.375). However, the most accurate diagnostic results in the multivariate analysis were obtained from random forest and classification tree models (AUC of 0.987 and 0.977, respectively). Essentially, PNI and post-operative white blood cell count provided the best information gain according to rank probabilities. In conclusion, PNI appears to be a critical parameter that merits further investigation during the preoperative evaluation of gynecological malignancies.
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Affiliation(s)
- Vasilios Pergialiotis
- First Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, "Alexandra" General Hospital, Athens, Greece
| | - Nikolaos Thomakos
- First Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, "Alexandra" General Hospital, Athens, Greece
| | - Theodoros Papalios
- First Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, "Alexandra" General Hospital, Athens, Greece
| | - Vasilios Lygizos
- First Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, "Alexandra" General Hospital, Athens, Greece
| | - Dimitrios Efthimios Vlachos
- First Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, "Alexandra" General Hospital, Athens, Greece
| | - Alexandros Rodolakis
- First Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, "Alexandra" General Hospital, Athens, Greece
| | - Dimitrios Haidopoulos
- First Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, "Alexandra" General Hospital, Athens, Greece
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Nasser S, Bilir E, Derin X, Richter R, Grabowski JP, Ali P, Kulbe H, Chekerov R, Braicu E, Sehouli J. Pre-Operative Malnutrition in Patients with Ovarian Cancer: What Are the Clinical Implications? Results of a Prospective Study. Cancers (Basel) 2024; 16:622. [PMID: 38339372 PMCID: PMC10854561 DOI: 10.3390/cancers16030622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 01/25/2024] [Accepted: 01/27/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Malnutrition was associated with worse survival outcomes, impaired quality of life, and deteriorated performance status across various cancer types. We aimed to identify risk factors for malnutrition in patients with epithelial ovarian cancer (EOC) and impact on survival. METHODS In our prospective observational monocentric study, we included the patients with primary and recurrent EOC, tubal or peritoneal cancer conducted. We assessed serum laboratory parameters, body mass index, nutritional risk index, nutritional risk screening score (NRS-2002), and bio-electrical impedance analysis. RESULTS We recruited a total of 152 patients. Patients > 65 years-old, with ascites of >500 mL, or with platinum-resistant EOC showed statistically significant increased risk of malnutrition when evaluated using NRS-2002 (p-values= 0.014, 0.001, and 0.007, respectively). NRS-2002 < 3 was an independent predictive factor for complete tumor resectability (p = 0.009). The patients with NRS-2002 ≥ 3 had a median overall survival (OS) of seven months (95% CI = 0-24 months), as compared to the patients with NRS-2002 < 3, where median OS was forty-six months (p = 0.001). A phase angle (PhAα) ≤ 4.5 was the strongest predictor of OS. CONCLUSIONS In our study, we found malnutrition to be an independent predictor of incomplete cytoreduction and independent prognostic factor for poor OS. Preoperative nutritional assessment is an effective tool in the identification of high-risk EOC groups characterized by poor clinical outcome.
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Affiliation(s)
- Sara Nasser
- Department of Gynecology with Center for Oncological Surgery, Charite Comprehensive Cancer Center, 13353 Berlin, Germany (E.B.)
| | - Esra Bilir
- Department of Global Health, Koç University Graduate School of Health Sciences, İstanbul 34450, Turkey;
| | - Xezal Derin
- Department of Gynecology with Center for Oncological Surgery, Charite Comprehensive Cancer Center, 13353 Berlin, Germany (E.B.)
| | - Rolf Richter
- Department of Gynecology with Center for Oncological Surgery, Charite Comprehensive Cancer Center, 13353 Berlin, Germany (E.B.)
| | - Jacek P. Grabowski
- Department of Gynecology with Center for Oncological Surgery, Charite Comprehensive Cancer Center, 13353 Berlin, Germany (E.B.)
| | - Paulina Ali
- Department of Gynecology with Center for Oncological Surgery, Charite Comprehensive Cancer Center, 13353 Berlin, Germany (E.B.)
| | - Hagen Kulbe
- Department of Gynecology with Center for Oncological Surgery, Charite Comprehensive Cancer Center, 13353 Berlin, Germany (E.B.)
| | - Radoslav Chekerov
- Department of Gynecology with Center for Oncological Surgery, Charite Comprehensive Cancer Center, 13353 Berlin, Germany (E.B.)
| | - Elena Braicu
- Department of Gynecology with Center for Oncological Surgery, Charite Comprehensive Cancer Center, 13353 Berlin, Germany (E.B.)
| | - Jalid Sehouli
- Department of Gynecology with Center for Oncological Surgery, Charite Comprehensive Cancer Center, 13353 Berlin, Germany (E.B.)
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Yu JH, Chen Y, Yin MG. Association between the prognostic nutritional index (PNI) and all-cause mortality in patients with chronic kidney disease. Ren Fail 2023; 45:2264393. [PMID: 37929916 PMCID: PMC10629424 DOI: 10.1080/0886022x.2023.2264393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 09/22/2023] [Indexed: 11/07/2023] Open
Abstract
BACKGROUND Nutrition and immunity play an important role in many chronic diseases. The prognostic nutritional index (PNI) has been proposed as a comprehensive indicator of an individual's immune and nutritional status. However, there is a lack of evidence regarding the association between the PNI and mortality in patients with chronic kidney disease (CKD). METHODS We used National Health and Nutrition Examination Survey (NHANES) data from 2001-2014 for participants with CKD. Mortality data were obtained from the National Death Index and matched to NHANES participants. Cox proportional hazards models were used to estimate hazard ratios for all-cause mortality.Results: The patients were 72.5 ± 9.8 years old, and 47.57% were male. The median follow-up was 58 months, and the mortality rate in patients with CKD was 30.27%. A higher PNI protected against all-cause mortality in patients with CKD, with an adjusted hazard ratio (aHR) of 0.98 (95% confidence interval (CI): 0.97-0.99). After grouping according to PNI quartiles, statistically significant between-group differences were observed in survival probabilities. The aHR for the lowest PNI quartile compared to the highest PNI quartile was 1.64 (95% CI: 1.26-2.14). Sensitivity analysis further supported this association. Restricted cubic spline analysis revealed an L-shaped association between the PNI and all-cause mortality in patients with CKD, with a critical value of 50.5. CONCLUSIONS The PNI is a protective factor in patients with CKD, with an L-shaped decrease in all-cause mortality with an increasing PNI.
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Affiliation(s)
- Jian-hong Yu
- Department of Clinical Laboratory, Zigong First People’s Hospital, Zigong, China
| | - Yu Chen
- Department of Clinical Laboratory, Zigong First People’s Hospital, Zigong, China
| | - Ming-gang Yin
- Department of Clinical Laboratory, Zigong First People’s Hospital, Zigong, China
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Zhang N, Liu H, Yang J, Zhong F. Development and validation of a nomogram based on multiple preoperative immunoinflammatory indexes for survival prediction in patients with stage IA-IB endometrial cancer. Am J Transl Res 2023; 15:6286-6298. [PMID: 37969209 PMCID: PMC10641344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 10/13/2023] [Indexed: 11/17/2023]
Abstract
OBJECTIVES To evaluate the preoperative systemic immune-inflammation index (SII), advanced lung cancer inflammation index (ALI), neutrophil to lymphocyte ratio (NLR), and prognostic nutritional index (PNI) capacity to predict the prognosis of stage IA-IB endometrial carcinoma (EC) patients after operation, and establish a nomogram model to guide clinical practice. METHODS A total of 387 patients with EC (R0 resection, stage IA-IB) were assessed. Clinical information and the SII, NLR, ALI, and PNI values were obtained. The low and high ratio groups were separated using the receiver operating characteristic curve (ROC). Pearson's χ2-test or Fisher's exact test was used to determine their relationship with clinical variables. To determine the independent prognostic factors, Cox regression was utilized to do the univariate and multivariate survival analyses. The Kaplan-Meier method was used to draw the survival curve in our survival analysis. Depending upon the independent prognostic factors, the nomogram for Overall survival (OS) and Disease-free survival (DFS) nomogram was developed, and its discrimination ability was validated by the consistency index (C-index) and calibration curve. RESULTS Cox regression analysis revealed that FIGO staging, Ki-67 expression level, PNI, and ALI are independent prognostic factors for both OS and DFS. Then a novel predictive nomogram was developed, and its C-index value for OS and DFS was 0.829 and 0.814, respectively. The calibration curves demonstrated consistency amid the predicted prognosis using the developed nomogram and the actual observed outcomes. CONCLUSIONS The ALI and PNI could serve as readily available prognostic indicators for OS and DFS prediction in stage IA-IB EC patients. The nomogram developed owned superior power for OS and DFS prediction in stage IA-IB EC patients, and it would assist clinical oncologists in accurately predicting the individual's OS and DFS.
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Affiliation(s)
- Nie Zhang
- Graduate School of Anhui Medical UniversityHefei, Anhui, China
- Department of Oncology, Fuyang Hospital of Anhui Medical UniversityFuyang, Anhui, China
| | - Hong Liu
- Department of Cardiovascular, Fuyang Hospital of Anhui Medical UniversityFuyang, Anhui, China
| | - Jiankang Yang
- Department of Cardiac Surgery, The First Affiliated Hospital of Anhui Medical UniversityHefei, Anhui, China
| | - Fei Zhong
- Department of Oncology, Fuyang Hospital of Anhui Medical UniversityFuyang, Anhui, China
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Zhu Y, He H, Qiu H, Zhang X, Wang L, Li W. Prognostic Nutritional Index Combined with Triglyceride-Glucose Index to Contrast a Nomogram for Predicting Contrast-Induced Kidney Injury in Type 2 Diabetes Mellitus Patients with Acute Coronary Syndrome After Percutaneous Coronary Intervention. Clin Interv Aging 2023; 18:1663-1673. [PMID: 37810953 PMCID: PMC10559899 DOI: 10.2147/cia.s429957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 09/27/2023] [Indexed: 10/10/2023] Open
Abstract
Objective Our objective was to develop and validate a nomogram model aiming at predicting the risk of contrast-induced acute kidney injury (CI-AKI) following percutaneous coronary intervention (PCI) in patients suffering from type 2 diabetes mellitus (T2DM) and also diagnosed with acute coronary syndrome (ACS). Methods The study gathered data from 722 T2DM patients with ACS who received PCI treatment at the Affiliated Hospital of Xuzhou Medical University between February 2019 and December 2022, serving as the training set. Considering the validation set, the study included 217 patients who received PCI at the East Affiliated Hospital of Xuzhou Medical University. The patients were classified into CI-AKI and non-CI-AKI groups. The study employed univariate and multivariate logistic analysis for identifying independent risk factors for CI-AKI, followed by developing a predictive nomogram model for CI-AKI risk using R software. The predictive performance and clinical utility of the nomogram were assessed through internal and external validation, utilizing the areas under the receiver operating characteristic curve (AUC-ROC), the Hosmer-Lemeshow test and calibration correction curve, and decision curve analysis (DCA). Results The nomogram comprised four variables: age, estimated glomerular filtration rate (eGFR), triglyceride-glucose (TyG) index, and prognostic nutritional index (PNI). The AUC-ROC were 0.785 (95% confidence interval (CI) 0.729-0.841) and 0.802 (95% CI 0.699-0.905) for the training and validation cohorts, respectively, indicating a high discriminative ability of the nomogram. The calibration assessment and decision curve analysis have substantiated the strong concordance and clinical usefulness of the aforementioned. Conclusion The nomogram exhibits favorable discrimination and accuracy, enabling it to visually and individually identify pre-procedure high-risk patients, and possesses a predictive capacity regarding CI-AKI incidence after PCI in patients diagnosed with both T2DM and ACS.
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Affiliation(s)
- Yinghua Zhu
- Institute of Cardiovascular Diseases, Xuzhou Medical University, Xuzhou, People’s Republic of China
| | - Haiyan He
- Department of Cardiology, Xuzhou Municipal Hospital Affiliated to Xuzhou Medical University, Xuzhou, People’s Republic of China
| | - Hang Qiu
- Institute of Cardiovascular Diseases, Xuzhou Medical University, Xuzhou, People’s Republic of China
| | - Xudong Zhang
- Institute of Cardiovascular Diseases, Xuzhou Medical University, Xuzhou, People’s Republic of China
| | - Linsheng Wang
- Institute of Cardiovascular Diseases, Xuzhou Medical University, Xuzhou, People’s Republic of China
| | - Wenhua Li
- Institute of Cardiovascular Diseases, Xuzhou Medical University, Xuzhou, People’s Republic of China
- Department of Cardiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, People’s Republic of China
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Erdogan B, Ozcan E, Gokmen I, Gokyer A, Kucukarda A, Kostek O, Hacioglu MB, Uzunoglu S, Cicin I. Relationship between prognostic nutritional index and neutrophil lymphocyte ratio with overall survival in patients with metastatic colorectal cancer receiving regorafenib. J Cancer Res Ther 2023; 19:762-767. [PMID: 37470607 DOI: 10.4103/jcrt.jcrt_1620_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Aim In this study, we aimed to analyze the effect of prognostic nutritional index and neutrophile lymphocyte ratio on the overall survival (OS) in patients treated with regorafenib. Materials and Methods Metastatic colorectal cancer (CRC) patients who treated with regorafenib between 2016 and 2020 in a single center were evaluated retrospectively. ROC analysis was used for neutrophile lymphocyte ratio (NLR's) and prognostic nutritional index (PNI's) optimum cut-off value. The relationship between OS with PNI and NLR was investigated. Results Fifty-two patient's data were analyzed. The median age was 57 years, 22 (41.5%) of the patients were female. The optimal cut-off value of PNI for OS was 45.7 according to ROC curve analysis. The median NLR value was accepted as 2.7. Median OS was 8.3 months. Patients who have high PNI value than 45.7 had longer OS (12.09 months vs. 6.31 months hazard ratio [HR]: 0.37 95% confidence interval [CI]: 0.19-0.73 P = 0.003) and there was a tendency for longer OS with low NLR value then median (12.05 months vs. 6.14 months HR: 0.54 95% CI: 0.29-1.23 P = 0.057). Primary tumor resected patients had longer OS than nonresected patients (12.05 months vs. 6.30 months HR: 0.34 95% CI: 0.17-0.66 P = 0.001). In multivariate analysis, high PNI value more than 45.7 (HR: 0.40 95% CI: 0.18-0.88 P = 0.02) and resection of the primary tumor (HR: 0.40 95% CI: 0.21-0.80 P = 0.01) were the only independent factors for longer OS. Conclusion Metastatic CRC patients with high pretreatment PNI and primary tumor resected are more likely to have longer OS with regorafenib. PNI is more reliable index than NLR to predict OS in metastatic CRC patients treated with regorafenib.
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Affiliation(s)
- Bulent Erdogan
- Department of Internal Medicine, Division of Medical Oncology, Trakya University School of Medicine, Edirne, Turkey
| | - Erkan Ozcan
- Department of Internal Medicine, Division of Medical Oncology, Trakya University School of Medicine, Edirne, Turkey
| | - Ivo Gokmen
- Department of Internal Medicine, Division of Medical Oncology, Trakya University School of Medicine, Edirne, Turkey
| | - Ali Gokyer
- Department of Internal Medicine, Division of Medical Oncology, Trakya University School of Medicine, Edirne, Turkey
| | - Ahmet Kucukarda
- Department of Internal Medicine, Division of Medical Oncology, Trakya University School of Medicine, Edirne, Turkey
| | - Osman Kostek
- Department of Internal Medicine, Division of Medical Oncology, Trakya University School of Medicine, Edirne, Turkey
| | - Muhammet Bekir Hacioglu
- Department of Internal Medicine, Division of Medical Oncology, Trakya University School of Medicine, Edirne, Turkey
| | - Sernaz Uzunoglu
- Department of Internal Medicine, Division of Medical Oncology, Trakya University School of Medicine, Edirne, Turkey
| | - Irfan Cicin
- Department of Internal Medicine, Division of Medical Oncology, Trakya University School of Medicine, Edirne, Turkey
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Dai M, Sun Q. Prognostic and clinicopathological significance of prognostic nutritional index (PNI) in patients with oral cancer: a meta-analysis. Aging (Albany NY) 2023; 15:1615-1627. [PMID: 36897190 PMCID: PMC10042682 DOI: 10.18632/aging.204576] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 02/13/2023] [Indexed: 03/09/2023]
Abstract
Accumulating literature has explored how prognostically significant the prognostic nutritional index (PNI) was for the oral carcinoma population, but with inconsistent findings. Therefore, we retrieved the most recent data and carried out this meta-analysis to comprehensively analyze the prognostic performance of pretreatment PNI in oral cancer. The electronic databases of PubMed, Embase, China National Knowledge Infrastructure (CNKI), Cochrane Library and Web of Science were fully retrieved. PNI's prognostic value for survival outcomes in oral carcinoma was assessed by estimating pooled hazard ratios (HRs) plus 95% confidence intervals (CIs). We examined the correlation of PNI with clinicopathological traits of oral carcinoma by utilizing the pooled odds ratios (ORs) plus 95% CIs. According to the pooled results of the present meta-analysis, which enrolled 10 studies involving 3,130 patients, for oral carcinoma suffers whose PNI was low, their disease-free survival (DFS) (HR=1.92, 95%CI=1.53-2.42, p<0.001) and overall survival (OS) (HR=2.44, 95%CI=1.45-4.12, p=0.001) would be inferior. Nonetheless, cancer-specific survival (CSS) was not linked significantly to PNI for the oral carcinoma population (HR=1.89, 95%CI=0.61-5.84, p=0.267). Significant associations of low PNI with TNM stages III-IV (OR=2.16, 95%CI=1.60-2.91, p<0.001) and age ≥ 65 years (OR=2.29, 95%CI=1.76-2.98, p<0.001) were found. As suggested by the present meta-analysis, a low PNI was linked to inferior DFS and OS among oral carcinoma patients. Oral cancer patients with low PNI may have high-risk of tumor progression. PNI could be served as a promising and effective index to predict prognosis in patients with oral cancer.
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Affiliation(s)
- Menglu Dai
- Clinical Laboratory, Huzhou Central Hospital, Affiliated Central Hospital of Huzhou University, Huzhou 313000, Zhejiang, China
| | - Qijun Sun
- Stomatology Therapeutic Center, Huzhou Central Hospital, Affiliated Central Hospital of Huzhou University, Huzhou 313000, Zhejiang, China
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11
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Shao Y, Cao W, Gao X, Tang M, Zhu D, Liu W. Pretreatment "prognostic nutritional index" as an indicator of outcome in lung cancer patients receiving ICI-based treatment: Systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e31113. [PMID: 36316884 PMCID: PMC9622676 DOI: 10.1097/md.0000000000031113] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND The pretreatment prognostic nutritional index (PNI) is an indicator of nutritional and immune status, and has potential use as a predictor of survival in cancer patients. Several retrospective studies have used the PNI to predict the outcome of lung cancer patients receiving different immune checkpoint inhibitors (ICIs), but the results have been inconsistent. The objective of our study is to assess the relationship of pretreatment PNI with survival outcomes in lung cancer patients who received ICI-based treatments by meta-analysis. METHODS We searched the EMBASE, PubMed, Cochrane Library, American Society of Clinical Oncology, and European Society of Medical Oncology databases to identify studies that reported overall survival (OS) or progression-free survival (PFS) in eligible patients. Eight studies were eligible based on predefined inclusion and exclusion criteria. Data and pooled indicators were extracted from these studies. Meta-analysis was used to analyze hazard ratios (HRs) and 95% confidence intervals (CIs) for OS and/or PFS and the prognostic value of pretreatment PNI. We completed the registration of the research protocol (Registration number: INPLASY202240087, DOI number: 10.37766/inplasy2022.4.0087). RESULTS We analyzed data from 8 eligible studies (831 patients). Meta-analysis showed that relative to patients with low pretreatment PNI, those with a high pretreatment PNI had better OS (HR = 2.50, 95% CI = 1.44-4.33, P = .001) and better PFS (HR = 1.94, 95% CI = 1.56-2.42, P < .001). Sensitivity analysis indicated these results were robust. There was also no evidence of publication bias. CONCLUSION Lung cancer patients receiving ICI-based treatments who had higher pretreatment PNI had better OS and PFS.
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Affiliation(s)
- Yifeng Shao
- Department of Thoracic Surgery, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Wei Cao
- Department of Urinary Surgery, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Xinliang Gao
- Department of Thoracic Surgery, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Mingbo Tang
- Department of Thoracic Surgery, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Dongshan Zhu
- Department of Thoracic Surgery, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Wei Liu
- Department of Thoracic Surgery, The First Hospital of Jilin University, Changchun, Jilin, China
- *Correspondence: Wei Liu, Department of Thoracic Surgery, The First Hospital of Jilin University, Changchun 130021, Jilin, China (e-mail: )
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Wang K, Lian L, Chen C, Wang M, Chen C, Hu X. The change in nutritional status is related to cardiovascular events in patients with pacemaker implantation: A 4-year follow-up study. Front Nutr 2022; 9:986731. [PMID: 36118780 PMCID: PMC9478387 DOI: 10.3389/fnut.2022.986731] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 08/09/2022] [Indexed: 11/13/2022] Open
Abstract
Background The aim of our study was to evaluate changes in nutritional status as measured by the prognostic nutritional index (PNI) and geriatric nutritional risk index (GNRI) scores, and their abilities to predict clinical prognosis in patients with pacemaker implantation (PMI). Methods A total of 595 patients who underwent permanent PMI from January 2011 to December 2020 were included. PNI and GNRI scores were separately calculated at the beginning day of PMI operation and at the end of 12-month follow-up, and their net changes (Δ) were calculated by PNI or GNRI scores at follow-up minus the corresponding scores on admission. The cohort patients were divided into low risk of malnutritional status (ΔPNI or ΔGNRI scores ≥ 0) and high risk of malnutritional status (ΔPNI or ΔGNRI scores < 0) groups. Primary outcome measure was a composite major adverse cardiovascular event (MCE), defined as heart failure hospitalization (HFH), myocardial infarction (MI), stroke, or death from any cause, presented as hazard ratios (HR) with 95% confidence intervals (CI) calculated by MCE in the crude or multivariate-adjusted Cox Proportional Hazards models. Receiver operating characteristic (ROC) curve analysis was used to compare the differential ability to predict incident MCEs betweenΔPNI andΔGNRI scores. Results In total, 16% of patients developed the MCE during the follow-up. The cumulative event rates determined by Kaplan–Meier analysis were significantly higher in the high risk of malnutritional patients compared to the low risk of malnutritional patients (P < 0.05). Adjusted multivariate analysis showed that decreased PNI scores (HR: 2.228, 95% CI: 1.482–3.350) and decreased GNRI scores (HR: 2.178, 95% CI: 1.439–3.295) were independently associated with favorable outcomes. ROC curve analysis revealed an area under curve (AUC) of 0.586 forΔPNI scores and AUC of 0.592 for ΔGNRI scores, but their predictive abilities were not statistically different. Conclusion Either positive change of PNI or GNRI scores were associated with reduced risk of MCEs in patients with PMI, and they have similar ability to predict clinical cardiometabolic risk. Additional enhancing nutritional status during follow-up may help to prevent unfavorable prognosis in clinical practices.
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Affiliation(s)
- Kaijing Wang
- Department of Ultrasound, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Liyou Lian
- Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- The Key Lab of Cardiovascular Disease, Science and Technology of Wenzhou, Wenzhou, China
| | - Chengpu Chen
- Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- The Key Lab of Cardiovascular Disease, Science and Technology of Wenzhou, Wenzhou, China
| | - Meiling Wang
- Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- The Key Lab of Cardiovascular Disease, Science and Technology of Wenzhou, Wenzhou, China
| | - Chen Chen
- Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- The Key Lab of Cardiovascular Disease, Science and Technology of Wenzhou, Wenzhou, China
- *Correspondence: Chen Chen,
| | - Xiang Hu
- Key Laboratory of Clinical Laboratory Diagnosis and Translational Research of Zhejiang Province, Department of Endocrine and Metabolic Diseases, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- Xiang Hu,
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13
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Red Cell Distribution Width and High Grade Serous Ovarian Cancer: Prognostic Marker? INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2022. [DOI: 10.1007/s40944-022-00625-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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14
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Chantharakhit C, Sujaritvanichpong N, Chantharakhit C. Prognostic Value of the Pre-Treatment Prognostic Nutritional Index for Patients with Unresectable Locally-Advanced and Advanced Stage Upper Gastrointestinal Tract Cancer. Int J Gen Med 2022; 15:6681-6689. [PMID: 36016983 PMCID: PMC9397539 DOI: 10.2147/ijgm.s372684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 08/11/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose The prognostic nutritional index (PNI) is used to distinguish immune-nutritional status. Previous studies have shown that it is significantly associated with patient outcomes for various malignancies. This study aimed to evaluate the prognostic impact of PNI in patients with unresectable locally-advanced and advanced stage upper gastrointestinal tract cancer, including esophageal cancer and gastric cancer. Methods A retrospective study of 170 unresectable stage III–IV esophageal cancer and gastric cancer patients was conducted from January 2018 to December 2020. In our retrospective analysis, the pretreatment PNI of patients was calculated and analyzed. The Youden index was estimated to select the optimal cut-off value for PNI. Univariate and multivariate flexible parametric proportional hazards models with restricted cubic splines (RCS) were used to identify independent prognostic factors, and the Kaplan–Meier method was used to estimate survival curves. Results The median follow-up period was 5 months (ranging from 0.06 to 36.92 months). We determined 52.9 as the cut-off value by using the maximum Youden index. Subsequently, patients in the testing group were classified into high PNI and low PNI groups. Kaplan–Meier curves showed the low PNI group had significantly poorer overall survival (OS) than the high PNI group. Median OS in the low PNI group was 4.43 months compared with 8.23 months in the high PNI group (HR 2.42, 95% CI 1.33–4.40, p = 0.004). In the univariate analysis, low PNI, ECOG PS 2, and ECOG PS 3–4 were associated with OS. According to multivariate analysis, low PNI was an independent prognostic factor for OS (HR 2.31, 95% CI 1.24–4.29, p = 0.008). Conclusion Pretreatment PNI is useful for independent prognosis of unresectable stage III–IV esophageal cancer and gastric cancer in patients.
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Affiliation(s)
- Chaichana Chantharakhit
- Division of Medical Oncology, Department of Internal Medicine, Buddhasothorn Hospital, Chachoengsao, Thailand
| | - Nantapa Sujaritvanichpong
- Division of Medical Oncology, Department of Internal Medicine, Buddhasothorn Hospital, Chachoengsao, Thailand
| | - Chanachai Chantharakhit
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Buddhasothorn Hospital, Chachoengsao, Thailand
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15
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Tan X, Chen H. The Prognostic Value of Prognostic Nutritional Index in Patients with Ovarian Cancer: A Systematic Review and Meta-Analysis. Nutr Cancer 2022; 75:73-81. [PMID: 35900054 DOI: 10.1080/01635581.2022.2104879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Controversy still exists with regard to the prognostic value of prognostic nutritional index (PNI) in ovarian cancer. A systematic search based on the databases of Web of Science, Embase, PubMed, Chinese National Knowledge Infrastructure (CNKI) and WanFang Dataset were conducted up to March 22, 2022. We included both retrospective and prospective observational studies with comparison of prognosis of patients who were divided into two groups: low and high PNI group. The Newcastle-Ottawa Scale (NOS) was applied to evaluate the quality of enrolled studies. All analyses were performed using Stata software. The pooled results were reported as hazard ratios (HRs) with the 95% confidence intervals (95% CIs). Finally, 12 studies involving 3,190 patients were included. High PNI group had a significantly improved overall survival (OS, HR: 0.67, 95% CI: 0.53-0.84), progression-free survival (PFS, HR: 0.74, 95% CI: 0.63-0.87), and cancer-specific survival (CSS, HR: 0.43, 95% CI: 0.20-0.94) compared with the low PNI group. The sensitivity analysis and publication bias indicated our results were reliable. PNI could be applied as a promising index to predict prognosis in ovarian cancer. Our results need to be validated in future studies.
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Affiliation(s)
- Xi Tan
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University) of Ministry of Education, Chengdu, Sichuan, PR China
| | - Hongqin Chen
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University) of Ministry of Education, Chengdu, Sichuan, PR China
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Rotolo S, Di Giorgio A, Cintoni M, Rinninella E, Palombaro M, Pulcini G, Schena CA, Chiantera V, Vizzielli G, Gasbarrini A, Pacelli F, Mele MC. Body composition and immunonutritional status in patients treated with pressurized intraperitoneal aerosol chemotherapy (PIPAC) for gastrointestinal peritoneal metastases: a prospective single-center analysis. Pleura Peritoneum 2022; 7:9-17. [PMID: 35602923 PMCID: PMC9069500 DOI: 10.1515/pp-2021-0142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 02/02/2022] [Indexed: 11/15/2022] Open
Abstract
Abstract
Objectives
Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is a novel drug administration method with promising efficacy for the treatment of peritoneal metastases (PM). This study aimed to evaluate the prognostic value of an immunonutritional assessment on the feasibility, safety, and survival in this setting.
Methods
Data of PM patients undergoing PIPAC between September 2018 and May 2020 were prospectively recorded. A CT scan-derived body composition assessment was performed for each patient.
Results
Fifty-one patients were enrolled, of which 30 (58%) underwent multiple PIPAC cycles, with a pathological response rate of 55%. Prognostic nutritional index (PNI) and neutrophil-to-lymphocytes predicted completion of more than one PIPAC cycle, with a cut off of 36.5 and 4.8 respectively. Muscle attenuation and body fat tissues were associated with pathological response. At multivariate Cox regression analysis, only the presence of a low PNI (HR 2.41, 95% CI 1.08–5.46) was significantly associated with a worse OS.
Conclusions
A pretreatment immunonutritional assessment may provide valuable information for PIPAC patients’ selection and survival, while body composition parameters are able to predict pathological response. Further larger studies are needed to validate the role of these biomarkers in tailoring the treatment and monitoring PM patients undergoing PIPAC.
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Affiliation(s)
- Stefano Rotolo
- Dipartimento di Scienze Mediche e Chirurgiche , UOC Chirurgia del Peritoneo e del Retroperitoneo, Fondazione Policlinico Universitario A. Gemelli IRCCS , Rome , Italy
- Dipartimento di Discipline Chirurgiche, Oncologiche e Stomatologiche (Di.Chir.On.S.) , Università degli Studi di Palermo , Palermo , Italy
| | - Andrea Di Giorgio
- Dipartimento di Scienze Mediche e Chirurgiche , UOC Chirurgia del Peritoneo e del Retroperitoneo, Fondazione Policlinico Universitario A. Gemelli IRCCS , Rome , Italy
| | - Marco Cintoni
- Dipartimento di Scienze Mediche e Chirurgiche , UOC di Nutrizione Clinica, Fondazione Policlinico Universitario A. Gemelli IRCCS , Rome , Italy
| | - Emanuele Rinninella
- Dipartimento di Scienze Mediche e Chirurgiche , UOC di Nutrizione Clinica, Fondazione Policlinico Universitario A. Gemelli IRCCS , Rome , Italy
| | - Marta Palombaro
- Dipartimento di Scienze Mediche e Chirurgiche , UOSD di Nutrizione Avanzata in Oncologia, Fondazione Policlinico Universitario A. Gemelli IRCCS , Rome , Italy
| | - Gabriele Pulcini
- Dipartimento di Scienze Mediche e Chirurgiche , UOSD di Nutrizione Avanzata in Oncologia, Fondazione Policlinico Universitario A. Gemelli IRCCS , Rome , Italy
| | - Carlo Alberto Schena
- Dipartimento di Scienze Mediche e Chirurgiche , UOC Chirurgia del Peritoneo e del Retroperitoneo, Fondazione Policlinico Universitario A. Gemelli IRCCS , Rome , Italy
| | - Vito Chiantera
- Dipartimento di Discipline Chirurgiche, Oncologiche e Stomatologiche (Di.Chir.On.S.) , Università degli Studi di Palermo , Palermo , Italy
| | - Giuseppe Vizzielli
- Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica , UOC Ginecologia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS , Rome , Italy
| | - Antonio Gasbarrini
- Dipartimento di Scienze Mediche e Chirurgiche , UOC Medicina Interna e Gastroenterologia, Fondazione Policlinico Universitario A. Gemelli IRCCS , Rome , Italy
- Dipartimento di Medicina e Chirurgia Traslazionale , Università Cattolica Del Sacro Cuore , Rome , Italy
| | - Fabio Pacelli
- Dipartimento di Scienze Mediche e Chirurgiche , UOC Chirurgia del Peritoneo e del Retroperitoneo, Fondazione Policlinico Universitario A. Gemelli IRCCS , Rome , Italy
| | - Maria Cristina Mele
- Dipartimento di Scienze Mediche e Chirurgiche , UOSD di Nutrizione Avanzata in Oncologia, Fondazione Policlinico Universitario A. Gemelli IRCCS , Rome , Italy
- Dipartimento di Medicina e Chirurgia Traslazionale , Università Cattolica Del Sacro Cuore , Rome , Italy
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Tranoulis A, Kwong FLA, Lakhiani A, Georgiou D, Yap J, Balega J. Prevalence of computed tomography-based sarcopenia and the prognostic value of skeletal muscle index and muscle attenuation amongst women with epithelial ovarian malignancy: A systematic review and meta-analysis. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2022; 48:1441-1454. [DOI: 10.1016/j.ejso.2022.02.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 02/16/2022] [Accepted: 02/21/2022] [Indexed: 12/21/2022]
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Xue S, Zhao H, Zhang K, Zhang H, Wang W. Prognostic and Clinicopathological Correlations of Pretreatment Prognostic Nutritional Index in Renal Cell Carcinoma: A Meta-Analysis. Urol Int 2022; 106:567-580. [PMID: 35073548 DOI: 10.1159/000521353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 12/06/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Prognostic nutritional index (PNI) was indicted as a potential prognostic biomarker for cancer. However, the conclusion remains uncertain for renal cell carcinoma (RCC). This study was to confirm the association of PNI with prognosis and clinicopathological features in RCCs. METHODS The PubMed, EMBASE, Cochrane Library, CNKI, and Wan Fang databases were searched to retrieve eligible studies. Hazard ratios (HRs) and 95% confidence intervals (CIs) were pooled to assess the strength of the association. RESULTS Fifteen studies were included. The results showed a low pretreatment PNI level was significantly associated with poor overall survival (HR = 1.67, 95% CI: 1.45-1.92), progression-free survival (HR = 1.72, 95% CI: 1.23-2.42), cancer-specific survival (HR = 1.17, 95% CI: 1.09-1.26), disease-free survival (HR = 1.28, 95% CI: 1.09-1.26), and recurrence-free survival (HR = 2.14, 95% CI: 1.38-3.31). This prognostic role of PNI was almost not changed by subgroup analysis based on study design, HR source, RCC type, sample size, cutoff, follow-up, treatment, and country. Furthermore, low PNI was correlated with old age, large tumor size and high T stage, Fuhrman grade, lymph node, and distant metastases. CONCLUSION Pretreatment PNI might be a promising indicator to beforehand predict the progression and prognosis for RCC patients.
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Affiliation(s)
- Senyao Xue
- Department of Urology, Yidu Central Hospital of Weifang, Qingzhou, China
| | - Hui Zhao
- Department of Nephrology, Yidu Central Hospital of Weifang, Qingzhou, China
| | - Kaikai Zhang
- Department of Interventional Therapy, Yidu Central Hospital of Weifang, Qingzhou, China
| | - Huapeng Zhang
- Department of Anesthesiology, Yidu Central Hospital of Weifang, Qingzhou, China
| | - Wei Wang
- Department of Anesthesiology, Yidu Central Hospital of Weifang, Qingzhou, China
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Karakaş S, Demirayak G, Önder AB, Özdemir İA, Comba C, Süzen Çaypınar S, Yıldız Ş, Avşar S, Bağhaki S, Yıldız GÖ, Erdoğan ŞV. The Association between the Preoperative Prognostic Nutritional Index and the Controlling Nutritional Status Score on Tumor Stage, Chemotherapeutic Response and Overall Survival in Ovarian Cancer. Nutr Cancer 2022; 74:1770-1779. [PMID: 34989281 DOI: 10.1080/01635581.2021.2022170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
This study aimed to investigate the association between preoperative prognostic nutritional index (PNI) and controlling nutritional status (CONUT) scores on the stage of ovarian cancer (OC), chemotherapeutic response, and overall survival (OS) in patients with OC. The data of the patients who operated due to OC between January 2015 and January 2020 in a tertiary referral hospital were recorded. The patients' basic characteristics, preoperative total cholesterol, albumin, lymphocyte count, tumor markers, disease stage, grade, chemotherapeutic response, OS, and progression-free survival were recorded. The PNI and the CONUT score were calculated. The mean PNI level was considerably higher in the early-stage group than the advanced-stage group (50.02 ± 6.8 vs. 46.3 ± 7.4, p = 0.005). The AUC was 63% for the cutoff point 45.98 of PNI, whereas the AUC was 42% for the cutoff point 1.5 of CONUT score in predicting early-stage disease. The PFS and OS were significantly higher in the high PNI group than the low PNI group (p = 0.01, p = 0.002, respectively). The patients with early-stage OC had significantly higher PNI levels and lower CONUT scores in our study population.
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Affiliation(s)
- Sema Karakaş
- Department of Gynecologic Oncology, University of Health Sciences, Bakirkoy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Gökhan Demirayak
- Department of Gynecologic Oncology, University of Health Sciences, Bakirkoy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Ayşe Büşra Önder
- Department of Gynecologic Oncology, University of Health Sciences, Bakirkoy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - İsa Aykut Özdemir
- Department of Gynecologic Oncology, Istanbul Medipol University, Istanbul, Turkey
| | - Cihan Comba
- Department of Gynecology and Obstetrics, University of Health Sciences, Haseki Training and Research Hospital, Istanbul, Turkey
| | - Sema Süzen Çaypınar
- Department of Gynecology and Obstetrics, University of Health Sciences, Cam and Sakura City Hospital, Istanbul, Turkey
| | - Şükrü Yıldız
- Department of Gynecologic Oncology, University of Health Sciences, Bakirkoy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Selim Avşar
- Department of Gynecologic Oncology, University of Health Sciences, Bakirkoy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Sema Bağhaki
- Department of Gynecologic Oncology, University of Health Sciences, Bakirkoy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Güneş Özlem Yıldız
- Department of Anesthesiology, University of Health Sciences, Bakirkoy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Şakir Volkan Erdoğan
- Department of Gynecology and Obstetrics, University of Health Sciences, Bağcılar Training and Research Hospital, Istanbul, Turkey
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20
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Zhang G, Wang C, Ma C, Miao L, He F, Fu C. A Novel Risk Factor for Para-Aortic Lymph Node Recurrence After Definite Pelvic Radiotherapy in Stage IIIB Cervical Cancer. Technol Cancer Res Treat 2022; 21:15330338221141541. [DOI: 10.1177/15330338221141541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background: Studies determining which patients with International Federation of Gynecology and Obstetrics (FIGO) stage IIIB disease benefit from prophylactic extended-field irradiation (EFRT), which can reduce para-aortic lymph node (PALN) failure rates, are limited. The study was designed to evaluate the value of the controlling nutritional status (CONUT) score as a risk factor for predicting PALN recurrence and identifying potential indications of prophylactic EFRT. Methods: From 2010 to 2015, a retrospective review was conducted among patients with FIGO stage IIIB cervical cancer who were treated with definitive pelvic radiotherapy or concurrent chemoradiotherapy. We analyzed para-aortic lymph node metastasis-free survival (PALNMFS) using Kaplan-Meier curves. Multivariate analyses were performed using Cox regression models. Results: A total of 116 patients with FIGO stage IIIB cervical cancer were included in the study and the median follow-up was 42.2 months (range: 3.5-104.2 months). Multivariate analysis revealed that the CONUT score (HR: 3.141; 95% CI: 2.321-5.436; P < .001) and ≥3 pelvic lymph node metastases (HR: 2.235; 95% CI: 1.428-11.242; P < .001) were independent risk predictors of PALNMFS. Compared with the low CONUT group (score<3), the high CONUT group (score≥3) was associated with a significantly worse 3-year disease-free survival rate (46.9 vs 69.5%, P = .001), a significantly lower 3-year overall survival rate (68.5 vs 79.7%, P = .016) and a significantly lower PALNMFS rate (74.8 vs 96.4%, P < .001). Conclusions: A high CONUT score (score≥3) and ≥3 pelvic metastatic lymph nodes were significant predictors of PALNMFS after pelvic radiation in FIGO stage IIIB cervical cancer patients. Patients with these risk factors might benefit from prophylactic EFRT.
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Affiliation(s)
- Guangyu Zhang
- Department of Radiation Oncology, Qilu Hospital of Shandong University, Jinan, China
| | - Cong Wang
- Department of Gynecology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Changdong Ma
- Department of Radiation Oncology, Qilu Hospital of Shandong University, Jinan, China
| | - Li Miao
- Department of Radiation Oncology, Qilu Hospital of Shandong University, Jinan, China
| | - Fangfang He
- Department of Radiation Oncology, Qilu Hospital of Shandong University, Jinan, China
| | - Chunli Fu
- Department of Geriatric Medicine, Qilu Hospital of Shandong University, Jinan, China
- Key Laboratory of Cardiovascular Proteomics of Shandong Province, Qilu Hospital of Shandong University, Jinan, China
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21
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Yan L, Nakamura T, Casadei-Gardini A, Bruixola G, Huang YL, Hu ZD. Long-term and short-term prognostic value of the prognostic nutritional index in cancer: a narrative review. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1630. [PMID: 34926674 PMCID: PMC8640913 DOI: 10.21037/atm-21-4528] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 10/02/2021] [Indexed: 12/11/2022]
Abstract
Objective To perform a narrative review of the prognostic value of prognostic nutritional index (PNI) in cancers. Background Prognostic estimation greatly determines the treatment approach in various cancers. The PNI, calculated using the serum albumin level and total lymphocyte count, is a useful indicator to assess nutritional and immunological conditions. The PNI represents a low-cost, easy-to-perform, noninvasive, rapid, and standardized tool for estimating the prognosis of cancer. Many studies have aimed to clarify the prognostic value of PNI for various types of cancer. Methods We summarize the studies, particularly the systematic reviews and meta-analyses, that have examined the prognostic value of PNI in common cancers. Conclusions The relevant studies indicate that low PNI is an independent prognostic factor for decreasing overall survival in many types of cancers. Disease-free survival and progression-free survival were also associated with PNI in some types of cancer including lung cancer and renal cell carcinoma. Therefore, we suggest that the measurement of PNI is a useful method to identify cancer patients that have a worse prognosis and that the treatment strategy for these patients be adjusted accordingly. We hypothesize that maintaining good nutritional status during treatment may improve outcomes of various cancers.
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Affiliation(s)
- Li Yan
- Department of Respiratory and Critical Care Medicine, the Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Tomoki Nakamura
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu-city, Mie, Japan
| | | | - Gema Bruixola
- Department of Medical Oncology, Biomedical Research Institute INCLIVA, University of Valencia, Valencia, Spain
| | - Yuan-Lan Huang
- Department of Special Food and Equipment, Naval Special Medical Center, the Naval Military Medical University, Shanghai, China
| | - Zhi-De Hu
- Department of Laboratory Medicine, the Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
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22
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Fu Y, He G, Liu Z, Wang J, Zhang Z, Bao Q, Wen J, Jin Z, Zhang W. Exploration and Validation of a Novel Inflammatory Response-Associated Gene Signature to Predict Osteosarcoma Prognosis and Immune Infiltration. J Inflamm Res 2021; 14:6719-6734. [PMID: 34916821 PMCID: PMC8668229 DOI: 10.2147/jir.s340477] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 12/01/2021] [Indexed: 01/21/2023] Open
Abstract
Background Inflammatory response took part in the progression of tumor and was regarded as the hallmark of cancer. However, the prognostic relationship between osteosarcoma and inflammatory response-associated genes (IRGs) was unclear. This research aimed to explore the correlations between osteosarcoma prognosis and IRG signature. Methods The inflammatory response-associated differentially expressed messenger RNAs (DEmRNAs) were screened out through Gene Expression Omnibus (GEO) and Molecular Signature Database (MSigDB) databases. Univariate and multivariate cox regression analyses were utilized to construct the IRG signature. The prognostic value of signature was investigated through Kaplan–Meier (KM) survival curve and nomogram. DEmRNAs among high and low inflammatory response-associated risks were identified and functional enrichment analyses were conducted. ESTIMATE, CIBERSORT and single-sample gene set enrichment analyses (ssGSEA) were implied to reveal the alterations in immune infiltration. All the above results were validated in Target database. The expression of IRGs was also validated in different cell lines by quantitative real-time PCR (qRT-PCR) and osteosarcoma patient samples by immunohistochemistry. Results The IRG signature that consisted of two genes (MYC, CLEC5A) was established. In training and validation datasets, patients with lower risk scores survived longer and the IRG signature was confirmed as the independent prognostic factor in osteosarcoma. The nomogram was constructed and the calibration curves demonstrated the reliability of this model. Functional analysis of risk score-associated DEmRNAs indicated that immune-related pathways and functions were significantly enriched. ssGSEA revealed that 14 immune cells and 11 immune functions were significantly dysregulated. The qRT-PCR results indicated IRGs were significantly differently expressed in osteosarcoma and osteoblast cell lines. The immunohistochemistry analyses of patients’ samples revealed the same result. Conclusion The novel osteosarcoma inflammatory response-associated prognostic signature was established and validated in this study. This model could serve as the biomarker and therapeutic target for osteosarcoma in the future.
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Affiliation(s)
- Yucheng Fu
- Department of Orthopedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopedics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, People's Republic of China
| | - Guoyu He
- Department of Orthopedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopedics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, People's Republic of China
| | - Zhuochao Liu
- Department of Orthopedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopedics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, People's Republic of China
| | - Jun Wang
- Department of Orthopedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopedics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, People's Republic of China
| | - Zhusheng Zhang
- Department of Orthopedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopedics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, People's Republic of China
| | - Qiyuan Bao
- Department of Orthopedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopedics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, People's Republic of China
| | - Junxiang Wen
- Department of Orthopedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopedics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, People's Republic of China
| | - Zhijian Jin
- Department of Orthopedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopedics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, People's Republic of China
| | - Weibin Zhang
- Department of Orthopedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopedics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, People's Republic of China
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23
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Mao C, Xu W, Ma W, Wang C, Guo Z, Yan J. Prognostic Value of Pretreatment Prognostic Nutritional Index in Patients With Renal Cell Carcinoma: A Meta-Analysis. Front Oncol 2021; 11:719941. [PMID: 34676162 PMCID: PMC8523954 DOI: 10.3389/fonc.2021.719941] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 09/10/2021] [Indexed: 01/11/2023] Open
Abstract
Background The pretreatment prognostic nutritional index (PNI) is correlated with poor prognosis in several malignancies. However, the prognostic role of PNI in patients with renal cell carcinoma (RCC) remains unclear. Therefore, we performed a meta-analysis to investigate the prognostic significance of PNI in patients with RCC. Methods We searched the PubMed, Web of Science, Embase, Scopus, and Cochrane Library databases up to February 2021. Pooled hazard ratios (HRs) and 95% confidence intervals (CIs) were used to estimate correlation between PNI and survival endpoints in RCC. Results Ten studies with 4,908 patients were included in the meta-analysis. The pooled results indicated that a low PNI associated with poor overall survival (HR = 2.10, 95% CI = 1.67–2.64, p<0.001), shorter progression-free survival, disease-free survival, recurrence-free survival (HR = 1.99, 95% CI = 1.67–2.36, p<0.001), and poor cancer-specific survival (HR = 2.95, 95% CI = 1.61–5.39, p<0.001). Additionally, the prognostic ability of PNI was not affected by subgroup analysis factors. Conclusion The meta-analysis indicated that low PNI associated with shorter survival outcomes in patients with RCC. Therefore, PNI could be used as an effective prognostic indicator in RCC.
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Affiliation(s)
- Changqing Mao
- Department of Nephrology, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Weixin Xu
- Department of Laboratory Medicine, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Weina Ma
- Department of Pharmacy, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Chun Wang
- Department of Oncology, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Zhaojiao Guo
- Department of Oncology, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Jun Yan
- Department of Oncology, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences, Shanghai, China
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24
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Chen L, Bai P, Kong X, Huang S, Wang Z, Wang X, Fang Y, Wang J. Prognostic Nutritional Index (PNI) in Patients With Breast Cancer Treated With Neoadjuvant Chemotherapy as a Useful Prognostic Indicator. Front Cell Dev Biol 2021; 9:656741. [PMID: 33859986 PMCID: PMC8042235 DOI: 10.3389/fcell.2021.656741] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 02/08/2021] [Indexed: 12/21/2022] Open
Abstract
Objective Prognostic nutritional index (PNI), calculated as serum albumin (ALB) (g/L) + 5 × total lymphocyte count (109/L), is initially used to evaluate nutritional status in patients undergoing surgery and may evaluate the therapeutic effects and predict the survival of various solid tumors. The present study aimed to evaluate the potential prognostic significance of PNI in breast cancer patients receiving neoadjuvant chemotherapy (NACT). Methods A total of 785 breast cancer patients treated with neoadjuvant chemotherapy were enrolled in this retrospective study. The optimal cutoff value of PNI by receiver operating characteristic curve stratified patients into a low-PNI group (<51) and a high PNI group (≥51). The associations between breast cancer and clinicopathological variables by PNI were determined by chi-square test or Fisher’s exact test. Kaplan–Meier plots and log-rank test were used to evaluate the clinical outcomes of disease-free survival (DFS) and overall survival (OS). The prognostic value of PNI was analyzed by univariate and multivariate Cox proportional hazards regression models. The toxicity of NACT was accessed by the National Cancer Institute Common Toxicity Criteria (NCI-CTC). Results The results indicated that PNI had prognostic significance by an optimal cutoff value of 51 on DFS and OS in univariate and multivariate Cox regression survival analyses. Breast cancer patients with a high PNI value had longer DFS and OS than those with a low PNI value [47.64 vs. 36.60 months, P < 0.0001, hazard ratio (HR) = 0.264, 95%CI = 0.160–0.435; 73.61 vs. 64.97 months, P < 0.0001, HR = 0.319, 95%CI = 0.207–0.491, respectively]. Furthermore, the results indicated that patients with high PNI had longer DFS and OS than those with low PNI in early stage and advanced breast cancer, especially in advanced breast cancer. The mean DFS and OS times for breast cancer patients with high PNI by the log-rank test were longer than in those with low PNI in different molecular subtypes. Moreover, the mean DFS and OS times in patients with high PNI by the log-rank test were longer than in those patients with low PNI without or with lymph vessel invasion. The common toxicities after neoadjuvant chemotherapy were hematologic and gastrointestinal reaction, and the PNI had no significance on the toxicities of all enrolled patients, except in anemia, leukopenia, and myelosuppression. Conclusion Pretreatment PNI with the advantages of being convenient, noninvasive, and reproducible was a useful prognostic indicator for breast cancer patients receiving neoadjuvant chemotherapy and is a promising biomarker for breast cancer on treatment strategy decisions.
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Affiliation(s)
- Li Chen
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ping Bai
- Department of Operation Room, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiangyi Kong
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shaolong Huang
- Department of Breast and Thyroid, Traumatic and Plastic Surgery, Tongren Municipal People's Hospital, Guizhou, China
| | - Zhongzhao Wang
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiangyu Wang
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yi Fang
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jing Wang
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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