Prognostic significance of the pretreatment prognostic nutritional index in patients with epithelial ovarian cancer

Nutritional index in relation to prognosis of endometrial cancer

Objective: Evaluate the prognostic value of the prognostic nutritional index (PNI) in patients with endometrial cancer (EC). Method: Laboratory and clinicopathological data from 370 patients who were diagnosed with EC between January 2010 and December 2021 were reviewed. The PNI was analyzed for correlations with recurrence and survival. The receiver operating characteristic curves were generated for the PNI. Optimal cut-off values were determined as the points at which the Youden index (sensitivity + specificity - 1) was maximal. Based on the results of the ROC curve analysis, the patients were grouped into high and low PNI groups. Differences in the clinicopathological characteristics between patients with high and low PNI were compared between the two groups. The effects of the prognostic factors were analyzed using univariate and multivariate Cox proportional hazards model. Results: The optimal cutoff value of the PNI was 52.74 for DFS (area under the curve: 0.817; 95% CI: 0.738-0.858, p <0.001). Significantly more patients in the low PNI group experienced recurrence (30.6% vs. 5.2%, p <0.001) and cancer-related death (17.8% vs. 2.8%, p <0.001). In multivariate analysis, PNI were independent prognostic factors for both DFS and overall survival OS. Conclusion: Low PNI was significantly associated with worse clinical outcomes in patients with EC. Our findings demonstrate that the PNI may be clinically reliable and useful as a prognostic marker for patients with EC. Further large-scale prospective studies are needed to confirm our findings.

Diagnostic value of CA125, HE4, and systemic immune-inflammation index in the preoperative investigation of ovarian masses

This study aimed to ascertain the diagnostic accuracy of CA125, HE4, systemic immune-inflammation index (SII), fibrinogen-to-albumin ratio (FAR), prognostic nutritional index (PNI), and their combination for ovarian cancer (OC) to discover an optimal combined diagnostic index for early diagnosis of OC. A thorough investigation was conducted to ascertain the correlation between these markers and the pathological characteristics of OC, thereby providing a foundation for early identification and treatment of this disorder. One hundred seventy patients with documented OC and benign ovarian tumors (BOTs) treated at Hebei General Hospital between January 2019 and December 2022 were included in this retrospective study. Data analysis was conducted using IBM SPSS Statistics version V26.0, MedCalc Statistical Software version 19.4.0, and the R Environment for Statistical Computing software (R Foundation for Statistical Computing). Isolated CA125 showed the best application value for differentiating benign ovarian tumors from OC when the defined variables were compared separately. The combination of CA125, HE4, FAR, SII, and PNI displayed a greater area under the operating characteristic curve curve than any one of them or other combinations of the 5 variables. Compared to CA125 alone, the combination of CA125, HE4, FAR, SII, and PNI showed a slight gain in sensitivity (83.91%), negative predictive value (83.91%), accuracy (85.88%), and a decrease in negative likelihood ratio (0.180%). Higher preoperative CA125, HE4, SII, and FAR levels, and lower PNI levels predicted a higher probability of advanced OC progression and lymph node metastasis. FAR has better application value than other inflammation-related markers (PNI and SII). This study suggests that preoperative serum SII, PNI, and FAR may be clinically valuable markers in patients with OC. FAR has better application value than other inflammation-related markers (PNI and SII). As we delve deeper into the inflammatory mechanisms associated with tumors, we may discover more effective combinations of tumor and inflammatory biomarkers.

Preoperative Prognostic Nutritional Index Is a Prognostic Indicator of Cancer-Specific Survival in Patients Undergoing Endometrial Cancer Surgery

BACKGROUND

The prognostic nutritional index (PNI) reflects systemic inflammation and nutritional status. This study aimed to evaluate the effect of preoperative PNI on postoperative cancer-specific survival in patients with endometrial cancer (EC).

METHODS

Demographic, laboratory, and clinical data were retrospectively collected from 894 patients who underwent surgical resection of EC. Preoperative PNIs were determined from the serum albumin concentration and total lymphocyte count, which were measured within 1 month before surgery. Patients were classified into high PNI (n = 619) and low PNI (n = 275) groups according to the preoperative PNI cut-off value of 50.6. The stabilized inverse probability of treatment weighting (IPTW) method was used to reduce bias: a weighting cohort divided into high PNI (n = 615.4) and low PNI (n = 272.3) groups. The primary outcome measure was postoperative cancer-specific survival.

RESULTS

The postoperative cancer-specific survival rate was higher in the high PNI group than the low PNI group in the unadjusted cohort (93.1% vs. 81.5%; proportion difference [95% confidence interval; 95% CI], 11.6% [6.6-16.6%]; P < 0.001) and in the IPTW-adjusted cohort (91.4% vs. 86.0%; 5.4% [0.8-10.2%]; P = 0.021). In the multivariate Cox proportional hazard regression model in the IPTW-adjusted cohort, high preoperative PNI (hazard ratio [95% CI], 0.60 [0.38-0.96]; P = 0.032) was an independent determinant of postoperative cancer-specific mortality. The multivariate-adjusted restricted cubic spline curve for the Cox regression model showed a significant negative association between preoperative PNI and postoperative cancer-specific mortality (P < 0.001).

CONCLUSION

High preoperative PNI was associated with improved postoperative cancer-specific survival in patients undergoing surgery for EC.

Using preoperative control nutritional status scores as prognostic factors for endometrial cancer

Background

Previous investigations have reported that controlling nutritional (CONUT) status scores, incorporating total cholesterol (TC) and serum albumin (SA) values, and total lymphocyte (LY) counts, are reliable malignant tumor predictors. However, CONUT scores for predicting endometrial cancer (EC) remain unexplored.

Objective

To evaluate preoperative CONUT scores as prognostic factors for postoperative EC.

Methods

We retrospectively evaluated preoperative CONUT scores in 785 surgically resected EC patients at our hospital between June 2012 and May 2016. Using time-dependent receiver operating characteristic (ROC) analyses, patients were split into: 1) CONUT-high (CH) (≥1) and 2) CONUT-low (CL) (<1) groups. Relationships between CONUT scores and different clinicopathological, pathological differentiation, muscle layer infiltration depth, and prognosis factors were examined, and Cox regression analyses performed to assess prognostic values on overall survival (OS) rates.

Results

We assigned 404 (51.5%) and 381 (58.5%) patients to CH and CL groups, respectively. In the CH group, body mass index (BMI), prognostic nutrition index (PNI), and LY/monocyte ratios (LMR) were decreased, however, neutrophil/LY (NLR) and platelet/LY ratios (PLR) were increased. Pathological differentiation analyses showed that G1 proportions were higher in the CL group, while G2 and G3 proportions were more prevalent in the CH group. Muscle layer infiltration depth in CL patients was < 50%, while that it was ≥50% in the CH group. No significant differences in OS rates were recorded between CH and CL groups over 60 months. However long-term survival (LTS) rates after 60 months in the CH group were significantly lower when compared with the CL group, and was more obvious in type II EC patients. Also, periuterine infiltration and preoperative CONUT scores were independent prognostic factors for OS rates as indicated by multi-factor analyses.

Conclusion

CONUT scores not only facilitated the estimation of nutritional status, but were highly beneficial for predicting OS rates in patients with EC after curative resection. CONUT scores provided high predictive values for LTS rates over 60 months in these patients.

Independent predictive value of blood inflammatory composite markers in ovarian cancer: recent clinical evidence and perspective focusing on NLR and PLR

Ovarian cancer (OC) is one of the deadliest malignant tumors affecting women worldwide. The predictive value of some blood inflammatory composite markers in OC has been extensively reported. They can be used for early detection and differential diagnosis of OC and can be used for predicting survival, treatment response, and recurrence in the affected patients. Here, we reviewed the predictive values of composite inflammatory markers based on complete blood count, namely neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio, and systemic inflammation index and markers based on blood protein, namely C-reactive protein-to-albumin ratio and prognostic nutritional index in OC, with a focus on NLR and PLR. We referred to the clinical studies on these six markers, reviewed the patient population, and summarized the marker cut-off values, significance, and limitations of these studies. All these studies were retrospective and most of them were single-center clinical studies with small sample sizes. We found that the cut-off values of these markers have not been unified, and methods used to determine these values varied among studies. The predictive value of these markers on survival was mainly reflected in the postoperative patients of multiple subtypes of ovarian cancer including epithelial OC, high-grade serous ovarian carcinoma, and ovarian clear cell carcinoma. We focused on NLR and PLR and calculated their pooled hazard ratios. NLR and PLR were reliable in predicting overall and progression-free survivals in patients with OC. Therefore, it is necessary to adjust important confounding factors and conduct a long-term follow-up prospective cohort study to further clarify the cut-off values of NLR and PLR and their clinical applications.

Low Prognostic Nutritional Index Contributes to High Adverse Events in Preeclampsia

Background

Preeclampsia (PE) is a common obstetric complication that has caused significant harm to pregnant mothers. The clinical significance of poor nutritional status in PE patients is unclear. The aim of our study was to evaluate the nutritional status as measured by the prognostic nutritional index (PNI) score at admission, and its ability to predict in-hospitalization adverse events in patients with PE.

Methods

We enrolled patients diagnosed with PE in the Third Affiliated Hospital of Guangzhou Medical University from January 2019 to December 2021. Patients were divided into low and high nutritional status group according to the cut-off value of PNI score at admission using the receiver operating characteristic (ROC) curve. PNI score were used to explore the relationship between PNI score and in-hospitalization adverse events presented with hazard ratio (HR) and 95% confidence intervals (CI).

Results

A total of 733 patients were included in the study. The proportion of adverse events and admission to intensive care unit (ICU) was higher in the low nutritional status group than in the high nutritional status group (P < 0.05). ROC curve analysis revealed an area under curve (AUC) of 0.628 for PNI score and the cut-off value of PNI was 37. The free-event rates determined by KM analysis were significantly lower in the low nutritional status compared to the high nutritional status (P < 0.05). Adjusted multivariate analysis showed that PNI score was independently associated with favorable outcomes (HR: 2.66; 95% CI: 1.724-4.050, P < 0.001).

Conclusion

High PNI score at admission was associated with reduced in-hospitalization risk of adverse events in patients with PE. Additional enhancing nutritional status during hospitalization may help to prevent unfavorable prognosis in clinical practices.

Impact of pre-treatment prognostic nutritional index and the haemoglobin, albumin, lymphocyte and platelet (HALP) score on endometrial cancer survival: A prospective database analysis

Purpose

The Onodera’s prognostic nutritional index (PNI) and the haemoglobin, albumin, lymphocyte and platelet (HALP) score are immune-nutritional indices that correlate with survival outcomes in several adult solid malignancies. The aim of this study was to investigate whether PNI and HALP are associated with survival outcomes in endometrial cancer.

Patients and methods

Women undergoing management for endometrial cancer were recruited to a single centre prospective cohort study. Pre-treatment PNI and HALP scores were computed for study participants and analysed as continuous variables and by selecting cut-off values based on previous publications. Both parameters were analysed in relation to overall, endometrial cancer-specific and recurrence-free survival using Kaplan-Meier estimation and multivariable Cox proportional regression.

Results

A total of 439 women, with a median age of 67 years (interquartile range (IQR), 58, 74) and BMI of 31kg/m² (IQR 26, 37) were included in the analysis. Most had low-grade (63.3%), early-stage (84.4% stage I/II) endometrial cancer of endometrioid histological subtype (72.7%). Primary treatment was surgery in 98.2% of cases. Adjusted overall mortality hazard ratios for PNI and HALP as continuous variables were 0.97(95%CI 0.94–1.00, p = 0.136) and 0.99(95%CI 0.98–1.01, p = 0.368), respectively. Women with pre-treatment PNI ≥45 had a 45% decrease in both overall (adjusted HR = 0.55, 95% CI 0.33–0.92, p = 0.022) and cancer-specific mortality risk (adjusted HR = 0.55, 95%CI 0.30–0.99, p = 0.048) compared to those with PNI <45. There was no evidence for an effect of PNI on recurrence free survival. HALP scores were associated with adverse clinico-pathologic factors, but not overall, cancer-specific or recurrence-free survival in the multivariable analysis.

Conclusion

PNI is an independent prognostic factor in endometrial cancer and has the potential to refine pre-operative risk assessment.

The Prognostic Value of Prognostic Nutritional Index in Patients with Ovarian Cancer: A Systematic Review and Meta-Analysis

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.

Progress in Applicability of Scoring Systems Based on Nutritional and Inflammatory Parameters for Ovarian Cancer

Ovarian cancer is a malignancy that seriously endangers women’s health; its case fatality rate ranks first among the gynecological malignancies. The status of nutrition of ovarian cancer patients is related to their prognoses. Thus, it is important to evaluate, monitor, and improve the nutritional status of ovarian cancer patients during their treatment. Currently, there are several tools for examining malnutrition and nutritional assessment, including NRI (nutrition risk index), PG-SGA (patient-generated subjective global assessment), and NRS 2002 (nutritional risk screening 2002). In addition to malnutrition risk examination and related assessment tools, the evaluation of muscle mass, C-reactive protein, lymphocytes, and other inflammation status indicators, such as neutrophils to lymphocytes ratio, lymphocyte-to-monocyte ratio, and C-reactive protein-albumin ratio, is of great importance. The nutritional status of ovarian cancer patients undergoing surgery affects their postoperative complications and survival rates. Accurate evaluation of perioperative nutrition in ovarian cancer patients is crucial in clinical settings. An intelligent nutritional diagnosis can be developed based on the results of its systematic and comprehensive assessment, which would lay a foundation for the implementation of personalized and precise nutritional therapy.

Clinical indicators useful in decision-making about palliative chemotherapy for end-of-life ovarian cancer patients

PURPOSE

Chemotherapy for end-of-life ovarian cancer patients is a complex and delicate problem. We evaluated whether active palliative chemotherapy is beneficial for such patients using inflammatory parameters, nutritional indicators, and the PPI (Palliative Prognostic Index), which predicts short-term prognosis.

METHODS

Thirty-six patients among 49 patients who died from ovarian cancer from 2014 to 2019 at our hospital were enrolled, whom clinical and laboratory data just before starting their final chemotherapy regimen could be obtained. Associations between the time from last chemotherapy to death and the following parameters were investigated: age, performance status, neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio, Modified Glasgow Prognostic Score (mGPS), Prognostic Nutritional Index (PNI) score, and PPI score.

RESULTS

The median age was 57 (range 19-80) years. The median time from last chemotherapy to death was 45.5 (range 11-110) days. Eight patients (22%) died within 30 days of their last chemotherapy regimen. In univariate analysis, median survival time was significantly shorter in patients with higher NLR, mGPS 2, and higher PPI values; NLR (≥ median vs. < median): 32 (range 11-80) days vs. 54 (range 35-110) days, p = 0.008; mGPS (2 vs. 0-1): 42 (range 11-80) days vs. 96 (range 49-110) days, p = 0.012; and PPI score (≥ median vs. < median): 38 (range 11-74) days vs. 60 (range 18-110) days, p = 0.005. However, in multivariate analysis, no factors were identified as independent prognostic factors for survival.

CONCLUSION

Parameters, such as NLR, mGPS, and PPI score, may be indicators for discontinuation of palliative chemotherapy, and may be useful for maximizing end-of-life care for ovarian cancer patients.

Albumin-to-Alkaline Phosphatase Ratio: Does It Predict Survival in Grade 1 and Grade 2 Neuroendocrine Tumors?

OBJECTIVES

Neuroendocrine tumors (NETs) are very heterogeneous tumors. This study aimed to evaluate prognostic value of an albumin-to-alkaline phosphatase (ALP) ratio (AAPR) in well-differentiated NETs.

METHODS

A total of 110 patients were included in this study. Albumin-to-alkaline phosphatase ratio was calculated by dividing albumin concentration (g/dL) to ALP level (U/L). Cutoff value for AAPR was determined by receiver operating characteristic analysis. Survival analysis was performed by Kaplan-Meier method with the log-rank test. A P value of less than 0.05 was considered statistically significant.

RESULTS

The optimum cutoff value for AAPR was 0.028. Patients were divided into 2 groups as patients with AAPR of 0.028 or less (n = 22, 20%) and with AAPR of greater than 0.028 (n = 88, 80%). Patients with AAPR of greater than 0.028 had statistically longer overall survival compared with patients with 0.028 or less (not reached vs 96.8 months, P = 0.001). In addition, AAPR has been shown to be an independent prognostic factor for overall survival in multivariate analysis (hazard ratio, 3.99; 95% confidence interval, 1.26-12.61, P = 0.018).

CONCLUSIONS

Patients with higher AAPR had more favorable prognosis compared with patients with lower AAPR. We demonstrated that AAPR can be of prognostic value in well-differentiated NETs.

The role of prognostic nutritional index for clinical outcomes of gastric cancer after total gastrectomy

The purpose of this article is to evaluate the relationship between the nutrition-based microenvironment and clinicopathological information for gastric cancer patients and to investigate the prognostic value of nutrition index for gastric cancer patients undergoing total gastrectomy. We retrospectively collected clinical information of 245 gastric cancer patients who underwent total gastrectomy in our hospital between January 1st 2005 and December 30th 2015. According to the prognostic nutritional index (PNI) level, they were divided into low PNI (< 43) group and high PNI (≥ 43) group. The relationship between PNI and the disease-free survival (DFS) and overall survival (OS) were analyzed by statistical analysis. Univariate analyses demonstrated that TNM stage (p = 0.025), patients age (p = 0.042), lymph node metastasis (p = 0.028), tumor differentiation (p = 0.037) and a low PNI (p = 0.033) were closely correlated with a poor prognosis. In multivariate analysis, TNM stage (p = 0.027) and a low PNI (p = 0.041) were found to be independently associated with poor survival. Additionally, when age was considered as a stratified factor, univariate analyses demonstrated that low PNI correlated with shorter DFS in non-elderly (< 65) patients (p = 0.022) and shorter DFS (p = 0.036) and OS (p = 0.047) in elderly (≥ 65) patients. The low prognostic nutritional index is an independent risk factor associated with poor gastric cancer survival which represents the nutritional microenvironment. Patients with low pre-operative prognostic nutritional index levels should be observed more closely after surgery to prevent the occurrence of post-operative complications in the near future.

Prognostic significance of preoperative prognostic nutritional index in ovarian cancer: A systematic review and meta-analysis

BACKGROUND

The prognostic significance of preoperative prognostic nutritional index (PNI) in ovarian cancer (OC) is uncertain, and this study is aimed to clarify the prognostic significance.

METHODS

We used 4 common databases for conducting a systematic review and meta-analysis, and eligible studies were included in the analysis. The association of preoperative PNI with overall survival (OS), progression-free survival (PFS), and clinicopathological parameters was analyzed.

RESULTS

A total of 2050 patients with OC receiving the surgical treatment were analyzed in this study. Patients with low PNI tended to have a shorter OS (hazard ratio [HR] = 1.82, 95% CI = 1.30-2.55, P < .01) and PFS (HR = 1.91, 95% CI = 1.53-2.39, P < .01) compared with those with high PNI. Besides, low PNI was significantly associated with more advanced International Federation of Gynecology and Obstetrics stage (P < .01), the occurrence of ascites (P < .01), larger residual tumor (P < .01), insensitive to chemotherapy (P < .01), and higher CA125 (P < .01) compared with high PNI in OC.

CONCLUSION

Low preoperative PNI is associated with shorter OS, shorter PFS, and worse clinicopathological parameters in OC. Low preoperative PNI is an unfavorable prognostic indicator of patients with OC.

The Preoperative Prognostic Nutritional Index for the Prediction of Outcomes in Patients with Early-Stage Ovarian Clear Cell Carcinoma

The prognostic nutritional index (PNI), which reflects preoperative malnutrition, is useful for predicting the incidence of postoperative complications and has been reported in recent years to predict the long-term prognosis of various malignancies. The purpose of this study was to clarify the significance of PNI as a prognostic factor for early-stage clear cell ovarian carcinoma. A total of 82 patients with stage I–II (FIGO 2014) ovarian clear cell carcinoma undergoing primary surgery at our hospital from January 2005 to December 2017 were enrolled. PNI was calculated using the formula: 10 × serum albumin (g/ dL) + 0.005 × peripheral blood lymphocyte count (/mm³). Preoperative PNI exhibited relatively high area under the curve value (0.709) for 5 year survival, and the optimal cutoff value was 46.5. The overall survival was significantly shorter in the PNI-low group than in the PNI-high group. Multivariate analysis showed that high PNI was a significant independent prognostic factor for favorable prognosis (hazard ratio = 0.102, p = 0.010). There was no significant difference in recurrence-free survival between the two groups (p = 0.220), but the postrecurrence survival was significantly longer in the PNI-high group than in the PNI-low group (p = 0.0383). The preoperative PNI was a useful predictor of prognosis, even in early-stage ovarian clear cell carcinoma.