A novel, externally validated inflammation-based prognostic algorithm in hepatocellular carcinoma: the prognostic nutritional index (PNI)

Abstract

Background:There is increasing evidence that the presence of an ongoing systemic inflammatory response is a stage-independent predictor of poor outcome in patients with cancer. The aim of this study was to investigate whether an inflammation-based prognostic score, the prognostic nutritional index (PNI), is associated with overall survival (OS) in patients with hepatocellular carcinoma (HCC).Methods:All patients with a new diagnosis of HCC presenting to the Medical Oncology Department, Hammersmith Hospital between 1993 and 2011 (n=112) were included. Demographic and clinical data were collected. Patients in whom the combined albumin (g l−1) × total lymphocyte count × 109 l−1 was ⩾45, at presentation, were allocated a PNI score of 0. Patients in whom this total score was <45 were allocated a score of 1. Univariate and multivariate analyses were performed to identify clinicopathological variables associated with OS. Independent predictors of survival identified on multivariate analysis were validated in an independent, stage-matched cohort of 68 patients.Results:Univariate analyses showed that PNI (P=0.003), intrahepatic spread (P<0.001), the presence of extrahepatic disease (P=0.006), portal vein thrombosis (P=0.02), tumour multifocality (P=0.003), alfa-fetoprotein >400 ng ml−1 (P<0.001) and Barcelona Clinic Liver Cancer score (P<0.01) were all predictors of OS in the training set. Multivariate analysis revealed the PNI (P=0.05), presence of extrahepatic disease (P<0.001) and degree of intrahepatic spread (P<0.001) as independent predictors of worse OS in this population. The PNI retained independent prognostic value in the validation set (P<0.001).Conclusion:The presence of a systemic inflammatory response, as measured by the PNI, is an independent and externally validated predictor of poor OS in patients with HCC.

Systemic Immune-inflammation Index, Based on Platelet Counts and Neutrophil-Lymphocyte Ratio, Is Useful for Predicting Prognosis in Small Cell Lung Cancer

“…Previous stud- ies have shown that elevated NLR and PLR at the baseline were associated with worse OS and disease-free interval in resected and advanced cancers (Proctor et al 2011;Lee et al 2013;Paramanathan et al 2014;Pinato et al 2014). PNI is not commonly used as a score for the measurement of systemic inflammatory responses, and a study of hepatocellular carcinoma (HCC) found that PNI was an independent and externally validated predictor of poor OS in patients with HCC (Pinato et al 2012). Only two studies have focused on the value of NLR for prognosis in SCLC, with the results indicating that elevated NLR could predict worse OS and PFS (Kang et al 2014;Wang et al 2014).…”

Novel immunological and nutritional-based prognostic index for gastric cancer

“…Identifying prognostic factors before surgery to help determine the optimal preoperative therapy and timing of surgery is important. Previous attempts have focused on a number of immuno-nutritional indices, including PNI, NLR, PLR, PI, and GPS [4,6,7,9,15,21,[25][26][27] . However, their reported prognostic value can vary between studies of the same cancer type; for example, in hepatocellular carcinoma, PLR was found to be a prognostic marker in one study, but another study suggested that only PNI was a prognostic marker [15] .…”

“…Its application as a prognostic marker was recently suggested by some researchers, and it was recently used to predict prognosis in a number of malignancies, including pancreatic, hepatocellular, and colorectal carcinoma. However, its prognostic significance in gastric cancer has not been fully studied, and the mechanisms that link PNI to outcome remain unclear [7][8][9] . In addition to PNI, markers of systematic inflammation, such as the number of white blood cells, neutrophils, platelets, and lymphocytes, and the indices derived from these, including the neutrophil-lymphocyte ratio (NLR) [10,11] and platelet-lymphocyte ratio (PLR), have also been used as prognostic markers.…”

Role of Supportive Care for Terminal Stage Hepatocellular Carcinoma

“…51 Prognostic nutritional index, has been found to be independently associated with overall survival in patients with hepatocellular carcinoma. 52 It is known that patients with weight loss and muscle wasting have poorer clinical outcomes than patients without such weight loss or muscle wasting. As a consequence, efforts have been made to supply nutrients with the intent of improving the nutritional status.…”