Baseline Low Prognostic Nutritional Index Predicts Poor Survival in Locally Advanced Nasopharyngeal Carcinomas Treated With Radical Concurrent Chemoradiotherapy

Abstract

Background: To retrospectively assess the impact of prognostic nutritional index (PNI) on survival outcomes of patients with locoregionally advanced nasopharyngeal carcinoma (LA-NPC) treated with concurrent chemoradiotherapy (CCRT). Methods: This study incorporated 154 patients with LA-NPC who received exclusive cisplatinum-based CCRT. Receiver operating characteristic (ROC) curve analysis was utilized for accessibility of pretreatment PNI cutoffs influencing survival results. The primary end point was the interaction between the overall survival (OS) and PNI values, while cancer-specific survival (CSS) locoregional progression-free survival (LR-PFS), distant metastasis-free survival (DMFS), and PFS were the secondary end points. Results: A rounded PNI cutoff value of 51 was identified in ROC curve analyses to exhibit significant link with CSS, OS, DMFS, and PFS outcomes, but not LR-PFS. Patients grouping per PNI value (!51 [N ¼ 95] vs <51 [N ¼ 49]) revealed that PNI < 51 group had significantly shorter median CSS (P < .001), OS (P < .001), DMFS (P < .001), and PFS (P < .001) times than the PNI ! 51 group, and the multivariate results confirmed the PNI < 51 as an independent predictor of poor outcomes for each end point (P < .05 for each). The unfavorable impact of the low PNI was also continued at 10-year time point with survival rates of 77.9% versus 42.4%, 73.6% versus 33.9%, 57.9% versus 27.1%, and 52.6% versus 23.7% for CSS, OS, DMFS, and PFS, respectively. Additionally, we found that PNI < 51 was significantly associated with higher rates of weight loss >5% over past 6 months (49.2% versus 11.6%; P ¼ .002) compared to PNI < 51 group. Conclusion: Low pre-CCRT PNI levels were independently associated with significantly reduced CSS, OS, DMFS, and PFS outcomes in patients with LA-NPC treated with definitive CCRT.

Low Advanced Lung Cancer Inflammation Index Predicts Poor Prognosis in Locally Advanced Nasopharyngeal Carcinoma Patients Treated with Definitive Concurrent Chemoradiotherapy

“…Reckoning that almost 40% of all mortalities are assigned to the intercurrent chronic illnesses or different causes as opposed to the LA-NPC itself [ 27 ], which was 29.2% in our present research, such kind of research may have utmost significance in the dismissal of perplexing cancer-unrelated causes and thorough evaluation of the definite merit of the intended prognostic factors or indices in this patients' group. Moreover, 90% higher locoregional control rates revealed from the IMRT literature for LA-NPC and our overall 10-year actuarial rate of 87.6% [ 11 , 28 , 29 ] altogether do not only disclose the most likely reason for the lack of a meaningful relationship between the ALI measures and LRPFS, but also robustly stress the pressing urgency for the implementation of more effective systemic agents to the current LA-NPC treatment algorithms to accomplish superior survival outcomes, such as the novel targeted agents and/or immunotherapies.…”

“…Additionally, the accessible proof has indicated a firm connection between the systemic inflammatory condition and a shortened survival span, as well as many cancer-related symptoms including pain, anorexia, debilitation, and cancer cachexia in numerous cancer types [ 5 ]. Therefore, as in other tumor primaries, various investigators focused on the inflammation and nutrition biomarkers in previous LA-NPC studies and identified some factors with notable prognostic utility; these include the body mass index (BMI), C-reactive protein (CRP) and albumin levels, neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), Glasgow prognostic score (GPS), and prognostic nutritional index (PNI) [ 6 – 11 ]. Jafri et al exhibited strong prognostic worth for the advanced lung cancer inflammation index (ALI), as a novel prognostic system, for patients with metastatic non-small-cell lung cancer [ 12 ].…”

Prognostic nutritional index and its dynamics after curative treatment are independent prognostic factors on survival in non-metastatic nasopharyngeal carcinoma

“…Three of these ve studies were from South Asia, while two of them were from Turkey. Furthermore, two of them used only univariate analysis (9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). Our study had a retrospective design, included only local and locally advanced NPC patients; the PNI cut-off was 50.65 for pre-treatment and 44.75 for post-treatment.…”

“…Many studies have shown that PNI is an important prognostic marker in various cancers (8). Some recently published studies also revealed that pre-treatment PNI is related to NPC patients' survival outcomes (9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20).…”

Prognostic Nutritional Index and its Dynamics After Curative Treatment are Independent Prognostic Factors on Survival in Non-Metastatic Nasopharyngeal Carcinoma

“…To compare the two Turkish population studies with our article, in the rst one written by Gundog (17). A part of our study was to evaluate pretreatment PNI as a prognostic factor, as these two pieces of research did.…”