Identification of prognostic nutritional index as a reliable prognostic indicator for advanced lung cancer patients receiving immune checkpoint inhibitors

Abstract

BackgroundPrognostic nutritional index (PNI) has been identified as a reliable prognostic factor for cancer adjuvant therapy. However, its prognostic value in lung cancer patients receiving immune checkpoint inhibitors (ICIs) remains inconclusive.MethodA systematic literature review and meta-analysis was performed based on online databases before March 1th 2023. The correlation of PNI with overall survival (OS) or progression-free survival (PFS) was determined using the hazard ratios (HRs) coupled with 95% confidence intervals (CIs). Then, a retrospective cohort enrolling 123 ICI-treated lung cancer patients from two hospitals was utilized for validation and further investigation.ResultsA total of 14 studies enrolling 1,260 lung cancer patients were included in the meta-analysis. The high PNI level was significantly correlated with better OS (HR = 2.56, 95% CI = 1.86–3.54) and PFS (HR = 1.91, 95% CI = 1.53–2.40) of the lung cancer patients. The subgroup analysis confirmed the results except for the PFS in patients receiving anti-PD-1 therapy (HR = 1.51, 95% CI = 0.86–2.65). In the retrospective study, the high PNI level was identified as a favorable factor for OS and PFS not only in the whole cohort but also in the subgroups stratified by non-small cell lung cancer and small cell lung cancer. The high PNI was also correlated with better anti-cancer therapy response and performed better than body mass index and serum albumin level in OS prediction. Finally, we established a novel prognostic nomogram based on PNI and other clinical parameters. The nomogram was found to perform well in predicting the 1-year OS of ICI-treated lung cancer patients.ConclusionBoth the meta-analysis and retrospective work demonstrate the PNI is a reliable prognostic factor for advanced lung cancer patients receiving ICI-based therapies. Our study further highlights the crucial role of nutrition assessment and intervention in cancer immunotherapy.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, identifier: CRD42023424146.

The preoperative nutritional and inflammatory indexs as prognostic factors in patients with early-stage resectable extrahepatic bile duct cancer

“…A recent report suggested the nutritional status may be correlated with the proportion and function of immune cells (such as T and memory cells) in the tumor microenvironment, therefore affecting the clinical e cacy of the immunotherapies [26] . Yan's study reported that PNI is a reliable prognostic factor for advanced lung cancer patients receiving immune checkpoint inhibitors-based therapies [27] . Yamada's study showed that low pretreatment PNI was an effective independent prognostic factor for shorter OS of patients with metastatic hormone-sensitive prostate cancer [28] .…”

Identification of C-PLAN index as a novel prognostic predictor for advanced lung cancer patients receiving immune checkpoint inhibitors

“…The systemic immune-inflammation index (SII), combining platelet count and NLR, is an unfavorable factor affecting the PFS of NSCLC patients receiving PD-1 inhibitors ( 13 ). Our team has previously proved prognostic nutritional index (PNI) as a reliable prognostic indicator for both ICI-treated NSCLC and small cell lung cancer (SCLC) patients ( 14 ). However, these prognostic indexes are mainly based on laboratory tests, ignoring individual status such as performance status (PS) and smoking status, which may be also crucial for ICI efficacy ( 15 , 16 ).…”