Neoadjuvant chemotherapy-induced decrease of prognostic nutrition index predicts poor prognosis in patients with breast cancer

Abstract

Background: The prognostic nutritional index (PNI), which is an easily calculated nutritional index, is significantly associated with patient outcomes in various solid malignancies. This study aimed to evaluate the prognostic impact of PNI changes in patients with breast cancer undergoing neoadjuvant chemotherapy (NAC). Methods: We reviewed patients with breast cancer who underwent NAC and a subsequent surgery for breast cancer between 2005 and 2016. PNI before and after NAC were calculated using the following formula: 10 × serum albumin (g/dl) + 0.005 × total lymphocyte count/mm 3. The relationship between PNI and prognosis was retrospectively analyzed. Results: In total, 191 patients were evaluated. There was no significant difference in disease-free survival (DFS) between the pre-NAC PNI high group and the pre-NAC PNI low group (cutoff: 53.1). However, PNI decreased in 181 patients (94.7%) after NAC and the mean PNI also significantly decreased after NAC from 52.6 ± 3.8 pre-NAC to 46.5 ± 4.4 post-NAC (p < 0.01). The mean ΔPNI, which was calculated as pre-NAC PNI minus post-NAC PNI, was 5.4. The high ΔPNI group showed significantly poorer DFS than the low ΔPNI group (cut off: 5.26) (p = 0.015). Moreover, high ΔPNI was an independent risk factor of DFS on multivariate analysis (p = 0.042). Conclusions: High decrease of PNI during NAC predicts poor prognosis. Thus, maintaining the nutritional status during NAC may result in better treatment outcomes in patients with breast cancer.

Skeletal muscle loss during neoadjuvant chemotherapy predicts poor prognosis in patients with breast cancer

“…In this regard, our results provide a novel finding that a decrease in SMI during NAC might have a negative effect on prognosis in patients with breast cancer. Similar to this study, we previously demonstrated that a decrease in PNI during NAC for patients with breast cancer was associated with worse prognosis, but not pretreatment PNI [ 3 ]. Furthermore, other studies have shown that changes in NLR during NAC correlated with the efficacy of NAC and patient survival [ 38 – 40 ].…”

“…In addition, NAC allows the evaluation of dynamic changes in the systemic conditions of patients who have a primary tumor during treatment . We previously demonstrated that a decrease in the prognostic nutritional index (PNI), which represents systemic nutritional and immunological status, during NAC had a prognostic impact in patients with breast cancer [ 3 ]. Hence, NAC may have the potential to provide other prognostic markers with respect to changes in patients’ status during treatment.…”

“…Previous studies have indicated that high body mass index (BMI) was associated with poor prognosis in patients with breast cancer [ 4 , 5 ]. Conversely, some studies have shown no correlation between BMI and patient outcomes in breast cancer [ 3 , 6 ]. This uncertainty underlying the influence of BMI is possibly, at least in part, because of the fact that BMI cannot account for the difference between adipose tissue and muscles and thus cannot evaluate the exact body composition.…”

“…Furthermore, unlike patients undergoing palliative chemotherapy for other types of cancer, those treated with NAC for breast cancer have early-stage cancer. Hence, patients with breast cancer undergoing NAC are not likely to be sarcopenic at diagnosis [ 3 ]. Accordingly, it is possible that the effect of skeletal muscle index (SMI) changes in patients with breast cancer undergoing NAC is not equivalent to that in patients with other types of cancer undergoing palliative chemotherapy.…”

Prognostic Value of the Systemic Immune-Inflammation Index and Prognostic Nutritional Index in Patients With Medulloblastoma Undergoing Surgical Resection

“…A high decrease in PNI during neoadjuvant chemotherapy predicts a poor prognosis. Maintaining nutritional status during neoadjuvant chemotherapy might lead to better treatment outcomes for the patients with breast cancer (12). Therefore, SII and PNI are prognostic indicators worthy of investigation in MB.…”