Prognostic Impact of Immunonutritional Status Changes During Preoperative Chemoradiation in Patients With Rectal Cancer

Abstract

PurposePrevious studies have demonstrated the prognostic impact of the prognostic nutritional index (PNI), a proposed indicator of immunonutritional statuses of surgical patients, on patients with various gastrointestinal cancers. Although the prognostic impact of the PNI on patients with colorectal cancer has been well established, its value has not been studied in patients treated with preoperative chemoradiation (pCRT). This study aimed to evaluate the prognostic impact of PNI on patients receiving pCRT for locally advanced rectal cancer (LARC).MethodsPatients with LARC who underwent curative pCRT followed by surgical resection were enrolled. The PNI was measured in all patients before and after pCRT, and the difference in values was calculated as the PNI difference (dPNI). Patients were classified according to dPNI (<5, 5–10, and >10). Clinicopathologic parameters and long-term oncologic outcomes were assessed according to dPNI classification.ResultsNo significant intergroup differences were observed in clinicopathologic parameters such as age, histologic grade, tumor location, tumor-node-metastasis stage, and postoperative complications. Approximately 53% of the patients had a mild dPNI (<5); only 15% had a high dPNI (>10). Univariate and multivariate analyses identified the dPNI as an independent prognostic factor for disease-free status (P < 0.01; hazard ratio [HR], 2.792; 95% confidence interval [CI], 1.577–4.942) and for cancer-specific survival (P = 0.012; HR, 2.469; 95%CI, 1.225–4.978).ConclusionThe dPNI is predictive of long-term outcomes in pCRT-treated patients with LARC. Further prospective studies should investigate whether immune-nutritional status correction during pCRT would improve oncologic outcomes.

<p>Low Prognostic Nutritional Index Predicts Poor Clinical Outcomes in Patients with Stage IIIB Non-small-cell Lung Carcinoma Undergoing Chemoradiotherapy</p>

“…However, this issue has been investigated in a group of 261 patients with locally advanced rectal cancer, where the patients were stratified arbitrarily into three groups according to the PNI difference (dPNI) between the neo-adjuvant CRT and pre-surgical measurements: dPNI < 5; dPNI of 5-10 and dPNI > 10; the dPNI was found to be firmly linked with survival outcomes. 47 Finally, our results ought not to be generalized to all stage IIIB NSCLC patients as they are restricted to a highly selected patients group with ECOG scores of 0-1, <80 years of age and BMI≥20 kg/m 2 .…”

<p>Preoperative Fibrinogen-Albumin Ratio Index (FARI) is a Reliable Prognosis and Chemoradiotherapy Sensitivity Predictor in Locally Advanced Rectal Cancer Patients Undergoing Radical Surgery Following Neoadjuvant Chemoradiotherapy</p>

“… 7 , 8 , 39 , 51 – 53 In addition, TRG was also correlated to the systemic inflammatory response and nutritional status. 54 , 55 Therefore, we further explored the relationship between FARI and response to NCRT. According to the survival analysis, TRG could not distinguish the patients with poor OS or DFS rates among all LARC patients ( Figure 6A and B , P=0.132 and P=0.499).…”

Immunological Status May Predict Response to Nivolumab in Non-small Cell Lung Cancer without Driver Mutations

“…Onodera et al reported that a simplified PNI, which is based on only two laboratory parameters (albumin value and lymphocyte count), can be measured easily and used routinely in clinical practice (14). The serum albumin concentration reflects not only the patient's nutritional status but also chronic inflammation, and the serum lymphocyte count has been identified as an objective parameter of inflammation (20). Several reports have described low PNI at diagnosis as being an independent marker of poor outcomes for patients with various types of cancer (10,11,20,21).…”

“…The serum albumin concentration reflects not only the patient's nutritional status but also chronic inflammation, and the serum lymphocyte count has been identified as an objective parameter of inflammation (20). Several reports have described low PNI at diagnosis as being an independent marker of poor outcomes for patients with various types of cancer (10,11,20,21). PNI values greater than 50 were defined as normal, while those less than 50, 45, and 40 were regarded as mild, moderate-to-severe, and serious malnutrition, respectively (10).…”