Prognostic nutritional index as a prognostic marker in glioblastoma: Data from a cohort of 282 Italian patients

Rigamonti, Andrea; Imbesi, F.; Silvani, Antonio; Lamperti, E.; Agostoni, Elio; Porcu, Luca; Simone, Irene De; Torri, Valter; Ciusani, Emilio; Bonato, Claudio; Salmaggi, Andrea

doi:10.1016/j.jns.2019.04.002

Cited by 20 publications

(21 citation statements)

References 22 publications

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“…For the latter, recent studies put forward to use prognostic nutritional index [PNI, calculated as albumin (g/L) + 5 × total lymphocyte count (10 9 /L)] and albumin-to-globulin ratio (AGR). As expected, most of the known studies proved preoperative AGR [ 9 , 10 , 14 – 16 ] and PNI [ 10 , 12 , 18 , 19 ] were independent prognostic factors of OS for patients with glioma. Unfortunately, there were still occasional studies to indicate PNI was not associated with prognosis.…”

Section: Introductionsupporting

confidence: 69%

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Prognostic significance of preoperative serum albumin, albumin-to-globulin ratio, and prognostic nutritional index for patients with glioma

Liu¹,

Wang²

2020

Medicine

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Background: The serum albumin, albumin-to-globulin ratio (AGR), and prognostic nutritional index (PNI) have been recommended to represent the nutritional and inflammatory status. Thus, they may be potential prognostic biomarkers for cancer. However, contradictory results were reported in different studies on glioma. The goal of this study was to perform a meta-analysis to re-evaluate their prognostic potential for glioma. Methods: Databases of PubMed, EMBASE, and Cochrane Library were systematically searched to enroll all the studies investigating the prognostic significance of albumin, AGR, and PNI for glioma. Pooled hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using STATA 13.0 software to indicate the intensity of association. Results: Eleven studies with 2928 cases were included. Overall meta-analysis showed that the prognostic values of albumin, AGR, and PNI were limited for glioma ( P > .05). However, subgroup analysis demonstrated a high preoperative serum albumin was significantly related with excellent OS of patients with GBM (HR = 0.95, 95% CI: 0.91–0.99, P = .018), while high PNI (HR = 0.56, 95% CI: 0.43–0.73, P < .001) and AGR (HR = 0.57, 95% CI: 0.34–0.96, P = .034) may be a protective factor of favorable OS for patients with high-grade gliomas. Furthermore, integration of all studies with multivariate analysis and clear cut-off also proved reduced preoperative serum albumin, AGR, and PNI were predictors of poor prognosis for patients with gliomas. Conclusion: Preoperative serum albumin, AGR, and PNI may represent promising biomarkers to predict the prognosis in patients with glioma, especially for high-grade.

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Section: Introductionsupporting

confidence: 69%

“…Unfortunately, there were still occasional studies to indicate PNI was not associated with prognosis. [ 13 , 14 , 20 ] Hereby, their prognostic significance also needs further assessment. [ 21 ]…”

Section: Introductionmentioning

confidence: 99%

Prognostic significance of preoperative serum albumin, albumin-to-globulin ratio, and prognostic nutritional index for patients with glioma

Liu¹,

Wang²

2020

Medicine

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“…It is easily calculated in daily routine, and a simple means to assess perioperative immunological and nutritional condition and stratify the risk of postoperative complications [14]. The preoperative or pretreatment PNI status is a good prognostic indicator in various cancers, including lung [15,16], gastric [17], and colorectal [18] cancers, and glioblastoma [19]. However, sufficient data regarding the application of the PNI in the field of cancer immunotherapy are lacking.…”

Section: Introductionmentioning

confidence: 99%

Peripheral blood markers predictive of outcome and immune-related adverse events in advanced non-small cell lung cancer treated with PD-1 inhibitors

Peng

Wang

Liu

et al. 2020

Cancer Immunol Immunother

175

145

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Background Selected patients with advanced non-small cell lung cancer (NSCLC) benefit from immunotherapy, especially immune checkpoint inhibitors such as PD-1 (programmed cell death protein 1) inhibitor. Peripheral blood biomarkers would be most convenient to predict treatment outcome and immune-related adverse events (irAEs) in candidate patients. This study explored associations between inflammation-related peripheral blood markers and onset of irAEs and outcome in patients with advanced NSCLC receiving PD-1 inhibitors. Methods A retrospective analysis was conducted of 102 patients with advanced NSCLC receiving PD-1 inhibitors from January 2017 to May 2019. Cox regression models were employed to assess the prognostic effect of low/high neutrophil/ lymphocyte ratio (NLR), lactate dehydrogenase (LDH), and prognostic nutrition index (PNI) on overall survival (OS) and progression-free survival (PFS). Logistic regression models were used to analyze the correlation between peripheral blood markers and the onset of irAEs. Result NLR < 5, LDH < 240 U/L, or PNI ≥ 45 was favorably associated with significantly better outcomes compared with higher, higher, or lower values, respectively. The multivariate analysis determined that these parameters were independently associated with both better PFS (p = 0.049, 0.046, 0.014, respectively) and longer OS (p = 0.007, 0.031, < 0.001, respectively). Patients with three favorable factors among NLR, LDH, and PNI had better PFS and OS than did those with two, one, or none. PNI and NLR were associated with the onset of irAEs. Conclusion In patients with advanced NSCLC treated with PD-1 inhibitors, pretreatment NLR, LDH, and PNI may be useful predictive markers of clinical outcome and irAEs.

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“…Two other retrospective studies have been con rmed PNI as an independent prognostic factor for survival in newly diagnosed glioblastoma [19][20] . Conversely, Rigamonti et al didn't nd any association between PNI and OS in their series of glioblastoma patients [HR = 0.79 (95%CI:0.61-1.03), p = 0.07] 21 . Studies about the clinical signi cance of PNI in patients with high-grade glioma are summarized in Table-4. Recurrent high-grade gliomas generally have a poor prognosis.…”

Section: Discussionmentioning

confidence: 86%

“…Serum albumin level has been found to be an independent prognostic factor for survival, and lower albumin levels correlated with poor prognosis in patients with GBM [14][15][16] . Recent studies also showed the PNI to be an independent prognostic factor for survival in GBM [17][18][19][20][21] . While the effect of preoperative PNI was studied in GBM, recurrent glioblastoma patients have not been included in these studies.…”

Section: Introductionmentioning

confidence: 95%

Impact of Prognostic Nutritional Index on Survival in Recurrent High-Grade Glial Tumors Treated with Systemic Treatment

Alan¹,

Telli²,

Başoğlu³

et al. 2020

Preprint

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Background: Primary brain tumors are relatively rare malignancy, with high-grade gliomas (glioblastoma multiforme and anaplastic gliomas) are the most common types . We aimed to evaluate the prognostic value of Prognostic Nutritional Index (PNI), which is calculated by lymphocyte count and albumin, in recurrent high-grade glioma patients treated with systemic treatment.Methods: Data of 92 patients with recurrent high-grade glioma who received systemic treatment and followed in our clinic between 2012-2018 was retrospectively collected and analyzed. PNI was calculated as: [(10 × serum albumin (g/dL)) + (0.005 × total lymphocyte count)]. Patients were categorized according to the median PNI value. We investigated the prognostic role of PNI groups, and survival outcomes.Results: Median value of PNI was 46.02, and median follow-up duration was 9 months (1-68 months). Median overall survival (OS) was 8.1 months (95%CI: 6.04-10.3). Median OS was significantly longer in patients with PNI> 46.02 compared to patients with PNI ≤ 46.02 (13.9 months (95%CI: 9.8-18.1), and 6.07 months (95%CI: 4.3-7.7), p=0.01, respectively). In multivariate analysis, PNI was found to be an independent prognostic factor for OS [HR:0.54(95%CI:0.3-0.97), p=0.03)].Conclusion: In our study, the PNI was found to be an independent prognostic biomarker in patients with recurrent high-grade gliomas, but further prospective trials are necessary to validate its prognostic role.

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Prognostic nutritional index as a prognostic marker in glioblastoma: Data from a cohort of 282 Italian patients

Cited by 20 publications

References 22 publications

Prognostic significance of preoperative serum albumin, albumin-to-globulin ratio, and prognostic nutritional index for patients with glioma

Prognostic significance of preoperative serum albumin, albumin-to-globulin ratio, and prognostic nutritional index for patients with glioma

Peripheral blood markers predictive of outcome and immune-related adverse events in advanced non-small cell lung cancer treated with PD-1 inhibitors

Impact of Prognostic Nutritional Index on Survival in Recurrent High-Grade Glial Tumors Treated with Systemic Treatment

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