Prognostic Nutritional Index as an independent prognostic factor in locoregionally advanced squamous cell head and neck cancer

Abstract

BackgroundLocally advanced head and neck squamous cell carcinoma (LAHNSCC) is a heterogeneous disease in which better predictive and prognostic factors are needed. Apart from TNM stage, both systemic inflammation and poor nutritional status have a negative impact on survival.MethodsWe retrospectively analysed two independent cohorts of a total of 145 patients with LAHNSCC treated with induction chemotherapy followed by concurrent chemoradiotherapy at two different academic institutions. Full clinical data, including the Prognostic Nutritional Index (PNI), neutrophil to lymphocyte ratio and derived neutrophil to lymphocyte ratio, were analysed in a training cohort of 50 patients. Receiver operating characteristic curve analysis was used to establish optimal cut-off. Univariate and multivariate analyses of prognostic factors for overall survival (OS) were performed. Independent predictors of OS identified in multivariate analysis were confirmed in a validation cohort of 95 patients.ResultsIn the univariate analysis, low PNI (PNI<45) (p=0.001), large primary tumour (T4) (p=0.044) and advanced lymph node disease (N2b-N3) (p=0.025) were significantly associated with poorer OS in the validation cohort. The independent prognostic factors in the multivariate analysis for OS identified in the training cohort were dRNL (p=0.030) and PNI (p=0.042). In the validation cohort, only the PNI remained as independent prognostic factor (p=0.007).ConclusionsPNI is a readily available, independent prognostic biomarker for OS in LAHNSCC. Adding PNI to tumour staging could improve individual risk stratification of patients with LAHNSCC in future clinical trials.

Determining Malnutrition Assessment Criteria to Predict One-Year Mortality for Locally Advanced Head and Neck Cancer Patients Undergoing Concurrent Chemoradiotherapy

“…Thrombocytosis may dampen the recognition and cytotoxicity of tumor cells by immune cells [28] or promote tumor growth by stimulating tumor angiogenesis, vascular invasion, and distant metastasis [32,33]. Our results reinforce the predictive values of PNI and PLR seen in previous retrospective studies, which showed that the PNI predicted overall survival and treatment-related toxicities in LAHNC patients [22,34] and that the PLR predicted survival outcomes and disease recurrence in HNC patients [35][36][37]. Moreover, this study demonstrated that the combination of these two parameters provided better prediction of one year mortality in LAHNC patients.…”

“…BMI was defined as weight in kilograms divided by height in meters squared (kg/m 2 ); BWL was calculated as (BW at diagnosis -ideal BW)/ideal BW × 100%. The laboratory nutrition indexes were calculated as follows: PNI, 10 × serum albumin (g/dL) + 0.005 × total lymphocyte count (TLC) (/mm 3 ), and NRI, 1.519 × serum albumin (g/L) + 41.7 × (initial BW/ideal BW) [22,23]. The NRI scores were classified into severe (< 83.5), moderate (83.5-97.5), mild (97.5-100), and no malnutrition (> 100) risk groups [23].…”

Onodera's prognostic nutritional index correlates with tumor immune environment and survival in patients with oral squamous cell carcinoma undergoing chemoradiotherapy

“…However, there have been few studies that have described the prognostic significance of OPNI for patients with head and neck cancer who undergo radiotherapy or chemoradiotherapy [ 23 ]. Although Bruixola et al reported that OPNI is an independent prognostic factor in locoregionally advanced squamous cell head and neck cancer who undergo chemoradiotherapy following induction chemotherapy [ 24 ]; to the best of our knowledge, our study is the first to report the prognostic value of OPNI in patients with OSCC who undergo definitive CRT. The results of the present study are also in line with current evidence, suggesting that OPNI could be useful for guiding treatment decisions for patients with OSCC undergoing chemotherapy and/or radiotherapy.…”

Prophylactic percutaneous endoscopic gastrostomy in patients with head and neck cancer: Influence on nutritional status, utilisation rate and complications

“…A multimodal treatment approach with a combination of surgery and non‐surgical/conservative treatment (ie, radiation, chemotherapy) is associated with extensive surgical wounds and mucositis which impairs the ability for oral food intake . Although there is an abundance of proposed clinical and laboratory parameters, there is still no general consensus how to best assess the nutritional status and consequently stratify the risk for malnutrition. Several studies for instance have shown that a low BMI is associated with poor overall survival .…”