Prognostic Nutritional Index (PNI) in Patients With Breast Cancer Treated With Neoadjuvant Chemotherapy as a Useful Prognostic Indicator

Abstract

ObjectivePrognostic nutritional index (PNI), calculated as serum albumin (ALB) (g/L) + 5 × total lymphocyte count (109/L), is initially used to evaluate nutritional status in patients undergoing surgery and may evaluate the therapeutic effects and predict the survival of various solid tumors. The present study aimed to evaluate the potential prognostic significance of PNI in breast cancer patients receiving neoadjuvant chemotherapy (NACT).MethodsA total of 785 breast cancer patients treated with neoadjuvant chemotherapy were enrolled in this retrospective study. The optimal cutoff value of PNI by receiver operating characteristic curve stratified patients into a low-PNI group (<51) and a high PNI group (≥51). The associations between breast cancer and clinicopathological variables by PNI were determined by chi-square test or Fisher’s exact test. Kaplan–Meier plots and log-rank test were used to evaluate the clinical outcomes of disease-free survival (DFS) and overall survival (OS). The prognostic value of PNI was analyzed by univariate and multivariate Cox proportional hazards regression models. The toxicity of NACT was accessed by the National Cancer Institute Common Toxicity Criteria (NCI-CTC).ResultsThe results indicated that PNI had prognostic significance by an optimal cutoff value of 51 on DFS and OS in univariate and multivariate Cox regression survival analyses. Breast cancer patients with a high PNI value had longer DFS and OS than those with a low PNI value [47.64 vs. 36.60 months, P < 0.0001, hazard ratio (HR) = 0.264, 95%CI = 0.160–0.435; 73.61 vs. 64.97 months, P < 0.0001, HR = 0.319, 95%CI = 0.207–0.491, respectively]. Furthermore, the results indicated that patients with high PNI had longer DFS and OS than those with low PNI in early stage and advanced breast cancer, especially in advanced breast cancer. The mean DFS and OS times for breast cancer patients with high PNI by the log-rank test were longer than in those with low PNI in different molecular subtypes. Moreover, the mean DFS and OS times in patients with high PNI by the log-rank test were longer than in those patients with low PNI without or with lymph vessel invasion. The common toxicities after neoadjuvant chemotherapy were hematologic and gastrointestinal reaction, and the PNI had no significance on the toxicities of all enrolled patients, except in anemia, leukopenia, and myelosuppression.ConclusionPretreatment PNI with the advantages of being convenient, noninvasive, and reproducible was a useful prognostic indicator for breast cancer patients receiving neoadjuvant chemotherapy and is a promising biomarker for breast cancer on treatment strategy decisions.

A Novel Inflammatory-Nutritional Prognostic Scoring System for Patients with Early-Stage Breast Cancer

“… 24 , 46 The PNI was summed using serum albumin levels and the peripheral lymphocyte counts, which have been proven to reflect the nutritional status of patients and are associated with their survival in many studies. 28 , 47 Elevation of the ALP level, another serum biological factor reflecting the nutritional status of humans, might represent a heavy tumor burden. 26 The AAPR is calculated by dividing the serum albumin level by the serum ALP level, and its prognostic value in several cancers has been commonly recognized, 48–50 similar to our previous study on patients with nonmetastatic breast cancer.…”

“…The relationship between obesity and an elevated risk of breast tumors might promote cancer-related inflammation, and PNI could be a convenient and useful biomarker for personalized therapeutic decisions for breast cancer. 27 , 28 …”

“…The relationship between obesity and an elevated risk of breast tumors might promote cancer-related inflammation, and PNI could be a convenient and useful biomarker for personalized therapeutic decisions for breast cancer. 27,28 Nowadays, increasing attention is being focused on the establishment of prognostic models based on abovementioned parameters for individualized survival prediction in women with breast cancer. However, no study has comprehensively studied all these inflammatory-nutritional biomarkers.…”

Correlation of the controlling nutritional status score and the prognostic nutritional index with the prognosis of patients treated with radiotherapy for small-cell lung cancer

“…In addition, tumor dyscrasia can also often lead to hypocholesterolemia in patients. It is well established that nutritional status as assessed by PNI and CONUT is significantly associated with the prognosis of patients with several malignancies, including breast (11), colorectal (12), lymphoma (13), esophageal (14), pancreatic (15), and cervical cancer (16).…”

The Prognostic Value of TNI (Tumor-Nutrition-Inflammation Index) in Patients with Advanced Lung Cancer

“…It has also been reported that low AGR or high SIRI is associated with poorer survival outcomes [6][7][8]. Nutritional and in ammatory indicators are related to the prognosis of patients with cancer [2,9,10]. Nevertheless, these studies focused on a single marker, patients at a certain stage, or a particular cytological classi cation.…”