Prognostic Nutritional Index, Tumor-infiltrating Lymphocytes, and Prognosis in Patients with Esophageal Cancer

Abstract

Objective: To determine whether prognostic nutritional index (PNI) affects clinical outcome through local immunity in esophageal cancers. Background: PNI is an indicator of nutritional status and systemic immune competence, and has attracted attention as a prognostic biomarker. Tumor-infiltrating lymphocytes (TILs) are a specific histological feature of human cancers, reflecting an individual's immunological tumor response. Methods: Using a nonbiased database of 337 curatively resected esophageal cancers, we evaluated the relationship between PNI, TILs status, CD8 expression by immunohistochemical staining, and clinical outcome. Results: Compared with PNI-high cases (n = 220), PNI-low cases (n = 117) showed significantly worse overall survival (log-rank P < 0.001; hazard ratio: 2.23; 95% confidence interval: 1.56–3.18; P < 0.001; multivariate hazard ratio: 1.67; 95% confidence interval: 1.14–2.44; P = 0.008). The TILs status was also significantly correlated with overall survival (P < 0.001). In addition, PNI was significantly associated with TILs status (P < 0.001) and the CD8-positive cell count (P = 0.041). A significant relationship between the peripheral blood lymphocyte count and TILs status was also observed (P < 0.001). Conclusions: PNI and TILs score expression were associated with clinical outcome in esophageal cancer, supporting their roles as prognostic biomarkers. Considering the relationship between PNI and TILs, nutritional status and systemic immune competence may influence patient prognosis through local immune response.

Prognostic Impact of Sarcopenia and Skeletal Muscle Loss During Neoadjuvant Chemoradiotherapy in Esophageal Cancer

“…The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were calculated as ANC/ALC and platelet count/ALC, respectively. In addition, we calculated the prognostic nutritional index (PNI), which is associated with the survival outcome and nutritional status of cancer patients, including esophageal cancer patients [24,25]. PNI was calculated as (10 × albumin [g/dL] + 0.005 × ALC) [26].…”

Prognostic Nutritional Index and Systemic Immune-Inflammation Index Predict the Prognosis of Patients with HCC

“…[16][17][18] The status of nutrition is also closely associated with postoperative complications and the clinical outcomes of patients with various solid tumors. Recently, many indicators containing nutritional and inflammatory variables have been found to play a role in predicting the prognoses for cancer patients, such as those with colorectal cancer, 19 esophageal cancer, 20 and so on. The concept of the prognostic nutritional index (PNI) was first proposed by Buzby et al 21 to evaluate the risk of gastrointestinal surgery.…”

Predictive value of prognostic nutritional index in patients with oral squamous cell carcinoma

“…Several lines of evidence have shown that PNI has been identified as a novel prognostic parameter. Lower PNI was significantly associated with inferior survival in nasopharyngeal carcinoma, hepatocellular carcinoma, esophageal cancer, renal cell carcinoma, and ovarian cancer (Du et al, 2015; Feng et al, 2018; Kang et al, 2017; Okadome et al, 2018; Pinato, North, & Sharma, 2012). However, it is noteworthy that the values of this prognostic biomarker considerably varied in diverse cancer contexts.…”

“…Accumulating evidence has revealed that it reflects immunonutritional status and systemic inflammatory reaction with more accuracy than other variables (Morgan et al, 2011). Furthermore, PNI has been reported to be a powerful and independent prognostic factor in human cancers such as colorectal cancer, gastric cancer, lung cancer, and esophageal cancer (Migita et al, 2013; Mori et al, 2015; Noh et al, 2017; Okadome et al, 2018). However, the prognostic significance of PNI in OSCC remains largely underexplored.…”