The prognostic value of preoperative prognostic nutritional index in patients with hypopharyngeal squamous cell carcinoma: a retrospective study

Abstract

BackgroundTo analyze the prognostic value of preoperative prognostic nutritional index (PNI) in predicting the survival outcome of hypopharyngeal squamous cell carcinoma (HPSCC) patients receiving radical surgery.MethodsFrom March 2006 to August 2016, 123 eligible HPSCC patients were reviewed. The preoperative PNI was calculated as serum albumin (g/dL) × 10 + total lymphocyte count (mm−3) × 0.005. These biomarkers were measured within 2 weeks prior to surgery. The impact of preoperative PNI on overall survival (OS), progression-free survival (PFS), locoregional recurrence-free survival (LRFS) and distant metastasis-free survival (DMFS) were analyzed using Kaplan–Meier method and Cox proportional hazards model.ResultsMedian value of 52.0 for the PNI was selected as the cutoff point. PNI value was then classified into two groups: high PNI (> 52.0) versus low PNI (≤ 52.0). Multivariate analysis showed that high preoperative PNI was an independent prognostic factor for better OS (P = 0.000), PFS (P = 0.001), LRFS (P = 0.005) and DMFS (P = 0.016).ConclusionsHigh PNI predicts superior survival in HPSCC patients treated with radical surgery. As easily accessible biomarkers, preoperative PNI together with the conventional TNM staging system can be utilized to enhance the accuracy in predicting survival and determining therapy strategies in these patients.

The prognostic value of tumor depth for cervical lymph node metastasis in hypopharyngeal and supraglottic carcinomas

“…Concomitantly, we performed a multivariate analysis adjusting for tumor sites and further subgroup analysis to evaluate the correlation between tumor depth and pathological classification. Despite it was inadequately powered to demonstrate nodal classification, our study raised sufficient questions for further research to be validated in large populations, because we previously confirmed the predictive value of nodal burden for survival in HPSCC . It is recognized that the major limitation of this study was its retrospective nature from a single institution and associated biases.…”

“…The incidence of initial N+ disease was previously reported to be 56.7%‐83.7% in HPSCC and 39.5%‐70% in SGSCC . However, surgical data from END have demonstrated a high risk of occult nodal metastasis of 31%‐57% in HPSCC and 10%‐18% in SGSCC .…”

“…As a consequence, the probability of distant metastasis rises proportionally with the occurrence of initial or delayed nodal disease . Nodal disease demonstrates a major problem in deteriorating survival and highlights the pivotal need for accurate diagnosis and therapeutic control.…”

“…HPSCC and SGSCC frequently present with initial cervical nodal metastatic disease (N+ disease) or with delayed regional metastasis . N+ disease is generally less responsive to treatment than the primary tumor .…”

“…N+ disease is generally less responsive to treatment than the primary tumor . It has been claimed to be a more potent prognostic indicator than the tumor stage of the primary lesion and is associated with a higher risk of regional relapse and distant metastasis, and inferior survival in patients with HPSCC and SGSCC …”