There is increasing evidence that the presence of an ongoing systemic inflammation response and the nutritional status are a stage-independent predictor of poor outcome in cancer patients. This study aims to investigate association of the Prognostic Nutritional Index (PNI), a proposed marker of cancer-related inflammation and nutritional status, with survival in LAHNSCC patients (pts).
We included 137 LAHNSCC pts treated with induction chemotherapy (ICT) followed by concurrent chemoradiotherapy (CCRT) at Hospital La Fe (HFV) (n = 50) and Hospital Clínico (HCV) (n = 87) between 2011-2016; they were used as a training (HFV) and validation (HCV) set respectively. Demographic and clinical data were collected. All nutritional factors were measured within 5 days before ICT. PNI was calculated as: 10× serum albumin concentration (g/dL) + 0.005× lymphocyte count (number/mm2) in peripheral blood (Nozoe et al, 2010). Receiver operating characteristic (ROC) curve was used to determine the optimal cutoff for PNI in the HFV set. Cox regression models were used to investigate the association of PNI with OS.Table:
1091P The Prognostic Nutritional Index (PNI): definition
|0 points||PNI ≥ cutoff = PNI-high group||Normal nutritional status – Low risk|
|1 point||PNI < cutoff = PNI-low group||Moderate severe nutritional impairment - High Risk|
At baseline, HFV pts were younger with a median age of 54.5 (41-59 years) vs 60.6(43-77 years) and with less advanced stage (stage III 18.8 vs 20.5%; stage IVA: 78.1 vs 62.1%; stage IVB:3.1 vs 17.2%). The optimal cutoff established in the HFV set was 45. According to this cutoff, 10 pts (20%) in HFV set had a low PNI. In HFV set, OS at 12-months follow-up (FU) was 75% in PNI-high group vs 37.5% in PNI-low group (P = 0.032) with a Hazard ratio of (HR) of 2.84 (95%CI 1.04-7.78) in the multivariate analysis. In the HCV set, a low PNI was found in 23 (26.4%) out of 87 pts. OS at 12-months FU was 95% in PNI-high group and 45% in PNI-low group (p = 0.007) with a HR of 3.9 (95% CI 1.45-10.98) in the multivariate analysis.
PNI is a valuable prognostic marker in LAHNSCC associated with survival in pts treated with ICT followed by CCRT. PNI could be useful for stratification in future clinical trials.
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All authors have declared no conflicts of interest.