ABC portend a dismal prognosis despite standard chemotherapy treatment. A proper risk-stratification is key to optimize the benefit-to-risk ratio of palliative treatment. The PNI is an immune-inflammatory and nutritional indicator showing to be prognostic across a number of malignancies. We aimed at investigating the impact on survival of the PNI in ABC patients (pts) treated with 1L.
Electronic medical records of pts diagnosed with ABC and treated with 1L between 2002 and 2018 at the Modena Cancer Centre were retrospectively reviewed. Clinical, pathological and biochemical variables of potential interest were collected. The PNI was calculated as follows: 10 × serum albumin concentration (g/dL) + 0.005 × peripheral lymphocyte count (number/mm2) and dichotomized using the ROC analysis with 36.7 as the cut-off value. Univariate and multivariate analysis were performed to assess the impact of covariates on overall survival (OS). Kaplan-Meier survival curves were generated and log-rank testing was used to make comparisons.
Overall, 114 pts fulfilled the inclusion criteria and were included in the analysis. 51% (n = 58) were female and 49% (n = 56) had an ECOG PS of 0. 35% (n = 40) of pts received a platinum/gemcitabine doublet, while 65% (n = 74) were treated with other regimens. The median OS in the cohort was 8.1 months. At the univariate analysis the following covariates were associated with OS: PNI (P < 0.0001), CA19.9 (P = 0.0063), CEA (P = 0.0004), LDH (P = 0.0360), alkaline phosphatase (P = 0.0308), monocyte count (P = 0.0124), neutrophil count (P = 0.0013), ECOG PS (P < 0.0001), neutrophil/lymphocyte ratio (NLR) (P < 0.0001). Interestingly, the PNI retained a statistical significance (P = 0.0011) also at the multivariate analysis, together with NLR (P = 0.0046) and ECOG PS (<0.0001). The median OS in pts with a PNI > 36.7 and < 36.7 was 12.1 months and 5.4 months, respectively.
We demonstrated an independent prognostic role for the PNI in a cohort of ABC treated with 1L. Since it is based on easy-to-collect and inexpensive parameters it should be implemented in the clinical practice to improve the accuracy of current available tools.
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All authors have declared no conflicts of interest.