Prognostic nutrition index strongly predicts survival in locally advanced NSCLC
Prognostic nutrition index (PNI) strongly predicts clinical outcomes in patients with locally advanced non-small-cell lung cancer (NSCLC), according to two studies presented at the International Association for the Study of Lung Cancer 19th World Conference on Lung Cancer (WCLC 2018).
In one study conducted by researchers from the Okayama University Hospital, Okayama, Japan, a lower PNI before induction chemoradiation therapy (CRT) in patients undergoing surgery was found to be associated with worse clinical outcomes. [Soh J, et al, WCLC 2018, abstract P1.17-15]
“PNI, calculated using serum albumin levels and peripheral lymphocyte count [PNI = 10 x serum albumin (g/dL) + 0.005 x total lymphocyte count (mm3)], has been used to predict clinical outcomes in various types of cancer,” the researchers pointed out. “Results of our study suggest that improving perioperative nutrition may promote better outcomes in patients with locally advanced NSCLC who receive induction CRT followed by surgery.”
The study included 128 patients with locally advanced NSCLC (stage IIA/IIB, n=15; stage IIIA, n=87; stage IIIB, n=25; stage IV, n=1) who underwent induction CRT followed by surgery at Okayama University Hospital. The patients’ PNIs were calculated before induction CRT (median of 5 days before administration), before surgery (median of 5 days before surgery), and after surgery (median of 30 days after surgery).
Results showed that the PNI value significantly decreased during the whole course of treatment in the overall population as well as in those who had highly invasive disease (n=60).
In multivariate analysis in patients with highly invasive disease, extremely low PNI (first quartile) before induction CRT was associated with significantly lower recurrence-free survival (RFS) (hazard ratio [HR], 2.7554; p=0.0261) and numerically lower overall survival (OS) (HR, 1.9482; p=0.2326). Meanwhile, ypN0 disease was significantly associated with better RFS (HR, 0.3900; p=0.0396) and OS (HR, 0.2487; p=0.0127). Postoperative complication (yes vs no) and postoperative length of hospital stays (>21 vs ≤21 days) failed to reach statistical significance in predicting RFS and OS in this setting.
Meanwhile, a Turkish retrospective study showed that PNI strongly predicted survival outcomes in 358 patients with stage IIIB NSCLC who had received radiotherapy at 60–66 Gy and at least one cycle of platinum-based doublet chemotherapy concomitantly. [Besen AA, et al, WCLC 2018, abstract P1.17-02]
Patients in the study were grouped by a PNI cutoff of 40.1 (ie, PNI ≥40 [n=183] and PNI <40 [n=175]). The median OS was 25.2 months in the overall population, while the median progression-free survival (PFS) and median locoregional PFS were 10.7 months and 15.4 months, respectively.
Compared with patients who had a PNI <40, those with a PNI ≥40 had significantly longer median OS (36.7 months vs 16.8 months; p<0.001), median locoregional PFS (19.5 months vs 11.5 months; p<0.001), and median PFS (13.6 months vs 8.6 months; p<0.001). In multivariate analysis, the prognostic value of PNI was found to be independent of other covariates.