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Background:
Numerous studies identified that pretreatment prognostic nutritional index (PNI) was significantly associated with the prognosis in various kinds of malignant tumors. However, the prognostic value of PNI in small cell lung cancer (SCLC) remains controversial. We performed the present meta-analysis to estimate the prognostic value of PN...
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Background: Small cell lung cancer (SCLC) is characterized with high risk of brain metastasis and poor survival. This study aimed to assess the prognostic role of LDH in limited stage small-cell lung cancer (LS-SCLC) treated with thoracic radiotherapy (TRT) and prophylactic cranial irradiation (PCI).
Methods: This study retrospectively evaluated 19...
Introduction Small cell lung cancer (SCLC) represents about 15% of all lung cancers. Extensive stage (ES) SCLC represents around 60% of diagnosed SCLC cancers. The median survival in untreated ES SCLC is 2 to 4 months and that of treated cases is 8 to 13 months.
Aim and Objectives This retrospective analysis aims to find out the clinical outcome of...
Citations
... Studies have linked hypoalbuminemia with reduced quality of life, shorter life expectancy, immunosuppression, and loss of muscle mass in cancer patients. Recent studies further demonstrated that hypoproteinemia contributes to malnutrition and weight loss, leading to poorer outcomes and increased cancer-related mortality (8,10,13,15,16). ...
... This study has several differences from the previous studies. This study combines NSCLC and SCLC, while some previous studies only analyze one type of lung cancer (14,15,22). Past studies evaluated PNI prospectively, whereas this study used a retrospective design to analyze data. ...
Systemic immune-inflammation index (SII) and prognostic nutritional index
(PNI) serve as simple and practical tests that help indicate inflammatory and
nutritional status to some extent. Lung cancer stands out as the most common
contributor to cancer-related mortality globally. It is associated with an
unfavorable prognosis. Most patients diagnosed with lung cancer have
metastasis at the time of diagnosis. Prognostic heterogeneity of cancer patients causes the need for more prognostic biomarkers. This study aimed to evaluate the clinical value of SII and PNI in predicting metastasis in lung cancer patients.SII and PNI provides a prognostic value in lung cancer. Retrospective cross-sectional research was conducted in this study involving 138 data from
medical records at the Inpatient and outpatient Department of Pulmonology,
RSPAL dr. Ramelan Surabaya in April 2019 to July 2023. Kolmogorov-Smirnov test, contingency coefficient test, and ROC analysis were done to analyze the data obtained. Patients with metastatic lung cancer had higher SII than those
without metastasis. The group of patients with metastasis had an average SII of
5391.34 and a PNI of 40.11. The group of patients without metastasis had an
average SII of 2849.52 and PNI of 43.05. Lung cancer metastasis was correlated significantly with SII but not with PNI. The cut-off value was determined using the ROC curve. The cut-off value for SII was 2198.54 (68.5% sensitivity and 58.7% specificity) and for PNI was 42.2 (62% sensitivity and 54.3% specificity). SII was correlated with lung cancer metastasis and may be a
promising indicator predicting of metastasis. PNI showed no significant
correlation with lung cancer metastasis.
Keywords: Systemic immune-inflammation index;Prognostic nutritional index;Lung cancer;Prognostic biomarker
#LungCancer #SystemicImmuneInflammationIndex #PrognosticNutritionalIndex
#CancerPrognosis #MetastasisPrediction #BiomarkersInCancer #CancerResearch #Oncology #PrognosticValue #SII #PNI
... 95% CI: 1.24-1.64, P 0.001) among SCLC patients [28]. Therefore, we deem that it is still needed to further explore the predictive role of pretreatment PNI for the prognosis in extensive-stage SCLC receiving first-line immunotherapy combined with chemotherapy. ...
The aim of this study was to further explore the association between pretreatment prognostic nutritional index (PNI) and survival among advanced lung cancer patients who received the first-line immunotherapy based on current relevant studies. Several databases were searched up to July 17, 2023. Progression-free survival (PFS) and overall survival (OS) were primary outcomes and the hazard ratios (HRs) with 95% confidence intervals (CIs) were combined. Subgroup analysis based on the pathological type [non-small cell lung cancer (NSCLC) vs small cell lung cancer (SCLC)] and combination of other therapies (yes vs no) were performed. Ten studies with 1291 patients were included eventually. The pooled results demonstrated that higher pretreatment PNI was significantly related to improved PFS (HR=0.62, 95% CI: 0.48-0.80, P＜0.001) and OS (HR=0.52, 95% CI: 0.37-0.73, P＜0.001). Subgroup analysis revealed that the predictive role of pretreatment PNI for PFS (HR=0.61, 95% CI: 0.45-0.81, P=0.001) and OS (HR=0.52, 95% CI: 0.35-0.77, P=0.001) was only observed among NSCLC patients and the combination of other therapies did not cause an impact on the prognostic role of PNI in lung cancer. Pretreatment PNI was significantly associated with prognosis in advanced NSCLC receiving first-line immunotherapy and patients with a lower pretreatment PNI had poorer survival.
... Measures of particular interest on laboratory testing included levels of LDH, sodium, and hemoglobin, previously identified as prognostic markers in ES-SCLC (14)(15)(16)(17). Our database did not include data on nutritional or inflammatory markers that have shown prognostic value in some studies (38). ECOG PS was obtained based on the description of patient functional status in the initial history and physical examination for patients whenever it was not explicitly stated. ...
Background
Extensive-stage small-cell lung cancer (ES-SCLC) is an incurable cancer with poor prognosis in which characteristics predictive of long-term survival are debated. The utility of agents such as immune checkpoint inhibitors highlights the importance of identifying key characteristics and treatment strategies that contribute to long-term survival and could help guide therapeutic decisions.
Objective
This real-world analysis examines the characteristics, treatment patterns, and clinical outcomes of patients receiving chemotherapy without immunotherapy for ES-SCLC in Manitoba, Canada.
Methods
A retrospective cohort study assessed patient characteristics, treatment, and survival duration (short: <6 months; medium: 6–24 months; long: >24 months) using the Manitoba Cancer Registry and CancerCare Manitoba records. Eligible patients were aged >18 years with cytologically confirmed ES-SCLC diagnosed between January 1, 2004, and December 31, 2018, and received cytotoxic chemotherapy (CT). The one-, two-, and five-year probabilities of overall survival (OS) were assessed relative to patient, disease, and treatment characteristics using Kaplan-Meier methods and Cox proportional hazards models.
Results
This analysis included 537 patients. Cisplatin was used in 56.1% of patients, 45.6% received thoracic radiotherapy (RT), and few received prophylactic cranial irradiation (PCI). In the overall cohort, one-, two- and five-year OS rates were 26%, 8%, and 3%, respectively. For patients with Eastern Cooperative Oncology Group Performance Status (ECOG PS) 0, OS rates at one, two, and five years were 43%, 17%, and 10%, respectively, vs. 27%, 8%, and 2% for those with ECOG PS 1–2, and 16%, 3%, and 3% for those with ECOG PS 3–4. In long-term survivors, ECOG PS scores were lower and abnormal laboratory test results were less frequent. Overall, 74.4% of long-term survivors received thoracic RT and 53.5% received PCI. Known poor prognostic factors – including brain/liver metastases, high lactate dehydrogenase (LDH), abnormal sodium, and low hemoglobin levels – were less common but still seen in long-term survivors.
Conclusion
Although rare, patients with ES-SCLC may experience long-term survival with CT ± thoracic RT ± PCI. Factors predicting long-term survival include traditional prognostic factors such as ECOG PS, LDH level, and receipt of thoracic RT or PCI. These findings support current treatment algorithms for ES-SCLC and provide baseline survival estimates to assess the real-world impact of adding immune checkpoint inhibitors in the future.
... Second to LDH and NSE, the PNI was also manifested as a valuable index for prognostic evaluation, especially for short-term survival in smokers or men subgroups. A pooled analysis including 4,164 patients with SCLC suggested that low PNI was correlated with decreased OS in SCLC (20). The study also illustrated that Eastern Cooperative Oncology Group (ECOG) performance status (PS) ≥2, extensive stage, and PCI were influencing factors for PNI. ...
Objective
Various studies have investigated the predictive significance of numerous peripheral blood biomarkers in patients with small cell lung cancer (SCLC). However, their predictive values have not been validated. This study assessed and evaluated the ability of common nutritional or inflammatory indicators to predict overall survival (OS) in patients with SCLC who received first-line chemotherapy.
Methods
Between January 2008 and July 2019, 560 patients with SCLC were enrolled at the Sichuan University West China Hospital. Eleven nutritional or inflammatory indices obtained before chemotherapy were evaluated. The cutoff values of continuous peripheral blood indices were confirmed through maximally selected rank statistics. The relationship of peripheral blood indices with OS was investigated through univariate and multivariate Cox regression analyses. Harrell’s concordance (C-index) and time-dependent receiver operating characteristic curve were used to evaluate the performance of these indices.
Results
A total of 560 patients with SCLC were enrolled in the study. All the patients received first-line chemotherapy. In the univariate Cox analysis, all indices, except the Naples score, were related to OS. In the multivariate analysis, albumin–globulin ratio was an independent factor linked with prognosis. All indices exhibited poor performance in OS prediction, with the area under the curve ranging from 0.500 to 0.700. The lactic dehydrogenase (LDH) and prognostic nutritional index (PNI) were comparatively superior predictors with C-index of 0.568 and 0.550, respectively. The LDH showed incremental predictive values, whereas the PNI showed diminishing values as survival time prolonged, especially for men or smokers. The LDH with highest sensitivity (0.646) and advanced lung cancer inflammation index (ALI) with highest specificity (0.952) were conducive to identifying death and survival at different time points.
Conclusion
Common inflammatory or nutritional biomarkers are only marginally useful in predicting outcomes in patients with SCLC receiving first-line chemotherapy. Among them, LDH, PNI, and ALI are relatively promising biomarkers for prognosis evaluation.
... PNI is derived from the serum albumin concentration and lymphocyte count, which is frequently adopted to reflect the nutritional and immunological status of patients (Xiao et al., 2022). A growing number of studies have elucidated that PNI is significantly correlated with the prognosis of patients with malignancies (Wang et al., 2018;Jiang et al., 2020c;Karimi et al., 2021). Emerging evidence also revealed that PNI is also significantly correlated with the prognosis of infectious disease (Doganci et al., 2020;Karimi et al., 2021;Xiao et al., 2022). ...
Background
Elderly cancer patients are more predisposed to developing nosocomial infections during anti-neoplastic treatment, and are associated with a bleaker prognosis. This study aimed to develop a novel risk classifier to predict the in-hospital death risk of nosocomial infections in this population.
Methods
Retrospective clinical data were collected from a National Cancer Regional Center in Northwest China. The Least Absolute Shrinkage and Selection Operator (LASSO) algorithm was utilized to filter the optimal variables for model development and avoid model overfitting. Logistic regression analysis was performed to identify the independent predictors of the in-hospital death risk. A nomogram was then developed to predict the in-hospital death risk of each participant. The performance of the nomogram was evaluated using receiver operating characteristics (ROC) curve, calibration curve, and decision curve analysis (DCA).
Results
A total of 569 elderly cancer patients were included in this study, and the estimated in-hospital mortality rate was 13.9%. The results of multivariate logistic regression analysis showed that ECOG-PS (odds ratio [OR]: 4.41, 95% confidence interval [CI]: 1.95-9.99), surgery type (OR: 0.18, 95%CI: 0.04-0.85), septic shock (OR: 5.92, 95%CI: 2.43-14.44), length of antibiotics treatment (OR: 0.21, 95%CI: 0.09-0.50), and prognostic nutritional index (PNI) (OR: 0.14, 95%CI: 0.06-0.33) were independent predictors of the in-hospital death risk of nosocomial infections in elderly cancer patients. A nomogram was then constructed to achieve personalized in-hospital death risk prediction. ROC curves yield excellent discrimination ability in the training (area under the curve [AUC]=0.882) and validation (AUC=0.825) cohorts. Additionally, the nomogram showed good calibration ability and net clinical benefit in both cohorts.
Conclusion
Nosocomial infections are a common and potentially fatal complication in elderly cancer patients. Clinical characteristics and infection types can vary among different age groups. The risk classifier developed in this study could accurately predict the in-hospital death risk for these patients, providing an important tool for personalized risk assessment and clinical decision-making.
... PNI is a synthetically nutritional evaluation index representing protein synthesis and the body's immune function. 51 Nutritional state may affect the metabolism and function of immune cells, and malnutrition can lead to immunosuppression and affects prognosis in patients. 52 PNI was originally used to assess the perioperative risk of gastrointestinal surgery patients. ...
... PNI is a synthetically nutritional evaluation index representing protein synthesis and the body's immune function. 51 Nutritional state may affect the metabolism and function of immune cells, and malnutrition can lead to immunosuppression and affects prognosis in patients. 52 PNI was originally used to assess the perioperative risk of gastrointestinal surgery patients. ...
Background:
The prognostic significance of nutrition indicators in patients with heart failure with preserved ejection fraction (HFpEF) is unclear.
Objectives:
This systematic review and meta-analysis aimed to assess the prognostic value of serum albumin (SA), the geriatric nutritional risk index (GNRI), and the prognostic nutritional index (PNI) in patients with HFpEF.
Methods:
Databases of PubMed, Embase, The Cochrane Library, and Web of Science were systematically searched for all studies published up to January 2022. The prognostic significance of SA, GNRI, and PNI for HFpEF was explored. Pooled hazard ratio (HR) and 95% confidence interval (CI) were estimated using the STATA 15.0 software. The Quality of Prognosis Studies tool was used to assess the quality of studies.
Results:
Nine studies met the inclusion criteria, and 5603 adults with HFpEF were included in the meta-analysis. The analyses showed that a decreased SA or GNRI was significantly related to high all-cause mortality (HR: 1.98; 95% CI: 1.282-3.057; p = 0.002; and HR: 1.812;95% CI: 1.064-3.086; p = 0.029, respectively). Furthermore, a lower SA indicates a bad composite outcome of all-cause mortality and HF rehospitalization (HR: 1.768; 95% CI: 1.483-2.108; p = 0.000), and a lower GNRI was significantly associated with high cardiovascular mortality (HR: 1.922; 95% CI: 1.504-2.457;p = 0.000). However, a lower PNI did not correlate with all-cause mortality (HR: 1.176; 95% CI: 0.858-1.612, p=0.314).
Conclusions:
Our meta-analysis indicates that SA and GNRI may be useful indicators to predict the prognosis of patients with HFpEF.
... The pretreatment platelet-to-lymphocyte ratio (PLR) in patients with ES-SCLC receiving first-line chemotherapy reportedly correlated with OS and PFS in a phase II trial cohort [16]. Similarly, some immunological and nutritional markers during platinum doublet chemotherapy have correlated with ES-SCLC prognosis, including the neutrophil-to-lymphocyte ratio (NLR) in a meta-analysis [17] and a single institute [18], the prognostic nutritional index (PNI) in a meta-analysis [19], PNI in combination with neuron-specific enolase [20], and the systemic immune-inflammation index (SII) in a single institute [21]. However, a contradictory report from a single institute exists where NLR did not correlate with OS in patients with SCLC [22]. ...
... Previous reports were used to define cut-off values for the following immunological and nutritional markers: PLR [16,25,26], NLR [17,18,21,22,26,27], PNI [19,20,26,28], and SII [21,29,30]. PLR was the ratio of absolute platelet count (/µL) divided by absolute lymphocyte count (/µL) and grouped based on PLR < 250 or ≥250. ...
... Thus, these markers were also investigated as candidate biomarkers for predicting treatment outcomes. PLR [16], NLR [17,18], PNI [19,20], and SII [21] are predictive of OS in patients with ES-SCLC. NLR and PNI significantly correlated with OS in this study. ...
Simple Summary
Chemoimmunotherapy improved overall survival (OS) and progression-free survival (PFS) in patients with extensive-stage small cell lung cancer (ES-SCLC) in two phase III trials, which set the age-stratified subgroup analyses at 65 years. Considering the super-aged society of Japan, treatment efficacy and safety in elderly patients ≥ 75 years with ES-SCLC should be validated through real-world Japanese evidence. Consecutive 225 Japanese patients with SCLC were evaluated, and 155 received chemoimmunotherapy (98 non-elderly and 57 elderly patients). The dose reduction at initiating the first cycle was significantly higher in the elderly (47.4%) than in the non-elderly (20.4%) patients (p = 0.03). The median PFS and OS in the non-elderly and the elderly were 5.1 and 14.1 months and 5.5 and 12.0 months, respectively, without significant differences. Multivariate analyses revealed that age, the baseline Eastern Cooperative Oncology Group performance status, and dose reduction at initiating the first chemoimmunotherapy cycle were not correlated with PFS or OS.
Abstract
Chemoimmunotherapy improved overall survival (OS) and progression-free survival (PFS) in patients with extensive-stage small cell lung cancer (ES-SCLC) in two phase III trials. They set the age-stratified subgroup analyses at 65 years; however, over half of the patients with lung cancer were newly diagnosed at ≥75 years in Japan. Therefore, treatment efficacy and safety in elderly patients ≥ 75 years with ES-SCLC should be evaluated through real-world Japanese evidence. Consecutive Japanese patients with untreated ES-SCLC or limited-stage SCLC unfit for chemoradiotherapy between 5 August 2019 and 28 February 2022 were evaluated. Patients treated with chemoimmunotherapy were divided into the non-elderly (<75 years) and elderly (≥75 years) groups, and efficacy, including PFS, OS, and post-progression survival (PPS) were evaluated. In total, 225 patients were treated with first-line therapy, and 155 received chemoimmunotherapy (98 non-elderly and 57 elderly patients). The median PFS and OS in non-elderly and elderly were 5.1 and 14.1 months and 5.5 and 12.0 months, respectively, without significant differences. Multivariate analyses revealed that age and dose reduction at the initiation of the first chemoimmunotherapy cycle were not correlated with PFS or OS. In addition, patients with an Eastern Cooperative Oncology Group performance status (ECOG-PS) = 0 who underwent second-line therapy had significantly longer PPS than those with ECOG-PS = 1 at second-line therapy initiation (p < 0.001). First-line chemoimmunotherapy had similar efficacy in elderly and non-elderly patients. Individual ECOG-PS maintenance during first-line chemoimmunotherapy is crucial for improving the PPS of patients proceeding to second-line therapy.
... Lymphocytes play an important role in tumor-related immunology and have strong antitumor immune functions (20). Therefore, PNI reflects the nutritional and immune status of patients and has been widely used as a prognostic indicator for various cancer patients (21)(22)(23)(24). Some previous studies have found that a low PNI is positively correlated with poor prognosis in patients with biliary tract cancer, and the use of this parameter has shown the potential to improve prediction and identify high-risk patients more accurately and precisely (25). ...
Background
The occurrence of postoperative complications of distal cholangiocarcinoma (dCCA) is an indicator of poor patient prognosis. This study aimed to determine the immune-nutritional indexes (INIs) that can predict short-term postoperative complications.
Methods
A retrospective analysis of 148 patients with dCCA who were operated radical pancreaticoduodenectomy at the First Hospital of Lanzhou University from December 2015 to March 2022 was conducted to assess the predictive value of preoperative INIs and preoperative laboratory tests for short-term postoperative complications, and a decision tree model was developed using classification and regression tree (CART) analysis to identify subgroups at risk for overall complications.
Results
In this study, 83 patients (56.08%) experienced overall complications. Clavien-Dindo grade III-V complications occurred in 20 patients (13.51%), and 2 patients died. The areas under curves (AUCs) of the preoperative prognostic nutritional index (PNI), controlling nutritional status (CONUT) score, and neutrophil-to-lymphocyte ratio (NLR) were compared; the PNI provided the maximum discrimination for complications (AUC = 0.685, 95% CI = 0.600–0.770), with an optimal cutoff value of 46.9, and the PNI ≤ 46.9 group had higher incidences of overall complications (70.67% vs. 40.00%, P < 0.001) and infectious complications (28.77% vs. 13.33%, P = 0.035). Multivariate logistic regression analysis identified PNI (OR = 0.87, 95% CI: 0.80–0.94) and total bilirubin (OR = 1.01, 95% CI: 1.00–1.01) were independent risk factors for overall complications ( P < 0.05). According to CART analysis, PNI was the most important parameter, followed by the total bilirubin (TBIL) level. Patients with a PNI lower than the critical value and TBIL higher than the critical value had the highest overall complication rate (90.24%); the risk prediction model had an AUC of 0.714 (95% CI, 0.640–0.789) and could be used to stratify the risk of overall complications and predict grade I-II complications ( P < 0.05).
Conclusion
The preoperative PNI is a good predictor for short-term complications after the radical resection of dCCA. The decision tree model makes PNI and TBIL easier to use in clinical practice.
... Recent studies have demonstrated that the nutritional and immune status of patients with tumours is equally important for cancer progression and prognosis. 4,5 The prognostic nutritional index (PNI) score is calculated using the serum albumin level and peripheral lymphocyte count, 6 which can indicate the nutritional and immune status of patients with tumours. The PNI score possesses the characteristics of being non-invasive, has real-time acquisition, and is economical in the clinic, thereby ensuring convenient application and promotion. ...
Background
Low baseline prognostic nutritional index (PNI) scores are associated with poor survival for various malignancies; however, they vary based on the cohort and time resulting in inaccurate results. We determined the predictive value of the PNI score variations in addition to the baseline PNI scores for patients with advanced non-small cell lung cancer (NSCLC) who received programmed cell death protein 1 (PD-1) inhibitor.
Methods
We retrospectively analysed 115 patients with advanced NSCLC who received PD-1 inhibitor. The median follow-up period was 28 months. Patients were clustered into four groups based on the combined PNI scores (combination of baseline and variation of PNI scores): ΔPNI-L-L, ΔPNI-L-H, ΔPNI-H-L, and ΔPNI-H-H subgroups. For instance, if PNI scores of patients with high baseline PNI score increased from baseline to 6 weeks after treatment, they were included in the ΔPNI-H-H subgroup. Cox regression models were used to identify the factors associated with survival.
Results
The baseline PNI score was only related to the overall survival (OS) (P = .026), and not to the overall response rate (ORR) (P = .299) and progression-free survival (PFS) (P = .207). The ORR was associated with the combined PNI scores (P = .017). A multivariable Cox regression analysis confirmed that the combined PNI scores were independent factors for PFS (ΔPNI-L-H, 12 months, hazard ratio [HR] = 0.449, P = .009; ΔPNI-H-L, 14 months, HR = 0.500, P = .019; and ΔPNI-H-H, 17 months, HR = 0.390, P = .012; vs ΔPNI-L-L, 8 months) and OS (ΔPNI-L-H, 27 months, HR = 0.403, P = .019; ΔPNI-H-L, 28 months, HR = 0.369, P = .010; and ΔPNI-H-H, not reached, HR = 0.087, P = .002; vs ΔPNI-L-L, 15 months).
Conclusions
Patients with high baseline PNI and increased PNI score had the better survival outcome. On dynamic monitoring and comprehensive assessment, the combined PNI scores significantly enhanced the survival predictive ability of patients with NSCLC treated with PD-1 inhibitor.
