He Zhen-Qiang, Ke Chao, Al-Nahari Fuad, Duan Hao, Guo Cheng-Cheng, Wang Yang, Zhang Xiang-Heng, Chen Yin-Sheng, Liu Zhi-Gang, Wang Jian, Chen Zhong-Ping, Jiang Xiao-Bing, Mou Yong-Gao
Department of Neurosurgery/Neuro-oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.
Key Laboratory of Translational Radiation Oncology, Hunan Province, Department of Radiation Oncology, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China.
J Neurooncol. 2017 Apr;132(2):239-247. doi: 10.1007/s11060-016-2361-0. Epub 2017 Jan 11.
Preoperative prognostic nutritional index (PNI) has been widely demonstrated to predict survival of patients with malignant tumors. Its utility in predicting outcomes in patients with high-grade gliomas (HGG) remains undefined. A retrospective study of 188 HGG patients was conducted. An optimal PNI cut-off value was applied to stratify patients into high PNI (≥52.55, n = 78) and low PNI (<52.55, n = 110) groups. Univariate and multivariate analysis was performed to identify prognostic factors associated with overall survival (OS) and progression free survival (PFS). The resulting prognostic models were externally validated using a demographic-matched cohort of 130 HGG patients. In the training set, PNI value was negatively correlated with age (p = 0.027) and tumor grade (p = 0.048). Both PFS (8.27 vs. 20.77 months, p < 0.001) and OS (13.57 vs. 33.23 months, p < 0.001) were significantly worse in the low PNI group. Strikingly, patients in high PNI group had a 52% decrease in the risk of tumor progression and 55% decrease of death relative to low PNI. Multivariate analysis further demonstrated PNI as an independent predictor for PFS (HR = 0.62, 95% CI 0.43-0.87) and OS (HR = 0.56, 95% CI 0.38-0.80). The PNI retained independent prognostic value in the validation set for both PFS (p = 0.013) and OS (p = 0.003). On subgroup analysis by tumor grade and treatment modalities, both PFS and OS were better for the patients with high PNI. The PNI is a potentially valuable preoperative marker for the survival of patients following HGG resection.
术前预后营养指数（PNI）已被广泛证明可预测恶性肿瘤患者的生存率。其在预测高级别胶质瘤（HGG）患者预后方面的作用仍不明确。对188例HGG患者进行了一项回顾性研究。应用最佳PNI临界值将患者分为高PNI组（≥52.55，n = 78）和低PNI组（<52.55，n = 110）。进行单因素和多因素分析以确定与总生存期（OS）和无进展生存期（PFS）相关的预后因素。使用130例HGG患者的人口统计学匹配队列对所得的预后模型进行外部验证。在训练集中，PNI值与年龄（p = 0.027）和肿瘤分级（p = 0.048）呈负相关。低PNI组的PFS（8.27个月对20.77个月，p < 0.001）和OS（13.57个月对33.23个月，p < 0.001）均显著更差。令人惊讶的是，相对于低PNI组，高PNI组患者的肿瘤进展风险降低了52%，死亡风险降低了55%。多因素分析进一步表明PNI是PFS（HR = 0.62，95%CI 0.43 - 0.87）和OS（HR = 0.56，95%CI 0.38 - 0.80）的独立预测因子。PNI在验证集中对PFS（p = 0.013）和OS（p = 0.003）均保留独立预后价值。根据肿瘤分级和治疗方式进行亚组分析，高PNI患者的PFS和OS均更好。PNI是HGG切除术后患者生存的一个潜在有价值的术前标志物。
