Oei Ronald Wihal, Ye Lulu, Kong Fangfang, Du Chengrun, Zhai Ruiping, Xu Tingting, Shen Chunying, Wang Xiaoshen, He Xiayun, Kong Lin, Hu Chaosu, Ying Hongmei
Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China,
Department of Oncology, Shanghai Medical College, Shanghai, People's Republic of China,
Cancer Manag Res. 2018 Aug 17;10:2785-2797. doi: 10.2147/CMAR.S171239. eCollection 2018.
The aim of this article is to investigate the significance of pretreatment prognostic nutritional index (PNI), systemic immune-inflammation index (SII), and their combination in nasopharyngeal carcinoma (NPC) patients receiving intensity-modulated radiotherapy (IMRT).
A total of 585 patients were included. PNI and SII were calculated within 2 weeks prior to treatment. The optimal cutoff points were determined based on receiver operating characteristics curve analysis. The correlation between variables was analyzed. Kaplan-Meier method and Cox proportional hazards model were performed to evaluate the impact of both indices on overall survival (OS), progression-free survival (PFS) and distant metastasis-free survival (DMFS). Further propensity score matching (PSM) was carried out to minimize the effects of confounders.
The optimal cutoff point of 53.0 for PNI and 527.20 for SII were selected. Pearson correlation coefficient showed an inverse correlation between PNI and SII ( = -0.232, < 0.001). Multivariate analysis demonstrated that pretreatment PNI was an independent prognostic factor for OS ( = 0.047) and DMFS ( = 0.002) while pretreatment SII was an independent prognostic factor for OS ( = 0.003), PFS ( = 0.002), and DMFS ( = 0.002). After PSM, both parameters remained as independent prognosticators of survival. Additional prognostic value was observed in the combined use of PNI and SII.
Pretreatment PNI and SII are promising indicators of survival in NPC patients undergoing IMRT. They can be utilized to refine current TNM staging system in predicting prognosis and developing an individualized treatment in these patients.
本文旨在探讨预处理预后营养指数（PNI）、全身免疫炎症指数（SII）及其联合应用在接受调强放疗（IMRT）的鼻咽癌（NPC）患者中的意义。
共纳入585例患者。在治疗前2周内计算PNI和SII。基于受试者工作特征曲线分析确定最佳截断点。分析变量之间的相关性。采用Kaplan-Meier法和Cox比例风险模型评估这两个指标对总生存期（OS）、无进展生存期（PFS）和无远处转移生存期（DMFS）的影响。进一步进行倾向评分匹配（PSM）以尽量减少混杂因素的影响。
选择PNI的最佳截断点为53.0，SII的最佳截断点为527.20。Pearson相关系数显示PNI与SII呈负相关（r = -0.232，P < 0.001）。多因素分析表明，预处理PNI是OS（P = 0.047）和DMFS（P = 0.002） 的独立预后因素，而预处理SII是OS（P = 0.003）、PFS（P = 0.002）和DMFS（P = 0.002）的独立预后因素。PSM后，这两个参数仍然是生存的独立预后因素。联合使用PNI和SII具有额外的预后价值。
预处理PNI和SII是接受IMRT的NPC患者生存的有前景的指标。它们可用于完善当前的TNM分期系统，以预测预后并为这些患者制定个体化治疗方案。
