Division of Breast and Endocrine Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, Japan.
BMC Cancer. 2020 Feb 27;20(1):160. doi: 10.1186/s12885-020-6647-4.
The prognostic nutritional index (PNI), which is an easily calculated nutritional index, is significantly associated with patient outcomes in various solid malignancies. This study aimed to evaluate the prognostic impact of PNI changes in patients with breast cancer undergoing neoadjuvant chemotherapy (NAC).
We reviewed patients with breast cancer who underwent NAC and a subsequent surgery for breast cancer between 2005 and 2016. PNI before and after NAC were calculated using the following formula: 10 × serum albumin (g/dl) + 0.005 × total lymphocyte count/mm. The relationship between PNI and prognosis was retrospectively analyzed.
In total, 191 patients were evaluated. There was no significant difference in disease-free survival (DFS) between the pre-NAC PNI high group and the pre-NAC PNI low group (cutoff: 53.1). However, PNI decreased in 181 patients (94.7%) after NAC and the mean PNI also significantly decreased after NAC from 52.6 ± 3.8 pre-NAC to 46.5 ± 4.4 post-NAC (p < 0.01). The mean ΔPNI, which was calculated as pre-NAC PNI minus post-NAC PNI, was 5.4. The high ΔPNI group showed significantly poorer DFS than the low ΔPNI group (cut off: 5.26) (p = 0.015). Moreover, high ΔPNI was an independent risk factor of DFS on multivariate analysis (p = 0.042).
High decrease of PNI during NAC predicts poor prognosis. Thus, maintaining the nutritional status during NAC may result in better treatment outcomes in patients with breast cancer.
预后营养指数（PNI）是一种易于计算的营养指数，与各种实体恶性肿瘤患者的预后显著相关。本研究旨在评估新辅助化疗（NAC）前后乳腺癌患者 PNI 变化的预后影响。
我们回顾了 2005 年至 2016 年间接受 NAC 和随后乳腺癌手术的乳腺癌患者。使用以下公式计算 NAC 前后的 PNI：10×血清白蛋白（g/dl）+0.005×总淋巴细胞计数/mm。回顾性分析 PNI 与预后的关系。
共评估了 191 例患者。NAC 前 PNI 高组与 NAC 前 PNI 低组之间无无病生存（DFS）差异（截止值：53.1）。然而，NAC 后 181 例患者（94.7%）的 PNI 下降，NAC 后平均 PNI 也从 NAC 前的 52.6±3.8 显著下降至 NAC 后的 46.5±4.4（p<0.01）。PNI 降低量（ΔPNI），定义为 NAC 前 PNI 减去 NAC 后 PNI，为 5.4。高ΔPNI 组的 DFS 明显低于低ΔPNI 组（截止值：5.26）（p=0.015）。此外，高ΔPNI 是 DFS 的独立危险因素（p=0.042）。
NAC 期间 PNI 下降幅度大预示预后不良。因此，在 NAC 期间保持营养状态可能会使乳腺癌患者获得更好的治疗效果。
