Chantharakhit Chaichana, Sujaritvanichpong Nantapa, Chantharakhit Chanachai
Division of Medical Oncology, Department of Internal Medicine, Buddhasothorn Hospital, Chachoengsao, Thailand.
Division of Endocrinology and Metabolism, Department of Internal Medicine, Buddhasothorn Hospital, Chachoengsao, Thailand.
Int J Gen Med. 2022 Aug 19;15:6681-6689. doi: 10.2147/IJGM.S372684. eCollection 2022.
The prognostic nutritional index (PNI) is used to distinguish immune-nutritional status. Previous studies have shown that it is significantly associated with patient outcomes for various malignancies. This study aimed to evaluate the prognostic impact of PNI in patients with unresectable locally-advanced and advanced stage upper gastrointestinal tract cancer, including esophageal cancer and gastric cancer.
A retrospective study of 170 unresectable stage III-IV esophageal cancer and gastric cancer patients was conducted from January 2018 to December 2020. In our retrospective analysis, the pretreatment PNI of patients was calculated and analyzed. The Youden index was estimated to select the optimal cut-off value for PNI. Univariate and multivariate flexible parametric proportional hazards models with restricted cubic splines (RCS) were used to identify independent prognostic factors, and the Kaplan-Meier method was used to estimate survival curves.
The median follow-up period was 5 months (ranging from 0.06 to 36.92 months). We determined 52.9 as the cut-off value by using the maximum Youden index. Subsequently, patients in the testing group were classified into high PNI and low PNI groups. Kaplan-Meier curves showed the low PNI group had significantly poorer overall survival (OS) than the high PNI group. Median OS in the low PNI group was 4.43 months compared with 8.23 months in the high PNI group (HR 2.42, 95% CI 1.33-4.40, p = 0.004). In the univariate analysis, low PNI, ECOG PS 2, and ECOG PS 3-4 were associated with OS. According to multivariate analysis, low PNI was an independent prognostic factor for OS (HR 2.31, 95% CI 1.24-4.29, p = 0.008).
Pretreatment PNI is useful for independent prognosis of unresectable stage III-IV esophageal cancer and gastric cancer in patients.
预后营养指数（PNI）用于区分免疫营养状态。既往研究表明，它与多种恶性肿瘤患者的预后显著相关。本研究旨在评估PNI对不可切除的局部晚期和晚期上消化道癌（包括食管癌和胃癌）患者的预后影响。
对2018年1月至2020年12月期间170例不可切除的III-IV期食管癌和胃癌患者进行回顾性研究。在我们的回顾性分析中，计算并分析了患者的治疗前PNI。通过约登指数估计选择PNI的最佳临界值。使用具有受限立方样条（RCS）的单变量和多变量灵活参数比例风险模型来识别独立的预后因素，并使用Kaplan-Meier方法估计生存曲线。
中位随访期为5个月（范围为0.06至36.92个月）。我们通过使用最大约登指数确定52.9为临界值。随后，将测试组中的患者分为高PNI组和低PNI组。Kaplan-Meier曲线显示，低PNI组的总生存期（OS）明显低于高PNI组。低PNI组的中位OS为4.43个月，而高PNI组为8.23个月（风险比2.42，95%置信区间1.33-4.40，p = 0.004）。在单变量分析中，低PNI、东部肿瘤协作组（ECOG）体能状态2级和ECOG体能状态3-4级与OS相关。根据多变量分析，低PNI是OS的独立预后因素（风险比2.31，95%置信区间1.24-4.29，p = 0.008）。
治疗前PNI对不可切除的III-IV期食管癌和胃癌患者的独立预后评估有用。
