Jiang Yan-Ming, Huang Shi-Ting, Pan Xin-Bin, Ma Jia-Lin, Zhu Xiao-Dong
Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, China.
Department of Oncology, Affiliated Wuming Hospital of Guangxi Medical University, Nanning, China.
Front Nutr. 2023 Feb 16;10:1036572. doi: 10.3389/fnut.2023.1036572. eCollection 2023.
This study explored the relationship between the prognostic nutritional index (PNI) and overall survival rate (OS) in patients with nasopharyngeal carcinoma (NPC), and established and validated an effective nomogram to predict clinical outcomes.
This study included 618 patients newly diagnosed with locoregionally advanced NPC. They were divided into training and validation cohorts at a ratio of 2:1 based on random numbers. The primary endpoint of this study was OS, progression-free survival (PFS) was the second endpoint. A nomogram was drawn from the results of multivariate analyses. Harrell's concordance index (C-index), area under the receiver operator characteristic curve (AUC), and decision curve analysis (DCA) were used to evaluate the clinical usefulness and predictive ability of the nomogram and were compared to the current 8th edition of the International Union Against Cancer/American Joint Committee (UICC/AJCC) staging system.
The PNI cutoff value was 48.1. Univariate analysis revealed that age ( < 0.001), T stage ( < 0.001), N stage ( = 0.036), tumor stage ( < 0.001), PNI ( = 0.001), lymphocyte-neutrophil ratio (NLR, = 0.002), and lactate dehydrogenase (LDH, = 0.009) were significantly associated with OS, age ( = 0.001), T-stage ( < 0.001), tumor stage ( < 0.001), N-stage ( = 0.011), PNI ( = 0.003), NLR ( = 0.051), and LDH ( = 0.03) were significantly associated with PFS. Multivariate analysis showed that age ( < 0.001), T-stage ( < 0.001), N-stage( = 0.02), LDH ( = 0.032), and PNI ( = 0.006) were significantly associated with OS, age ( = 0.004), T-stage (<0.001), N-stage (<0.001), PNI ( = 0.022) were significantly associated with PFS. The C-index of the nomogram was 0.702 (95% confidence interval [CI]: 0.653-0.751). The Akaike information criterion (AIC) value of the nomogram for OS was 1142.538. The C-index of the TNM staging system was 0.647 (95% CI, 0.594-0.70) and the AIC was 1163.698. The C-index, DCA, and AUC of the nomogram demonstrated its clinical value and higher overall net benefit compared to the 8th edition of the TNM staging system.
The PNI represents a new inflammation-nutrition-based prognostic factor for patients with NPC. In the proposed nomogram, PNI and LDH were present, which led to a more accurate prognostic prediction than the current staging system for patients with NPC.
本研究探讨鼻咽癌（NPC）患者的预后营养指数（PNI）与总生存率（OS）之间的关系，并建立和验证一种有效的列线图以预测临床结局。
本研究纳入618例新诊断为局部晚期NPC的患者。根据随机数字以2:1的比例将他们分为训练队列和验证队列。本研究的主要终点是OS，无进展生存期（PFS）是次要终点。根据多变量分析结果绘制列线图。使用Harrell一致性指数（C指数）、受试者工作特征曲线下面积（AUC）和决策曲线分析（DCA）来评估列线图的临床实用性和预测能力，并与当前第8版国际抗癌联盟/美国联合委员会（UICC/AJCC）分期系统进行比较。
PNI临界值为48.1。单变量分析显示，年龄（<0.001）、T分期（<0.001）、N分期（=0.036）、肿瘤分期（<0.001）、PNI（=0.001）、淋巴细胞与中性粒细胞比值（NLR，=0.002）和乳酸脱氢酶（LDH，=0.009）与OS显著相关；年龄（=0.001）、T分期（<0.001）、肿瘤分期（<0.001）、N分期（=0.011）、PNI（=0.003）、NLR（=0.051）和LDH（=0.03）与PFS显著相关。多变量分析显示，年龄（<0.001）；T分期（<0.001）、N分期（=0.02）、LDH（=0.032）和PNI（=0.006）与OS显著相关；年龄（=0.004）、T分期（<0.001）、N分期（<0.001）、PNI（=0.022）与PFS显著相关。列线图C指数为0.702（95%置信区间[CI]：0.653-0.751）。OS列线图的赤池信息准则（AIC）值为1142.538。TNM分期系统C指数为0.647（95%CI，0.594-0.70），AIC为1163.698。列线图的C指数、DCA和AUC表明其具有临床价值，且与第8版TNM分期系统相比具有更高的总体净效益。
PNI是一种基于炎症-营养的新的NPC患者预后因素。在提出的列线图中纳入了PNI和LDH，与当前分期系统相比，能对NPC患者进行更准确的预后预测。
