将预后营养指数鉴定为接受免疫检查点抑制剂治疗的晚期肺癌患者的可靠预后指标。

Identification of prognostic nutritional index as a reliable prognostic indicator for advanced lung cancer patients receiving immune checkpoint inhibitors.

作者信息

Yan Xuebing, Wang Jiaxin, Mao Jingxian, Wang Ying, Wang Xiangjun, Yang Mengxue, Qiao Hong

机构信息

Department of Oncology, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China.

Department of Oncology, Hefei Cancer Hospital, Chinese Academy of Sciences, Hefei, China.

出版信息

Front Nutr. 2023 Jul 28;10:1213255. doi: 10.3389/fnut.2023.1213255. eCollection 2023.

BACKGROUND

Prognostic nutritional index (PNI) has been identified as a reliable prognostic factor for cancer adjuvant therapy. However, its prognostic value in lung cancer patients receiving immune checkpoint inhibitors (ICIs) remains inconclusive.

METHOD

A systematic literature review and meta-analysis was performed based on online databases before March 1th 2023. The correlation of PNI with overall survival (OS) or progression-free survival (PFS) was determined using the hazard ratios (HRs) coupled with 95% confidence intervals (CIs). Then, a retrospective cohort enrolling 123 ICI-treated lung cancer patients from two hospitals was utilized for validation and further investigation.

RESULTS

A total of 14 studies enrolling 1,260 lung cancer patients were included in the meta-analysis. The high PNI level was significantly correlated with better OS (HR = 2.56, 95% CI = 1.86-3.54) and PFS (HR = 1.91, 95% CI = 1.53-2.40) of the lung cancer patients. The subgroup analysis confirmed the results except for the PFS in patients receiving anti-PD-1 therapy (HR = 1.51, 95% CI = 0.86-2.65). In the retrospective study, the high PNI level was identified as a favorable factor for OS and PFS not only in the whole cohort but also in the subgroups stratified by non-small cell lung cancer and small cell lung cancer. The high PNI was also correlated with better anti-cancer therapy response and performed better than body mass index and serum albumin level in OS prediction. Finally, we established a novel prognostic nomogram based on PNI and other clinical parameters. The nomogram was found to perform well in predicting the 1-year OS of ICI-treated lung cancer patients.

CONCLUSION

Both the meta-analysis and retrospective work demonstrate the PNI is a reliable prognostic factor for advanced lung cancer patients receiving ICI-based therapies. Our study further highlights the crucial role of nutrition assessment and intervention in cancer immunotherapy.

SYSTEMATIC REVIEW REGISTRATION

https://www.crd.york.ac.uk/prospero/, identifier: CRD42023424146.

背景

预后营养指数（PNI）已被确定为癌症辅助治疗的可靠预后因素。然而，其在接受免疫检查点抑制剂（ICI）治疗的肺癌患者中的预后价值仍不明确。

方法

基于2023年3月1日前的在线数据库进行系统的文献综述和荟萃分析。使用风险比（HR）和95%置信区间（CI）确定PNI与总生存期（OS）或无进展生存期（PFS）的相关性。然后，利用一项回顾性队列研究对来自两家医院的123例接受ICI治疗的肺癌患者进行验证和进一步研究。

结果

荟萃分析共纳入14项研究，涉及1260例肺癌患者。高PNI水平与肺癌患者更好的OS（HR = 2.56，95%CI = 1.86 - 3.54）和PFS（HR = 1.91，95%CI = 1.53 - 2.40）显著相关。亚组分析证实了该结果，但接受抗PD - 1治疗患者的PFS除外（HR = 1.51，95%CI = 0.86 - 2.65）。在回顾性研究中，高PNI水平不仅在整个队列中，而且在按非小细胞肺癌和小细胞肺癌分层的亚组中，均被确定为OS和PFS的有利因素。高PNI还与更好的抗癌治疗反应相关，并且在OS预测方面比体重指数和血清白蛋白水平表现更好。最后，我们基于PNI和其他临床参数建立了一种新的预后列线图。该列线图在预测接受ICI治疗的肺癌患者1年OS方面表现良好。