Taban Hakan, Erman Mustafa, Guven Deniz Can, Aktas Burak Yasin, Yilmaz Feride, Yaşar Serkan, Yildirim Hasan Cagri, Aslan Ferit, Aksoy Sercan
Medical Oncology Clinic, Medical Park Ankara Hospital, 06370 Ankara, Turkey.
Department of Preventive Oncology, Hacettepe University Cancer Institute, 06230 Ankara, Turkey.
Medicina (Kaunas). 2025 Jun 18;61(6):1105. doi: 10.3390/medicina61061105.
: The prognostic nutritional index (PNI), a marker reflecting both nutritional and immune status, has been associated with prognosis in various malignancies. However, evidence in metastatic castration-resistant prostate cancer (mCRPC), particularly from non-Asian populations, remains limited. This study aimed to evaluate the prognostic value of baseline PNI and to develop a blood-based prognostic model in mCRPC patients treated with abiraterone acetate (AA), enzalutamide (ENZA), or cabazitaxel (CABA). : This retrospective study included mCRPC patients treated with AA, ENZA, or CABA before or after docetaxel. PNI was calculated as: 10 × serum albumin (g/dL) + 0.005 × total lymphocyte count (/mm). Patients were classified into low-PNI (≤40.8) and high-PNI (>40.8) groups using the median PNI value. Survival outcomes were analyzed using Kaplan-Meier and Cox regression methods. : A total of 299 patients were analyzed: 133 (44.5%) received AA, 106 (35.5%) ENZA, and 60 (20.0%) CABA. Patients with high PNI had significantly longer median overall survival (OS; 30.2 vs. 12.6 months, < 0.001), radiologic progression-free survival (rPFS; 13.5 vs. 6.7 months, < 0.001), and PSA progression-free survival (PSA-PFS; 10.2 vs. 5.1 months, < 0.001). These associations remained significant across all treatment subgroups. In multivariate analysis, prostate surgery (HR: 0.6), high PNI (HR: 0.5), PSA response (HR: 0.5), and elevated ALP (HR: 1.6) were independent predictors of OS. A prognostic model incorporating PNI, alkaline phosphatase, and anemia stratified patients into four risk groups with distinct OS: 49.1, 30.8, 18.8, and 9.1 months, respectively. : This is the largest study to date in a non-Asian mCRPC population showing that baseline PNI is a strong, independent prognostic factor for survival. The proposed blood-based tool may aid in clinical risk stratification, pending prospective validation.
预后营养指数（PNI）是一种反映营养和免疫状态的标志物，已被证明与多种恶性肿瘤的预后相关。然而，关于转移性去势抵抗性前列腺癌（mCRPC）的证据，尤其是来自非亚洲人群的证据仍然有限。本研究旨在评估基线PNI的预后价值，并为接受醋酸阿比特龙（AA）、恩杂鲁胺（ENZA）或卡巴他赛（CABA）治疗的mCRPC患者建立一种基于血液的预后模型。 ：这项回顾性研究纳入了在多西他赛治疗之前或之后接受AA、ENZA或CABA治疗的mCRPC患者。PNI的计算方法为：10×血清白蛋白（g/dL）+0.005×总淋巴细胞计数（/mm）。使用PNI的中位数将患者分为低PNI（≤40.8）和高PNI（>40.8）组。采用Kaplan-Meier和Cox回归方法分析生存结果。 ：共分析了299例患者：133例（44.5%）接受AA治疗，106例（35.5%）接受ENZA治疗，60例（20.0%）接受CABA治疗。高PNI患者的中位总生存期（OS）显著更长（30.2个月对12.6个月，<0.001），放射学无进展生存期（rPFS）（13.5个月对6.7个月，<0.001），以及前列腺特异性抗原无进展生存期（PSA-PFS）（10.2个月对5.1个月，<0.001）。这些关联在所有治疗亚组中均保持显著。在多变量分析中，前列腺手术（HR：0.6）、高PNI（HR：0.5）、PSA反应（HR：0.5）和碱性磷酸酶升高（HR：1.6）是OS的独立预测因素。一个包含PNI、碱性磷酸酶和贫血的预后模型将患者分为四个风险组，其OS明显不同：分别为49.1个月、30.8个月、18.8个月和9.1个月。 ：这是迄今为止在非亚洲mCRPC人群中开展的最大规模研究，表明基线PNI是生存的一个强大的独立预后因素。所提出的基于血液的工具可能有助于临床风险分层，有待前瞻性验证。
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