Prognostic Nutritional Index and Clinical Response in Locally Advanced Cervical Cancer.
Gangopadhyay Aparna
Nutrition and cancer
: The prognostic nutritional index (PNI), a marker of immune-nutrition balance, has predictive value in the survival and prognosis of various cancers. However, the impact of PNI on response to chemoradiation is poorly understood.: A total of 583 women with locally advanced cervical cancer from two centers were clinically assessed for complete response after chemoradiation. The baseline PNI was individually recorded, and the significance of association between PNI and complete response was analyzed using logistic regression. ROC (receiver operating characteristics) curves were analyzed to determine the cutoff value of PNI that significantly predicted complete response.: Logistic regression analysis demonstrated that the PNI was significantly associated with complete response following chemo radiation ( < 0.0001). Analysis of the ROC curve for PNI demonstrated an optimal cut off value of 44.8 ( < 0.0001, sensitivity 66.7, and specificity 88.5); the area under the ROC curve was 0.813 (Youden's index J, 0.7519).: The PNI is significantly associated with clinical complete response to chemoradiation in locally advanced cervical cancer. Low baseline PNI may lower the likelihood of complete response after chemoradiation. In particular, those with PNI values below 44 should be carefully monitored during treatment; nutritional interventions may offer benefit in these women.
10.1080/01635581.2020.1729820
Prognostic and clinicopathological effect of the prognostic nutritional index (PNI) in patients with cervical cancer: a meta-analysis.
Annals of medicine
BACKGROUND:Numerous studies have explored whether the prognostic nutritional index (PNI) can predict the prognosis of cervical cancer (CC); however, their findings remain controversial. This meta-analysis focused on evaluating the relationship between the PNI and the prognosis of patients with CC. METHODS:Relevant articles were collected from specific databases up to March 16, 2023. The relationship between the PNI and survival outcomes in patients with CC was estimated using combined hazard ratios (HRs) and associated 95% confidence intervals (CIs). The association of the PNI with clinicopathological features in patients with CC was assessed by combining odds ratios (ORs) and associated 95% CIs. RESULTS:Nine articles with 2508 cases were included in the meta-analysis. According to our pooled findings, a decreased PNI showed a significant association with worse overall survival (OS) (HR = 2.98, 95% CI = 2.22-3.99, < .001) as well as progression-free survival (PFS) (HR = 2.43, 95% CI = 1.92-3.07, < .001) in patients with CC. The subgroup analysis indicated that the results were reliable. Moreover, the decreased PNI showed a significant association with the presence of lymph node metastasis (LN metastasis, OR = 1.53, 95% CI = 1.04-82.24, = .030) and maximum tumor size >4 cm (OR = 1.73, 95% CI = 1.21-2.46, = .002). However, the PNI was not significantly associated with histology, differentiation, or FIGO stage. CONCLUSION:In this study, a low PNI predicted dismal OS and PFS in patients with CC, who also tend to suffer from LN metastasis and larger tumor size. PNI is a promising biomarker for predicting the prognosis of patients with CC in clinical practice.
10.1080/07853890.2023.2288705
Predictive value of prognostic nutritional index for outcomes of cervical cancer: A systematic review and meta‑analysis.
Experimental and therapeutic medicine
Cervical cancer is a major global health concern. Prognostic markers for cervical cancer have traditionally focused on tumor characteristics. However, there is a growing recognition of the importaxnce of the nutritional status of the patient as a possible prognostic indicator. The present meta-analysis aims to estimate the role of the prognostic nutritional index (PNI) in predicting overall survival (OS) and progression-free survival (PFS) in patients with cervical cancer. Medline, Google Scholar, Science Direct and Cochrane Central databases were systematically searched for studies reporting PNI in patients with cervical cancer. Inclusion criteria were applied to select relevant studies and data extraction was performed by two independent investigators. Risk of bias was assessed by the Newcastle-Ottawa Scale (NOS). The present meta-analysis included 10 studies with 2,352 participants. The pooled analysis showed that in patients with cervical cancer PNI did not have a significant prognostic utility in predicting OS [univariate hazard ration (HR): 1.38; 95% confidence interval (CI): 0.77-2.48) or PFS (univariate HR: 1.12; 95% CI: 0.44-2.68). These results were consistent even after adjusting for other confounders using multivariate analysis (pooled HR: 1.06 for OS; 95% CI: 0.64-1.76; pooled HR: 1.22 for PFS; 95% CI: 0.65-2.30). Subgroup analyses were also performed based on region, PNI cut-off, sample size, grade of evidence and treatment protocol and did not demonstrate any significant prognostic value of PNI. The funnel plot demonstrated symmetry, suggesting the absence of publication bias. The present meta-analysis indicated that PNI does not have a significant prognostic utility in predicting OS or PFS in women with cervical cancer. Further research is warranted to explore alternative nutritional indicators and identify reliable prognostic markers in this patient population.
10.3892/etm.2024.12605
Nutritional index in relation to prognosis of endometrial cancer.
International journal of medical sciences
Evaluate the prognostic value of the prognostic nutritional index (PNI) in patients with endometrial cancer (EC). Laboratory and clinicopathological data from 370 patients who were diagnosed with EC between January 2010 and December 2021 were reviewed. The PNI was analyzed for correlations with recurrence and survival. The receiver operating characteristic curves were generated for the PNI. Optimal cut-off values were determined as the points at which the Youden index (sensitivity + specificity - 1) was maximal. Based on the results of the ROC curve analysis, the patients were grouped into high and low PNI groups. Differences in the clinicopathological characteristics between patients with high and low PNI were compared between the two groups. The effects of the prognostic factors were analyzed using univariate and multivariate Cox proportional hazards model. The optimal cutoff value of the PNI was 52.74 for DFS (area under the curve: 0.817; 95% CI: 0.738-0.858, <0.001). Significantly more patients in the low PNI group experienced recurrence (30.6% vs. 5.2%, <0.001) and cancer-related death (17.8% vs. 2.8%, <0.001). In multivariate analysis, PNI were independent prognostic factors for both DFS and overall survival OS. Low PNI was significantly associated with worse clinical outcomes in patients with EC. Our findings demonstrate that the PNI may be clinically reliable and useful as a prognostic marker for patients with EC. Further large-scale prospective studies are needed to confirm our findings.
10.7150/ijms.87752
Preoperative Prognostic Nutritional Index Is a Prognostic Indicator of Cancer-Specific Survival in Patients Undergoing Endometrial Cancer Surgery.
Journal of Korean medical science
BACKGROUND:The prognostic nutritional index (PNI) reflects systemic inflammation and nutritional status. This study aimed to evaluate the effect of preoperative PNI on postoperative cancer-specific survival in patients with endometrial cancer (EC). METHODS:Demographic, laboratory, and clinical data were retrospectively collected from 894 patients who underwent surgical resection of EC. Preoperative PNIs were determined from the serum albumin concentration and total lymphocyte count, which were measured within 1 month before surgery. Patients were classified into high PNI (n = 619) and low PNI (n = 275) groups according to the preoperative PNI cut-off value of 50.6. The stabilized inverse probability of treatment weighting (IPTW) method was used to reduce bias: a weighting cohort divided into high PNI (n = 615.4) and low PNI (n = 272.3) groups. The primary outcome measure was postoperative cancer-specific survival. RESULTS:The postoperative cancer-specific survival rate was higher in the high PNI group than the low PNI group in the unadjusted cohort (93.1% vs. 81.5%; proportion difference [95% confidence interval; 95% CI], 11.6% [6.6-16.6%]; < 0.001) and in the IPTW-adjusted cohort (91.4% vs. 86.0%; 5.4% [0.8-10.2%]; = 0.021). In the multivariate Cox proportional hazard regression model in the IPTW-adjusted cohort, high preoperative PNI (hazard ratio [95% CI], 0.60 [0.38-0.96]; = 0.032) was an independent determinant of postoperative cancer-specific mortality. The multivariate-adjusted restricted cubic spline curve for the Cox regression model showed a significant negative association between preoperative PNI and postoperative cancer-specific mortality ( < 0.001). CONCLUSION:High preoperative PNI was associated with improved postoperative cancer-specific survival in patients undergoing surgery for EC.
10.3346/jkms.2023.38.e163
Prognostic effect of the pretreatment prognostic nutritional index in cervical, ovarian, and endometrial cancer: a meta-analysis.
BMC women's health
BACKGROUND:The prognostic value of the pretreatment prognostic nutritional index (PNI) for gynaecological malignancies remain unclear. This meta-analysis aimed to explore the predictive significance of the PNI for gynaecological tumours. METHODS:The PubMed, Embase, Web of Science, and Cochrane Library databases were searched up to January 30, 2024, to identify relevant studies. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated to assess the associations of the PNI with overall survival (OS), progression-free survival (PFS), and disease-free survival (DFS) in patients with gynaecological tumours. We examined the correlation of the PNI with clinicopathological parameters of patients with gynaecological carcinoma by utilizing pooled odds ratios (ORs) and 95% CIs. RESULTS:A total of 28 articles involving 9,428 patients were included in the meta-analysis. The results revealed that a low PNI significantly predicted worse OS (HR = 1.60, 95% CI: 1.39-1.84, P < 0.001), PFS (HR = 1.63, 95% CI: 1.20-2.23, P = 0.002), and DFS (HR = 1.73, 95% CI: 1.19-2.52, P = 0.004). In addition, the subgroup analysis confirmed that the PNI had a prognostic effect on OS for all cancer types, but a significant association with PFS was not observed in patients with cervical cancer. A low PNI was significantly associated with FIGO stages III‒IV (OR = 2.30, 95% CI: 1.89‒2.80, P < 0.001) and LN metastasis (OR = 2.76, 95% CI: 2. 05‒3.73, P < 0.001). CONCLUSION:The PNI may be noninvasive and promising biomarker for predicting the prognosis of patients with gynaecological tumours.
10.1186/s12905-024-03310-w
Prognostic Nutritional Index and the Survival of Patients with Endometrial cancer: A Meta-analysis.
Reproductive sciences (Thousand Oaks, Calif.)
The prognostic nutritional index (PNI) has emerged as a potential predictor of clinical outcomes in various cancers. However, a quantativetily analysis of its role in endometrial cancer (EC) remains lacking. This meta-analysis aims to evaluate the prognostic value of PNI on the survival outcomes of patients with EC. A comprehensive literature search was conducted in PubMed, EMBASE, Web of Science, Wanfang, and CNKI to identify relevant cohort studies. Studies were included if they provided sufficient data to calculate hazard ratios (HRs) for overall survival (OS) and progression-free survival (PFS) based on PNI levels. Data extraction and quality assessment were performed independently by two reviewers. Pooled HRs with 95% confidence intervals (CIs) were calculated using a random-effects model to account for heterogeneity. A total of 10 studies, encompassing 3656 patients, met the inclusion criteria. The meta-analysis revealed that a low PNI was significantly associated with poorer OS (HR = 2.01, 95% CI = 1.62-2.49, p < 0.05; I = 54%) and PFS (HR = 2.75, 95% CI = 1.74-4.33, p < 0.05; I = 78%) in patients with EC. Subgroup analyses indicated that the prognostic impact of PNI was consistent in studies from Asian and non-Asian countries, and across studies with different ages of the patients, cutoff values of PNI, and follow-up duration (p for subgroup difference all > 0.05). In conclusion, the PNI is a prognostic marker for survival in patients with EC.
10.1007/s43032-024-01686-6
Using preoperative control nutritional status scores as prognostic factors for endometrial cancer.
Frontiers in oncology
Background:Previous investigations have reported that controlling nutritional (CONUT) status scores, incorporating total cholesterol (TC) and serum albumin (SA) values, and total lymphocyte (LY) counts, are reliable malignant tumor predictors. However, CONUT scores for predicting endometrial cancer (EC) remain unexplored. Objective:To evaluate preoperative CONUT scores as prognostic factors for postoperative EC. Methods:We retrospectively evaluated preoperative CONUT scores in 785 surgically resected EC patients at our hospital between June 2012 and May 2016. Using time-dependent receiver operating characteristic (ROC) analyses, patients were split into: 1) CONUT-high (CH) (≥1) and 2) CONUT-low (CL) (<1) groups. Relationships between CONUT scores and different clinicopathological, pathological differentiation, muscle layer infiltration depth, and prognosis factors were examined, and Cox regression analyses performed to assess prognostic values on overall survival (OS) rates. Results:We assigned 404 (51.5%) and 381 (58.5%) patients to CH and CL groups, respectively. In the CH group, body mass index (BMI), prognostic nutrition index (PNI), and LY/monocyte ratios (LMR) were decreased, however, neutrophil/LY (NLR) and platelet/LY ratios (PLR) were increased. Pathological differentiation analyses showed that G1 proportions were higher in the CL group, while G2 and G3 proportions were more prevalent in the CH group. Muscle layer infiltration depth in CL patients was < 50%, while that it was ≥50% in the CH group. No significant differences in OS rates were recorded between CH and CL groups over 60 months. However long-term survival (LTS) rates after 60 months in the CH group were significantly lower when compared with the CL group, and was more obvious in type II EC patients. Also, periuterine infiltration and preoperative CONUT scores were independent prognostic factors for OS rates as indicated by multi-factor analyses. Conclusion:CONUT scores not only facilitated the estimation of nutritional status, but were highly beneficial for predicting OS rates in patients with EC after curative resection. CONUT scores provided high predictive values for LTS rates over 60 months in these patients.
10.3389/fonc.2023.1126576
Prognostic and clinicopathological role of prognostic nutritional index (PNI) in endometrial cancer: A meta-analysis.
Heliyon
Background:The effect of prognostic nutritional index (PNI) on predicting prognosis of endometrial cancer (EC) patients has been widely analyzed, but no consistent findings are obtained. We therefore performed a meta-analysis for determining accurate role of PNI in predicting EC prognosis. Methods:We comprehensively searched PubMed, Web of Science, Embase, Cochrane Library, and CNKI databases from inception till January 5, 2024. Correlation between PNI and survival outcomes in EC was evaluated by pooled hazard ratios (HRs) and 95 % confidence intervals (CIs). Results:There were altogether eight articles involving 3,164 patients enrolled into this meta-analysis. According to our pooled results, low PNI significantly predicted the dismal overall survival (OS) (HR = 1.72, 95%CI = 1.33-2.22, p < 0.001) and inferior progression-free survival (PFS)/disease-free survival (DFS)/recurrence-free survival (RFS) (HR = 2.49, 95%CI = 1.62-3.84, p < 0.001) for EC patients. Furthermore, as revealed by our pooled results, a decreased PNI was significantly connected to FIGO stage III-IV (OR = 2.06, 95%CI = 1.42-2.99, p < 0.001), tumor grade of G3 (OR = 1.68, 95%CI = 1.32-2.14, p < 0.001), presence of lymphovascular space invasion (LVSI) (OR = 1.72, 95%CI = 1.14-2.61, p = 0.010), and presence of myometrial invasion (MMI) (OR = 2.04, 95%CI = 1.51-2.77, p < 0.001) in EC. Conclusion:According to our meta-analysis results, the decreased PNI is markedly related to poor OS and inferior PFS/DFS/RFS of EC patients. Additionally, decreased PNI was indicative of features implying tumor progression and development in EC.
10.1016/j.heliyon.2024.e35211
Impact of pre-treatment prognostic nutritional index and the haemoglobin, albumin, lymphocyte and platelet (HALP) score on endometrial cancer survival: A prospective database analysis.
PloS one
PURPOSE:The Onodera's prognostic nutritional index (PNI) and the haemoglobin, albumin, lymphocyte and platelet (HALP) score are immune-nutritional indices that correlate with survival outcomes in several adult solid malignancies. The aim of this study was to investigate whether PNI and HALP are associated with survival outcomes in endometrial cancer. PATIENTS AND METHODS:Women undergoing management for endometrial cancer were recruited to a single centre prospective cohort study. Pre-treatment PNI and HALP scores were computed for study participants and analysed as continuous variables and by selecting cut-off values based on previous publications. Both parameters were analysed in relation to overall, endometrial cancer-specific and recurrence-free survival using Kaplan-Meier estimation and multivariable Cox proportional regression. RESULTS:A total of 439 women, with a median age of 67 years (interquartile range (IQR), 58, 74) and BMI of 31kg/m2 (IQR 26, 37) were included in the analysis. Most had low-grade (63.3%), early-stage (84.4% stage I/II) endometrial cancer of endometrioid histological subtype (72.7%). Primary treatment was surgery in 98.2% of cases. Adjusted overall mortality hazard ratios for PNI and HALP as continuous variables were 0.97(95%CI 0.94-1.00, p = 0.136) and 0.99(95%CI 0.98-1.01, p = 0.368), respectively. Women with pre-treatment PNI ≥45 had a 45% decrease in both overall (adjusted HR = 0.55, 95% CI 0.33-0.92, p = 0.022) and cancer-specific mortality risk (adjusted HR = 0.55, 95%CI 0.30-0.99, p = 0.048) compared to those with PNI <45. There was no evidence for an effect of PNI on recurrence free survival. HALP scores were associated with adverse clinico-pathologic factors, but not overall, cancer-specific or recurrence-free survival in the multivariable analysis. CONCLUSION:PNI is an independent prognostic factor in endometrial cancer and has the potential to refine pre-operative risk assessment.
10.1371/journal.pone.0272232