Abstract
Please indicate where the abstract has been published before: Annals of HematologyBackground:Cachexia is an indicator of tumor progression in patients with malignancy. Cachectic patients exhibit intolerance and a reduced response to antitumor therapy, and have an unfavorable prognosis. An international consensus proposed diagnostic criteria for cancer cachexia including weight loss, low body mass index (BMI), and/or presence of sarcopenia. Other potential biomarkers (e.g., albumin, C‐reactive protein, pro‐inflammatory cytokines, and microRNAs) and scoring systems (e.g., cachexia score [CASCO], Glasgow prognostic score [GPS], prognostic nutritional index [PNI]) have also been studied to diagnose cancer cachexia and assess its severity.Aims:In this study, we assessed the associations among PNI, other clinical outcomes, and survival in patients with DLBCL. Then we sought valid cachexia markers with prognostic significance and designed a novel model to improve the prognostic ability of well‐known clinical indices for patients with DLBCL.Methods:A total of 228 DLBCL patients treated with first‐line R‐CHOP (rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone) were retrospectively reviewed. PNI was calculated as 10 × serum levels of albumin (g/dL) + 0.005 × absolute lymphocyte count (/mm3). Patients were categorized into low‐ and high‐PNI groups based on a cut‐off value of 40. The nomogram for predicting overall survival (OS) was constructed using a Cox regression model. PNI was positively correlated with skeletal muscle index, body mass index, and serum levels of albumin.Results:The low‐PNI group had a lower complete response rate (60.3% vs. 87.6%), increased treatment‐related toxicity, and more frequent treatment discontinuation (43.5% vs. 8.8%) than the high‐PNI group. The median OS was shorter in the low‐PNI group than the high‐PNI group (15.6 months vs. not reached; p < 0.001, Figure.1). Multivariate Cox regression analyses showed that PNI, sarcopenia, and the international prognostic index (IPI) were independent prognostic factors for OS. The nomogram developed using this regression model showed excellent discriminatory ability for predicting OS (c‐index, 0.80) compared to the IPI alone (c‐index, 0.75).Summary/Conclusion:This study supports the results of a previous study [29], whereby low PNI is an independent poor prognostic factor in patients with DLBCL treated with first‐line R‐CHOP immunochemotherapy. In addition, we newly found that treatment‐related toxicity and early discontinuation of treatment occurred more frequently in DLBCL patients with low PNI. We anticipate that the new prognostic nomogram developed using PNI, SMI, and IPI may help to realize individualized therapy that considers both the disease characteristics and the patient's tolerance to treatment in patients with DLBCL. This will be validated externally in a future study.image
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