Abstract
We aimed to identify the prognostic and predictive values of post-treatment prognostic nutritional index (PNI) and PNI dynamics in nasopharyngeal cancer patients (NPC) in this study. One hundred seven non-metastatic NPC patients were included. PNI was calculated by using the following formula: [10 × serum albumin value (gr/dL)] + [0.005 × total lymphocyte count (per mm3)]. ROC analysis was used for determining prognostic PNI values and univariate and multivariate statistical analyses for prognostic characterization of PNI. The statistically significant cut-off values for pre- and post-treatment PNI were 50.65 and 44.75, respectively. Of the pre-treatment PNI analysis, PNI ≤ 50.65 group had shorter loco-regional recurrence-free survival (LRRFS), distant metastasis-free survival (DMFS), and overall survival (OS). Furthermore, for post-treatment PNI analysis, PNI ≤ 44.75 group had shorter LRRFS and OS. In univariate analysis, only pre-treatment PNI was associated with LRRFS and DMFS, while pre- and post-treatment PNI were both associated with OS. In multivariate analysis, both PNI were independent prognostic markers for OS. In the combined analysis, pre- and post-treatment PNI, differences between the groups were statistically significant, and the PNI dynamics was an independent prognostic indicator for OS. PNI is a useful, independent prognostic marker for non-metastatic NPC patients. It is used for either pre- or post-treatment patients. Furthermore, changes in pre-treatment PNI value after curative treatment is a significant indicator for OS.
Highlights
Nasopharyngeal cancer (NPC) is a rare head and neck tumor and is usually endemic in South Asia and Africa
All patients were above 18 years old, had a biopsy- confirmed World Health Organization (WHO) type I-II or III NPC, treated with RT only or combined with chemotherapy according to the disease stage, had complete pre-and post-treatment clinical and laboratory data
Our study demonstrated that post-treatment prognostic nutritional index (PNI) and PNI values change after curative treatment (PNI dynamics) had a statistically significant association with overall survival (OS) as pre-treatment PNI
Summary
Nasopharyngeal cancer (NPC) is a rare head and neck tumor and is usually endemic in South Asia and Africa. Due to the unsuitability of anatomical location for surgery and its chemo-radiosensitivity, radiotherapy (RT) or combined-modality therapy is the standard of care for NPC [2]. The treatment depends on the tumor, node, and metastasis (TNM) stage in NPC [4]. The most important prognostic factor is TNM staging, NPC patients with the same clinical stage have different clinical courses. The most likely explanation is that TNM is primarily an anatomical staging system and does not reflect the pathobiology of the tumor and clinical factors of the host. Identifying prognosis-related markers and their use in practical life may eliminate TNM staging deficiency in determining prognosis [4]
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