Abstract
ObjectivePrognostic nutritional index (PNI), calculated as serum albumin (ALB) (g/L) + 5 × total lymphocyte count (109/L), is initially used to evaluate nutritional status in patients undergoing surgery and may evaluate the therapeutic effects and predict the survival of various solid tumors. The present study aimed to evaluate the potential prognostic significance of PNI in breast cancer patients receiving neoadjuvant chemotherapy (NACT).MethodsA total of 785 breast cancer patients treated with neoadjuvant chemotherapy were enrolled in this retrospective study. The optimal cutoff value of PNI by receiver operating characteristic curve stratified patients into a low-PNI group (<51) and a high PNI group (≥51). The associations between breast cancer and clinicopathological variables by PNI were determined by chi-square test or Fisher’s exact test. Kaplan–Meier plots and log-rank test were used to evaluate the clinical outcomes of disease-free survival (DFS) and overall survival (OS). The prognostic value of PNI was analyzed by univariate and multivariate Cox proportional hazards regression models. The toxicity of NACT was accessed by the National Cancer Institute Common Toxicity Criteria (NCI-CTC).ResultsThe results indicated that PNI had prognostic significance by an optimal cutoff value of 51 on DFS and OS in univariate and multivariate Cox regression survival analyses. Breast cancer patients with a high PNI value had longer DFS and OS than those with a low PNI value [47.64 vs. 36.60 months, P < 0.0001, hazard ratio (HR) = 0.264, 95%CI = 0.160–0.435; 73.61 vs. 64.97 months, P < 0.0001, HR = 0.319, 95%CI = 0.207–0.491, respectively]. Furthermore, the results indicated that patients with high PNI had longer DFS and OS than those with low PNI in early stage and advanced breast cancer, especially in advanced breast cancer. The mean DFS and OS times for breast cancer patients with high PNI by the log-rank test were longer than in those with low PNI in different molecular subtypes. Moreover, the mean DFS and OS times in patients with high PNI by the log-rank test were longer than in those patients with low PNI without or with lymph vessel invasion. The common toxicities after neoadjuvant chemotherapy were hematologic and gastrointestinal reaction, and the PNI had no significance on the toxicities of all enrolled patients, except in anemia, leukopenia, and myelosuppression.ConclusionPretreatment PNI with the advantages of being convenient, noninvasive, and reproducible was a useful prognostic indicator for breast cancer patients receiving neoadjuvant chemotherapy and is a promising biomarker for breast cancer on treatment strategy decisions.
Highlights
Breast cancer is the most common cancer in women and is the most frequent cause of cancer-related morbidity and mortality for women throughout the world (Siegel et al, 2019)
A total of 785 breast cancer patients were enrolled in this study: 477 breast cancer patients were assigned to the Neoadjuvant chemotherapy (NACT) group and 308 breast cancer patients were assigned to the non-NACT group
Of all enrolled breast patients, the results indicated that patients with high Prognostic nutritional index (PNI) had longer Disease-free survival (DFS) and overall survival (OS) than those with low PNI in early stage breast cancer (χ2 = 2.223, P = 0.136 and χ2 = 1.650, P = 0.199, respectively; Figures 2A,B)
Summary
Breast cancer is the most common cancer in women and is the most frequent cause of cancer-related morbidity and mortality for women throughout the world (Siegel et al, 2019). The prolonged survival trajectory of breast cancer survivors remains complicated and unpredictable by breast cancer recurrence or treatment-related physical effects (Lucas et al, 2017). Malnutrition is a common finding in cancer patients, and their nutritional status is an important factor influencing their prognosis depending on the clinical type, pathological stage, curative treatment, and the individual patient (Bumrungpert et al, 2018; Clemente et al, 2018). BMI has been proven as an independent prognostic factor for breast cancer, and patients with very high or low BMI have poorer survival compared with normal-weight patients (Bhaskaran et al, 2014; Cespedes Feliciano et al, 2017). Malnutrition and poor immune status may increase the risk of postoperative complications, decrease the response to antitumor therapy, and be associated with poor survival (Liu et al, 2015; Okadome et al, 2020)
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