The combination of pretreatment prognostic nutritional index and neuron-specific enolase enhances prognosis predicting value of small cell lung cancer.

Abstract

Tumor and immune-inflammatory biomarkers have been demonstrated to be closely associated with cancer prognosis. The present study aims to assess the prognostic value of pretreatment prognostic nutritional index (PNI), carcinoembryonic antigen (CEA), and neuron-specific enolase (NSE) in small cell lung cancer (SCLC). A retrospective analysis of 301 SCLC patients treated with platinum-based chemotherapy was performed. Overall survival (OS) was assessed by Kaplan-Meier and multivariate Cox hazard analyses. The median OS for total cases was 15.0months. On univariate analysis, tumor stage (P<0.001), pretreatment PNI (P<0.001), CEA (P=0.039), NSE (P=0.010), distant metastasis numbers (P<0.001), and thoracic radiotherapy (P<0.001) were found to be the predictors of OS. Multivariate analysis showed limited stage, high PNI, NSE < 15μg/L, and chemoradiotherapy were positive independent prognostic factors (P<0.05). Low PNI and NSE ≥ 15μg/L were closely correlated with a high tumor burden status. Three cohorts of SCLC with significant different survival outcomes were divided based on variable PNI and NSE levels. Patients with high PNI and NSE < 15μg/L showed the best OS of 24.5months, while patients with low PNI and NSE ≥ 15μg/L had the worst survival outcome of 10.0months. Patients with low PNI and NSE < 15μg/L or high PNI and NSE ≥ 15μg/L had the similar outcome of 16.5 and 17.0months, respectively. Pretreatment PNI and NSE were independent prognostic factors of SCLC. The combination of PNI and NSE enhanced the OS predicting ability, and patients with high PNI and NSE < 15μg/L had the best survival outcome.