Abstract
BackgroundStudies confirmed the predictive value of the prognostic nutrition index (PNI) in many malignant tumors. However, it did not reach a consensus in glioma. Therefore, this study investigated the prognostic value of preoperative PNI in operable high-grade glioma and established a nomogram.MethodsClinical data of high-grade glioma patients were retrospectively analyzed. The primary endpoint was overall survival (OS). Survival analysis was conducted by the Kaplan–Meier method, log-rank test, and Cox regression analysis. A nomogram was established. The prediction effect of the nomogram covering PNI was verified by area under the curve (AUC).ResultsA total of 91 operable high-grade glioma patients were included. Kaplan–Meier analysis showed that among grade IV gliomas (n = 55), patients with higher PNI (>44) showed a trend of OS benefit (p = 0.138). In grade III glioma (n = 36), patients with higher PNI (>47) had longer OS (p = 0.023). However, the intersecting Kaplan–Meier curve suggested that there may be some confounding factors. Cox regression analysis showed that higher PNI was an independent prognostic factor for grade IV glioma (HR = 0.388, p = 0.040). In grade III glioma, there was no statistically relationship between PNI levels and prognosis. When evaluating the prognostic ability of PNI alone by ROC, the AUC in grade III and IV gliomas was low, indicating that PNI alone had poor predictive power for OS. Interestingly, we found that the nomogram including preoperative PNI, age, extent of resection, number of gliomas, and MGMT methylation status could predict the prognosis of patients with grade IV glioma well.ConclusionThe PNI level before surgery was an independent prognostic factor for patients with grade IV glioma. The nomogram covering PNI in patients with grade IV glioma also proved the value of PNI. However, the value of PNI in grade III glioma needs to be further evaluated. More prospective studies are needed to verify this conclusion.
Highlights
The overall prognosis of patients with high-grade glioma is poor, and the survival of patients varied greatly, and their 5-year survival rate fluctuates between 5.5% and 75.2% [1]
No tumor remaining was considered as gross total resection (GTR), tumor resection extent > 90% was considered as near total resection (NTR), tumor resection extent between 80% and 90% was considered as subtotal resection (STR), and tumor resection extent
When assessing the prognostic ability of prognostic nutritional index (PNI) in grade III and IV gliomas through the ROC curve, we found that the area under the curve (AUC) was not high (0.65 and 0.50, respectively, Figure 2), which indicated that PNI alone had a limited effect of predicting OS in patients with high-grade glioma
Summary
The overall prognosis of patients with high-grade glioma is poor, and the survival of patients varied greatly, and their 5-year survival rate fluctuates between 5.5% and 75.2% [1]. Research showed that the prognosis of patients with high-grade glioma was related to factors such as patient age, tumor characteristics, and treatment methods [1]. The accuracy in predicting the prognosis of high-grade gliomas is still limited. It is necessary to find more prognostic factors to comprehensively evaluate the prognosis of patients with highgrade glioma. This study intended to explore the prognostic value of PNI in patients with operable highgrade glioma. Studies confirmed the predictive value of the prognostic nutrition index (PNI) in many malignant tumors. It did not reach a consensus in glioma. This study investigated the prognostic value of preoperative PNI in operable high-grade glioma and established a nomogram
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