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Low Prognostic Nutritional Index Predicts Poor Clinical Outcomes in Patients with Stage IIIB Non-small-cell Lung Carcinoma Undergoing Chemoradiotherapy

Authors Ozdemir Y, Topkan E, Mertsoylu H, Selek U

Received 1 February 2020

Accepted for publication 6 March 2020

Published 16 March 2020 Volume 2020:12 Pages 1959—1967


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Editor who approved publication: Dr Chien-Feng Li

Yurday Ozdemir,1 Erkan Topkan,1 Huseyin Mertsoylu,2 Ugur Selek3,4

1Department of Radiation Oncology, Baskent University Medical Faculty, Adana, Turkey; 2Department of Medical Oncology, Baskent University Medical Faculty, Adana, Turkey; 3School of Medicine, Department of Radiation Oncology, Koc University, Istanbul, Turkey; 4MD Anderson Cancer Center, Department of Radiation Oncology, The University of Texas, Houston, TX, USA

Correspondence: Yurday Ozdemir
Department of Radiation Oncology, Baskent University Medical Faculty, Adana 01120, Turkey
Tel +90 505 594 2169
Fax +90 322 344 4452

Purpose: To investigate the prognostic utility of the prognostic nutritional index (PNI) in stage IIIB non-small-cell lung carcinoma (NSCLC) patients undergoing concurrent chemoradiotherapy (CRT).
Methods: A total of 358 stage IIIB NSCLC patients who received a total dose of 60– 66 Gy (2 Gy/fraction) radiotherapy and ≥ 1 cycle(s) of platinum-based chemotherapy were analyzed. The receiver operating curve analysis was utilized to identify the optimal PNI cut-off value demonstrating a significant connection with the overall survival (OS), locoregional progression-free survival (LRPFS), and progression-free survival (PFS).
Results: At a median follow-up time of  22.5 months (range: 2.4– 123.5),  30.2% and 14% of the patients were still alive and free of disease progression, respectively.The median OS, LRPFS, and PFS were 25.2 [95% confidence interval (CI): 36.3– 46.6 months], 15.4 (95% CI: 26.6– 35.3 months), and 10.7 (95% CI: 36.8– 69.9 months), individually, for the whole study accomplice. The ROC analysis revealed an optimum rounded cut-off that associated meaningfully with each of the OS [area under the curve (AUC): 84.1%; sensitivity: 75.9%;72.4% specificity], LRPFS (AUC: 92.4%; sensitivity: 87.9%; 85.1% specificity), and PFS (AUC: 80.1%; sensitivity: 73.7%; 71.6% specificity) at a value of  40.5. Comparative analyses revealed that the patients presenting with PNI≤ 40.5 had significantly inferior OS (16.8 vs 36.7; P< 0.001), LRPFS (11.5 vs 19.5; P< 0.001), and PFS (8.6 vs 13.6; P< 0.001) outcomes compared to patients with PNI> 40.5. In univariate analyses, lower T-stage (1– 2 vs 3– 4; P< 0.001), lower N-stage (N2 vs N3; P< 0.001), anemia status (absent vs present; P< 0.001), weight loss status (< 5% vs ≥ 5%; P< 0.001), and PNI group (≤ 40.5 vs > 40.5; P< 0.001) were the factors found to be associated with OS, LRPFS and PFS results. The results of multivariate analysis exhibited that the PNI was independently associated with each of the OS (P< 0.001), LRPFS (P< 0.001), and PFS (P< 0.001) outcomes.
Conclusion: The pretreatment PNI appears to be a robust novel prognostic factor that stratifies patients with stage IIIB NSCLC into two significantly distinct survival groups after CRT.

Keywords: prognostic nutritional index, non-small-cell lung carcinoma, prognosis, chemoradiotherapy, survival results

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