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The value of the Prognostic Nutritional Index (PNI) in predicting outcomes and guiding the treatment strategy of nasopharyngeal carcinoma (NPC) patients receiving intensity-modulated radiotherapy (IMRT) with or without chemotherapy

  • Original Article – Clinical Oncology
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Abstract

Purpose

The purpose of this study was to investigate the significance of the Prognostic Nutritional Index (PNI) in predicting prognoses and guiding treatment choices of nasopharyngeal carcinoma (NPC) patients receiving intensity-modulated radiotherapy (IMRT).

Methods

The 539 patients with newly diagnosed non-metastatic NPC were retrospectively analysed. The PNI was calculated as 10 × serum albumin (g/dL) + 0.005 × total lymphocyte count (per mm3). All patients were split randomly into a training set and a testing set. Receiver operating characteristic (ROC) curves were used to identify the cut-off value of PNI and test its prognostic validity. Survival curves were calculated by Kaplan–Meier method, and differences were compared with log-rank test.

Results

The median follow-up time was 109.5 months. The 5-year locoregional recurrence-free survival (LRRFS), distant metastasis-free survival (DMFS), disease-specific survival (DSS) and overall survival (OS) of the whole cohort were 90.6, 85.8, 85.3 and 82.7%, respectively. The PNI cut-off value was 52.0 in the training set, which was significant in predicting DMFS, DSS and OS in the testing set. According to the PNI cut-off value, 220 patients of II–IVb stage treated by concurrent chemoradiotherapy (CCRT) were classified into PNI ≤ 52.0 and >52.0 groups and the 5-year LRRFS, DMFS, DSS, and OS of PNI ≤ 52.0 group were significantly worse than the PNI > 52.0 group.

Conclusion

Our results suggest that the PNI is a reliable independent prognostic factor in NPC patients treated with IMRT. For stage II-IVb patients with PNI ≤ 52.0, CCRT alone does not achieve satisfactory outcomes, and further studies on treatment optimization are needed.

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    Authors and Affiliations

    1. Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, 510060, People’s Republic of China

      Jingjing Miao, Lin Wang, Haijun Wu, Xiang Guo & Chong Zhao

    2. Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, 510060, People’s Republic of China

      Jingjing Miao, Weiwei Xiao, Fei Han, Xiaowu Deng & Chong Zhao

    Authors
    1. Jingjing Miao
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    2. Weiwei Xiao
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    3. Lin Wang
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    6. Xiaowu Deng
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    Correspondence to Xiang Guo or Chong Zhao.

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    All authors declare that he/she has no conflict of interest.

    Funding

    This study was funded by the Science and Technology Project of Guangdong Province (Grant Number 2014A020212433), the Doctoral Fund of Ministry of Education (Grant Number 20130171120111); and the National Natural Science Foundation of China (CN) (Grant Number 8140111403).

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    Informed consent was obtained from all individual participants included in the study.

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    J. Miao, W. Xiao authors contribute to this work equally.

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    Miao, J., Xiao, W., Wang, L. et al. The value of the Prognostic Nutritional Index (PNI) in predicting outcomes and guiding the treatment strategy of nasopharyngeal carcinoma (NPC) patients receiving intensity-modulated radiotherapy (IMRT) with or without chemotherapy. J Cancer Res Clin Oncol 143, 1263–1273 (2017). https://doi.org/10.1007/s00432-017-2360-3

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    • DOI: https://doi.org/10.1007/s00432-017-2360-3

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