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Prognostic nutrition index affects the prognosis of patients undergoing trimodality therapy for locally advanced non-small cell lung cancer

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Abstract

Purpose

Trimodality therapy, comprised of induction chemoradiotherapy (iCRT) followed by surgery, is a highly invasive treatment option for locally advanced non-small cell lung cancers (LA-NSCLCs; defined as a heterogenous disease). We conducted this study to investigate the prognostic nutritional index (PNI) of LA-NSCLC patients undergoing trimodality therapy, which has not been studied in detail before.

Methods

The subjects of this retrospective study were 127 patients who underwent trimodality therapy between 1999 and 2016. We measured the PNI at three points: before iCRT (pre-iCRT), before the operation, and after the operation.

Results

PNIs decreased significantly as treatment progressed. Patients with clinical T3/4 (cT3/4) disease had a significantly lower PNI than those with cT1/2 disease, but the extent of lymph-node metastasis did not affect the PNI at any point. Using the cut-off values of receiver-operating curve analyses, multivariable analyses revealed that a high PNI pre-iCRT correlated significantly with a better survival of LA-NSCLC patients, especially those with cT3/4 disease (hazard ratio 3.84; 95% confidential interval 1.34–12.5, P = 0.012).

Conclusions

Measuring the PNI before trimodality therapy is important for predicting the clinical outcome of patients with LA-NSCLC, with differing predictive ability according to the disease extent. Perioperative intensive nutritional intervention must be considered for patients who undergo trimodality therapy for LA-NSCLC.

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Acknowledgements

We would like to thank Drs. Akihiro Miura, Shunsaku Miyauchi, Kota Araki, Yuta Takahashi, Eisuke Kurihara, Yusuke Ogoshi, Kei Namba, Takahiro Yoshioka, Hidejiro Torigoe, and Hiroki Sato (Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences) for their help with the collection of data from the medical records. This study did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Author notes

  1. Junichi Soh

    Present address: Division of Thoracic Surgery, Department of Surgery, KINDAI University Faculty of Medicine, 377-2 Ono-higashi, Osaka-Sayama, Osaka, 856-0039, Japan

Authors and Affiliations

  1. Departments of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan

    Junichi Soh, Ken Suzawa, Kazuhiko Shien, Shinji Otani, Hiromasa Yamamoto, Mikio Okazaki, Seiichiro Sugimoto, Masaomi Yamane & Shinichi Toyooka

  2. Department of Radiology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan

    Kuniaki Katsui & Susumu Kanazawa

  3. Department of Respiratory Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan

    Katsuyuki Kiura

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  1. Junichi Soh
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Correspondence to Junichi Soh.

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595_2020_2067_MOESM1_ESM.tif

Supplementary file1 Prognostic role of PNI before surgery on clinical outcome. The receiver operating curves (ROCs) were generated for all patients (n = 127, a) and for the patients with cT3/4 disease (n = 72, c). The Kaplan-Meier curves of overall survival (OS) and relapse-free survival (RFS) for all the patients (b) and for the patients with cT3/4 disease(d), respectively. The cutoff values of PNI before trimodality therapy for each population were defined by each representative ROC analysis. AUC, area under curve (TIF 21303 kb)

595_2020_2067_MOESM2_ESM.tif

Supplementary file2 Prognostic role of the ratio of PNI before surgery to PNI before trimodality therapy on clinical outcome. The Kaplan-Meier curves of overall survival (OS) and relapse-free survival (RFS) for all patients (a) and for the patients with cT3/4 disease (b), respectively. A ratio of less than 1.0 means the pre-iCRT PNI value was higher than the pre-op PNI value (TIF 21172 kb)

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Soh, J., Suzawa, K., Shien, K. et al. Prognostic nutrition index affects the prognosis of patients undergoing trimodality therapy for locally advanced non-small cell lung cancer. Surg Today 50, 1610–1618 (2020). https://doi.org/10.1007/s00595-020-02067-7

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  • DOI: https://doi.org/10.1007/s00595-020-02067-7

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