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Prognostic nutritional index predicts outcomes of malignant pleural mesothelioma

Abstract

Purpose

Nutritional status has been associated with long-time outcomes in cancer patients. We investigated whether the prognostic nutritional index (PNI), an indicator of nutritional status, affects overall survival in patients with malignant pleural mesothelioma (MPM).

Methods

We enrolled 121 patients with histologically confirmed MPM, who had successfully undergone biopsy by medical thoracoscopy in this study. Demographic, clinical and laboratory data were collected retrospectively. The PNI was calculated as 10× serum albumin value (g/dl) + 0.005 × total lymphocyte count (per mm3) in peripheral blood. Univariate and multivariate analyses were used to identify prognostic factors.

Results

Mean pretreatment PNI was 44.6. PNI was significantly associated with age (P = 0.031), smoking habits (P = 0.039) and weight loss (P = 0.029). Survival analysis showed PNI to be an independent prognostic factor in MPM. Patients with lower PNIs (PNI < 44.6) had greater risk of death than those with higher PNIs (PNI ≥ 44.6; hazard ratio: 2.290; 95 % confidence interval: 1.415–3.706; P = 0.001). These analyses were adjusted for patient age, gender, smoking habits, dyspnea, chest pain, weight loss, primary site of tumor, histology, platinum-based systemic chemotherapy, hospital and stage.

Conclusions

Pretreatment PNI is a novel independent prognostic factor in MPM.

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References

  • Andreoli A, De Lorenzo A, Cadeddu F, Iacopino L, Grande M (2011) New trends in nutritional status assessment of cancer patients. Eur Rev Med Pharmacol Sci 15(5):469–480

    CAS  PubMed  Google Scholar 

  • Bagheri R, Haghi SZ, Rahim MB, Attaran D, Toosi MS (2011) Malignant pleural mesothelioma: clinicopathologic and survival characteristic in a consecutive series of 40 patients. Ann Thorac Cardiovasc Surg Off J Assoc Thorac Cardiovasc Surg Asia 17(2):130–136

    Google Scholar 

  • Baldwin C, Spiro A, McGough C, Norman AR, Gillbanks A, Thomas K, Cunningham D, O’Brien M, Andreyev HJ (2011) Simple nutritional intervention in patients with advanced cancers of the gastrointestinal tract, non-small cell lung cancers or mesothelioma and weight loss receiving chemotherapy: a randomised controlled trial. J Hum Nutr diet Off J British Diet Assoc 24(5):431–440. doi:10.1111/j.1365-277X.2011.01189.x

    CAS  Article  Google Scholar 

  • Barreto Penie J (2005) State of malnutrition in Cuban hospitals. Nutrition 21(4):487–497. doi:10.1016/j.nut.2004.08.019

    Article  PubMed  Google Scholar 

  • Benizri EI, Bereder JM, Rahili A, Bernard JL, Benchimol D (2013) Ascites and malnutrition are predictive factors for incomplete cytoreductive surgery for peritoneal carcinomatosis from gastric cancer. Am J Surg 205(6):668–673. doi:10.1016/j.amjsurg.2012.06.009

    Article  PubMed  Google Scholar 

  • Borasio P, Berruti A, Bille A, Lausi P, Levra MG, Giardino R, Ardissone F (2008) Malignant pleural mesothelioma: clinicopathologic and survival characteristics in a consecutive series of 394 patients. Eur J Cardio-Thorac. Surg Off J Eur Assoc Cardio-Thorac Surg 33(2):307–313. doi:10.1016/j.ejcts.2007.09.044

    Article  Google Scholar 

  • Chen H, Hansen MJ, Jones JE, Vlahos R, Anderson GP, Morris MJ (2008) Long-term cigarette smoke exposure increases uncoupling protein expression but reduces energy intake. Brain Res 1228:81–88. doi:10.1016/j.brainres.2008.06.067

    CAS  Article  PubMed  Google Scholar 

  • de Perrot M, Feld R, Cho BC, Bezjak A, Anraku M, Burkes R, Roberts H, Tsao MS, Leighl N, Keshavjee S, Johnston MR (2009) Trimodality therapy with induction chemotherapy followed by extrapleural pneumonectomy and adjuvant high-dose hemithoracic radiation for malignant pleural mesothelioma. J Clin Oncol Off J Am Soc Clin Oncol 27(9):1413–1418. doi:10.1200/JCO.2008.17.5604

    Article  Google Scholar 

  • Edwards JG, Abrams KR, Leverment JN, Spyt TJ, Waller DA, O’Byrne KJ (2000) Prognostic factors for malignant mesothelioma in 142 patients: validation of CALGB and EORTC prognostic scoring systems. Thorax 55(9):731–735

    PubMed Central  CAS  Article  PubMed  Google Scholar 

  • Flores RM, Zakowski M, Venkatraman E, Krug L, Rosenzweig K, Dycoco J, Lee C, Yeoh C, Bains M, Rusch V (2007) Prognostic factors in the treatment of malignant pleural mesothelioma at a large tertiary referral center. J Thorac Oncol Off Publ Int Assoc Study Lung Cancer 2(10):957–965. doi:10.1097/JTO.0b013e31815608d9

    Google Scholar 

  • Fulkerson JA, French SA (2003) Cigarette smoking for weight loss or control among adolescents: gender and racial/ethnic differences. J Adolesc Health Off Publ Soc Adolesc Med 32(4):306–313

    Article  Google Scholar 

  • Gemba K, Fujimoto N, Aoe K, Kato K, Takeshima Y, Inai K, Kishimoto T (2013) Treatment and survival analyses of malignant mesothelioma in Japan. Acta Oncol 52(4):803–808. doi:10.3109/0284186X.2012.709948

    Article  PubMed  Google Scholar 

  • Herndon JE, Green MR, Chahinian AP, Corson JM, Suzuki Y, Vogelzang NJ (1998) Factors predictive of survival among 337 patients with mesothelioma treated between 1984 and 1994 by the Cancer and Leukemia Group B. Chest 113(3):723–731

    CAS  Article  PubMed  Google Scholar 

  • Hodgson JT, McElvenny DM, Darnton AJ, Price MJ, Peto J (2005) The expected burden of mesothelioma mortality in Great Britain from 2002 to 2050. Br J Cancer 92(3):587–593. doi:10.1038/sj.bjc.6602307

    PubMed Central  CAS  PubMed  Google Scholar 

  • Kanda M, Fujii T, Kodera Y, Nagai S, Takeda S, Nakao A (2011) Nutritional predictors of postoperative outcome in pancreatic cancer. British J Surg 98(2):268–274. doi:10.1002/bjs.7305

    CAS  Article  Google Scholar 

  • Kao SC, Vardy J, Chatfield M, Corte P, Pavlakis N, Clarke C, van Zandwijk N, Clarke S (2013) Validation of prognostic factors in malignant pleural mesothelioma: a retrospective analysis of data from patients seeking compensation from the New South Wales Dust Diseases Board. Clin Lung Cancer 14(1):70–77. doi:10.1016/j.cllc.2012.03.011

    Article  PubMed  Google Scholar 

  • Khalid U, Spiro A, Baldwin C, Sharma B, McGough C, Norman AR, Eisen T, O’Brien ME, Cunningham D, Andreyev HJ (2007) Symptoms and weight loss in patients with gastrointestinal and lung cancer at presentation. Support Care Cancer Off J Multinatl Assoc Support Care Cancer 15(1):39–46. doi:10.1007/s00520-006-0091-0

    CAS  Google Scholar 

  • Lee H, Cho YS, Jung S, Kim H (2013) Effect of nutritional risk at admission on the length of hospital stay and mortality in gastrointestinal cancer patients. Clin Nutr Res 2(1):12–18. doi:10.7762/cnr.2013.2.1.12

    PubMed Central  Article  PubMed  Google Scholar 

  • Migita K, Takayama T, Saeki K, Matsumoto S, Wakatsuki K, Enomoto K, Tanaka T, Ito M, Kurumatani N, Nakajima Y (2013) The prognostic nutritional index predicts long-term outcomes of gastric cancer patients independent of tumor stage. Ann Surg Oncol. doi:10.1245/s10434-013-2926-5

    PubMed  Google Scholar 

  • Morgan TM, Tang D, Stratton KL, Barocas DA, Anderson CB, Gregg JR, Chang SS, Cookson MS, Herrell SD, Smith JA Jr, Clark PE (2011) Preoperative nutritional status is an important predictor of survival in patients undergoing surgery for renal cell carcinoma. Eur Urol 59(6):923–928. doi:10.1016/j.eururo.2011.01.034

    PubMed Central  Article  PubMed  Google Scholar 

  • Nozoe T, Kimura Y, Ishida M, Saeki H, Korenaga D, Sugimachi K (2002) Correlation of pre-operative nutritional condition with post-operative complications in surgical treatment for oesophageal carcinoma. Eur J Surg Oncol J Eur Soc Surg Oncol British Assoc Surg Oncol 28(4):396–400

    CAS  Google Scholar 

  • Nozoe T, Kohno M, Iguchi T, Mori E, Maeda T, Matsukuma A, Ezaki T (2012) The prognostic nutritional index can be a prognostic indicator in colorectal carcinoma. Surg Today 42(6):532–535. doi:10.1007/s00595-011-0061-0

    Article  PubMed  Google Scholar 

  • Okada I, Shirahata A, Soda H, Saitou M, Kigawa G, Nemoto H, Sanada Y, Hibi K (2012) Significance of Onodera’s prognostic nutritional index for treating unresectable or recurrent colorectal cancer with chemotherapy. Gan to kagaku ryoho Cancer Chemother 39(2):231–235

    Google Scholar 

  • Onodera T, Goseki N, Kosaki G (1984) Prognostic nutritional index in gastrointestinal surgery of malnourished cancer patients. Nihon Geka Gakkai zasshi 85(9):1001–1005

    CAS  PubMed  Google Scholar 

  • Pinato DJ, North BV, Sharma R (2012) A novel, externally validated inflammation-based prognostic algorithm in hepatocellular carcinoma: the prognostic nutritional index (PNI). Br J Cancer 106(8):1439–1445. doi:10.1038/bjc.2012.92

    PubMed Central  CAS  Article  PubMed  Google Scholar 

  • Proctor MJ, Morrison DS, Talwar D, Balmer SM, Fletcher CD, O’Reilly DS, Foulis AK, Horgan PG, McMillan DC (2011) A comparison of inflammation-based prognostic scores in patients with cancer. A Glasgow inflammation outcome study. Eur J Cancer 47(17):2633–2641. doi:10.1016/j.ejca.2011.03.028

    Article  PubMed  Google Scholar 

  • Ray-Coquard I, Cropet C, Van Glabbeke M, Sebban C, Le Cesne A, Judson I, Tredan O, Verweij J, Biron P, Labidi I, Guastalla JP, Bachelot T, Perol D, Chabaud S, Hogendoorn PC, Cassier P, Dufresne A, Blay JY (2009) Lymphopenia as a prognostic factor for overall survival in advanced carcinomas, sarcomas, and lymphomas. Cancer Res 69(13):5383–5391. doi:10.1158/0008-5472.CAN-08-3845

    PubMed Central  CAS  Article  PubMed  Google Scholar 

  • Rusch VW (1995) A proposed new international TNM staging system for malignant pleural mesothelioma. From the International Mesothelioma Interest Group. Chest 108(4):1122–1128

    CAS  Article  PubMed  Google Scholar 

  • Ryan M, White K, Roydhouse JK, Fethney J (2012) A description of the nutritional status and quality of life of Australian gynaecological cancer patients over time. Eur J Oncol Nurs Off J Eur Oncol Nurs Soc 16(5):453–459. doi:10.1016/j.ejon.2011.10.007

    Article  Google Scholar 

  • Smale BF, Mullen JL, Buzby GP, Rosato EF (1981) The efficacy of nutritional assessment and support in cancer surgery. Cancer 47(10):2375–2381

    CAS  Article  PubMed  Google Scholar 

  • Tanrikulu AC, Abakay A, Kaplan MA, Kucukoner M, Palanci Y, Evliyaoglu O, Sezgi C, Sen H, Carkanat AI, Kirbas G (2010) A clinical, radiographic and laboratory evaluation of prognostic factors in 363 patients with malignant pleural mesothelioma. Respir Int Rev Thorac Dis 80(6):480–487. doi:10.1159/000321370

    Google Scholar 

  • Tong H, Isenring E, Yates P (2009) The prevalence of nutrition impact symptoms and their relationship to quality of life and clinical outcomes in medical oncology patients. Support Care Cancer Off J Multinatl Assoc Support Care Cancer 17(1):83–90. doi:10.1007/s00520-008-0472-7

    CAS  Google Scholar 

  • Travis WD, Brambilla E, Muller-Hermelink HK, Harris CC (eds) (2004) World Health Organization Classification of Tumours. Pathology & Genetics. Tumours of the Lung, Pleura, Thymus and Heart. IARC, Lyon

    Google Scholar 

  • Van Cutsem E, Arends J (2005) The causes and consequences of cancer-associated malnutrition. Eur J Oncol Nurs Off J Eur Oncol Nurs Soc 9(Suppl 2):S51–S63. doi:10.1016/j.ejon.2005.09.007

    Article  Google Scholar 

  • van Meerbeeck JP, Gaafar R, Manegold C, Van Klaveren RJ, Van Marck EA, Vincent M, Legrand C, Bottomley A, Debruyne C, Giaccone G (2005) Randomized phase III study of cisplatin with or without raltitrexed in patients with malignant pleural mesothelioma: an intergroup study of the European Organisation for Research and Treatment of Cancer Lung Cancer Group and the National Cancer Institute of Canada. J Clin Oncol Off J Am Soc Clin Oncol 23(28):6881–6889. doi:10.1200/JCO.20005.14.589

    Article  Google Scholar 

  • Vogelzang NJ, Rusthoven JJ, Symanowski J, Denham C, Kaukel E, Ruffie P, Gatzemeier U, Boyer M, Emri S, Manegold C, Niyikiza C, Paoletti P (2003) Phase III study of pemetrexed in combination with cisplatin versus cisplatin alone in patients with malignant pleural mesothelioma. J Clin Oncol Off J Am Soc Clin Oncol 21(14):2636–2644. doi:10.1200/JCO.2003.11.136

    CAS  Article  Google Scholar 

  • Wager-Srdar SA, Levine AS, Morley JE, Hoidal JR, Niewoehner DE (1984) Effects of cigarette smoke and nicotine on feeding and energy. Physiol Behav 32(3):389–395

    CAS  Article  PubMed  Google Scholar 

  • Watanabe M, Iwatsuki M, Iwagami S, Ishimoto T, Baba Y, Baba H (2012) Prognostic nutritional index predicts outcomes of gastrectomy in the elderly. World J Surg 36(7):1632–1639. doi:10.1007/s00268-012-1526-z

    Article  PubMed  Google Scholar 

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Acknowledgments

We thank the staff at the Department of Respiratory Medicine of Shandong Provincial Hospital Affiliated to Shandong University and Qilu Hospital of Shandong University as well as the staff at the Department of Tuberculosis Medicine of Shandong Provincial Chest Hospital for their assistance in collecting the clinical data.

Conflict of interest

We declare that we have no conflict of interest.

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Correspondence to Qing-Hua Liu or Dian-Jie Lin.

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Yao, ZH., Tian, GY., Wan, YY. et al. Prognostic nutritional index predicts outcomes of malignant pleural mesothelioma. J Cancer Res Clin Oncol 139, 2117–2123 (2013). https://doi.org/10.1007/s00432-013-1523-0

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  • DOI: https://doi.org/10.1007/s00432-013-1523-0

Keywords

  • Prognostic nutritional index
  • Malignant pleural mesothelioma
  • Survival
  • Prognosis