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Low prognostic nutritional index is associated with poor outcome in middle-aged and elderly patients with non-metastatic nasopharyngeal carcinoma: a retrospective cohort study

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Abstract

Background

Prognostic nutritional index (PNI) and age are effective prognostic factors for patients with non-metastatic nasopharyngeal carcinoma (NPC), and an interaction between them may exist. However, the age cutoff value is generally set at 45 years in current studies. The clinical implications of PNI in middle-aged and elderly patients are unclear. Therefore, we aimed to uncover this issue.

Patients and methods

We retrospectively collected data from 132 middle-aged and elderly (≥ 45 years old) patients with non-metastatic NPC. The association between covariates and the PNI was analyzed using 2 or t-test. The effect of PNI on the prognosis was evaluated using univariate and multivariate Cox regression analyses. Unadjusted and multivariate-adjusted models were applied. Stratified and interactive analyses were performed to investigate the potential source of heterogeneity.

Results

Median age (61.0 years versus 59.5 years) and the proportion of patients aged ≥ 60 years (57.6% versus 50.0%) in the low-PNI group were higher than those in the high-PNI group (P > 0.05). The patients with a low PNI had shorter overall survival (OS) (hazard ratio (HR) = 0.86, 95% confidence interval (CI) = 0.80–0.93; P < 0.001) and progression-free survival (PFS) (HR = 0.93, 95% CI = 0.87–0.99; P = 0.034). The results remained stable after three adjusted models of covariates, including age (P < 0.05). No significant interactions were observed in middle-aged (45–59 years) and elderly (≥ 60 years) subgroups for OS and PFS (P for interaction > 0.05).

Conclusion

Although there is an interaction between PNI and age, PNI is an independent prognostic factor in middle-aged and elderly patients with non-metastatic NPC.

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Data availability

The dataset in this study is available from the corresponding author upon reasonable request.

Code availability

Not applicable.

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Acknowledgements

We thank the team of clinical scientists for their helpful review and constructive comments regarding the manuscript.

Funding

This research project was supported by the Medical and Health Science and Technology Program of Zhejiang Province (2020RC040).

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Authors and Affiliations

  1. Department of Radiotherapy, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, Zhejiang, China

    Bo Wu, Ling-qin Ni & Yong Wang

  2. Department of Radiotherapy, Taizhou Hospital, Linhai, Zhejiang, China

    Hai-hua Yang

  3. Department of Urology, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, Zhejiang, China

    Shan-kun Zhao

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Contributions

Study conception and design: BW and SKZ; data collection: LQN and HHY; data analysis and interpretation: BW and LQN; manuscript writing: BW and YW. All authors reviewed the manuscript.

BW and LQN: Writing (original draft), SKZ and YW: writing (review and editing), LQN and HHY: data curation and investigation; SKZ and BW: supervision.

Corresponding author

Correspondence to Shan-kun Zhao.

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Ethics approval

The study was approved by the human research ethics committees of Taizhou Central Hospital (Taizhou University Hospital) and Taizhou Hospital (No. 2019-SC-019, Date: 06/09/2019).

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Wu, B., Ni, Lq., Wang, Y. et al. Low prognostic nutritional index is associated with poor outcome in middle-aged and elderly patients with non-metastatic nasopharyngeal carcinoma: a retrospective cohort study. Support Care Cancer 30, 8895–8904 (2022). https://doi.org/10.1007/s00520-022-07286-x

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