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Validation and comparison of prognostic values of GNRI, PNI, and CONUT in newly diagnosed diffuse large B cell lymphoma

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Abstract

Diffuse large B cell lymphoma (DLBCL) is the most common type of aggressive non-Hodgkin lymphoma. Emerging evidence indicates that poor nutritional status determined with nutritional indices such as geriatric nutritional risk index (GNRI), prognostic nutritional index (PNI), and controlling nutritional status score (CONUT) was associated with poor prognosis of DLBCL. We conducted this multicenter retrospective study to validate and compare prognostic values of the three indices in 615 newly diagnosed DLBCL patients. The overall survival (OS) in patients with poor nutritional status determined with each of these nutritional indices were significantly inferior compared with that in those without nutritional risks (5-year OS in patients with GNRI < 95.7 and GNRI ≥ 95.7 were 56.4% and 83.5%, P < 0.001; PNI < 42.4 and PNI ≥ 42.4 were 56.1% and 81.0%, P < 0.001; CONUT > 4 and CONUT ≤ 4 were 53.1% and 77.1%, P < 0.001). GNRI and CONUT were independent prognostic predictors for OS (GNRI < 95.7, hazard ratio [HR] 1.83, 95% confidence interval [CI] 1.22–2.74, P = 0.0032; CONUT > 4, HR 1.53, 95% CI 1.05–2.23, P = 0.028) after multivariate analyses. Nutritional status determined with GNRI affected OS more strongly in the patients with nongerminal center B cell–like (nonGCB) DLBCL compared with that in those with GCB-type DLBCL. In conclusion, baseline poor nutritional status determined based on GNRI or CONUT was an independent risk factor of newly diagnosed DLBCL, and GNRI was also useful as an independent prognostic factor for patients with nonGCB-type DLBCL.

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Acknowledgment

The authors would like to thank the nursing and medical staff who looked after the patients.

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  1. Toshihiro Matsukawa and Keito Suto contributed equally to this work.

Authors and Affiliations

  1. Department of Internal Medicine/Hematology, Kushiro Rosai Hospital, 13-23 Nakazono-Cho, Kushiro, 085-8533, Japan

    Toshihiro Matsukawa, Keito Suto, Shota Yoshida, Hisashi Oda & Takuto Miyagishima

  2. Department of Hematology, Sapporo Hokuyu Hospital, Sapporo, Japan

    Keito Suto, Koichiro Minauchi & Shuichi Ota

  3. Blood Disorders Center, Aiiku Hospital, Sapporo, Japan

    Minoru Kanaya, Koh Izumiyama & Akio Mori

  4. Department of Hematology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan

    Daigo Hashimoto & Takanori Teshima

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  1. Toshihiro Matsukawa
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North Japan Hematology Study Group (NJHSG)

Contributions

T. Matsukawa, K.S., M.K., and K.I. designed this study. T. Matsukawa, K.S., M.K., K.I., K.M., S.Y., H.O, T. Miyagishima, A.M., and S.O. performed recruitment and treatment. T.Matsukawa, K.S., M.K., K.I., and S.Y. collected the data. T. Matsukawa, K.S., and D.H. analyzed and interpreted data. T. Matsukawa and D.H. wrote the manuscript. T.T. supervised this study.

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Correspondence to Toshihiro Matsukawa.

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All procedures involving human participants were in accordance with the ethical standards of institutional and/or national research committees and with the Declaration of Helsinki. This study was approved by institutional review board of each hospital.

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Matsukawa, T., Suto, K., Kanaya, M. et al. Validation and comparison of prognostic values of GNRI, PNI, and CONUT in newly diagnosed diffuse large B cell lymphoma. Ann Hematol 99, 2859–2868 (2020). https://doi.org/10.1007/s00277-020-04262-5

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