Top

Journal of Cancer Research and Clinical Oncology

Published in:

01-07-2017 | Original Article – Clinical Oncology

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

Authors: Jingjing Miao, Weiwei Xiao, Lin Wang, Fei Han, Haijun Wu, Xiaowu Deng, Xiang Guo, Chong Zhao

Published in: Journal of Cancer Research and Clinical Oncology | Issue 7/2017

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.

Available only for authorised users

Capuano G, Grosso A, Gentile PC, Battista M, Bianciardi F, Di Palma A, Pavese I, Satta F, Tosti M, Palladino A, Coiro G, Di Palma M (2008) Influence of weight loss on outcomes in patients with head and neck cancer undergoing concurrent chemoradiotherapy. Head Neck 30(4):503–508. doi:10.1002/hed.20737 CrossRefPubMed

Chen C, Fei Z, Pan J, Bai P, Chen L (2011) Significance of primary tumor volume and T-stage on prognosis in nasopharyngeal carcinoma treated with intensity-modulated radiation therapy. Jpn J Clin Oncol 41:537–542. doi:10.1093/jjco/hyq242 CrossRefPubMed

Chen L, Mao Y-P, Xie FY, Liu LZ, Sun Y, Tian L, Tang LL, Lin AH, Li L, Ma J (2012a) The seventh edition of the UICC/AJCC staging system for nasopharyngeal carcinoma is prognostically useful for patients treated with intensity-modulated radiotherapy from an endemic area in China. Radiother Oncol 104:331–337. doi:10.1016/j.radonc.2011.10.009 CrossRefPubMed

Chen L, Hu CS, Chen X-Z, Hu GQ, Cheng ZB, Sun Y, Li WX, Chen YY, Xie FY, Liang SB, Chen Y, Xu TT, Li B, Long GX, Wang SY, Zheng BM, Guo Y, Sun Y, Mao YP, Tang LL (2012b) Concurrent chemoradiotherapy plus adjuvant chemotherapy versus concurrent chemoradiotherapy alone in patients with locoregionally advanced nasopharyngeal carcinoma: a phase 3 multicentre randomised controlled trial. Lancet Oncol 13:163–171. doi:10.1016/S1470-2045(11)70320-5 CrossRefPubMed

Du X-J, Tang L-L, Mao YP, Guo R, Sun Y, Lin AH, Ma J (2015) Value of the prognostic nutritional index and weight loss in predicting metastasis and long-term mortality in nasopharyngeal carcinoma. J Transl Med 13:364. doi:10.1186/s12967-015-0729-0 CrossRefPubMedPubMedCentral

Fleming ID, Cooper JS, Henson DE (1997) AJCC cancer staging manual. 5th edn. Lippincott-Raven, Philadelphia

Goodwin WJ Jr, Torres J (1984) The value of the prognostic nutritional index in the management of patients with advanced carcinoma of the head and neck. Head Neck Surg 6:932–937. doi:10.1002/hed.2890060507 CrossRefPubMed

Guo R, Sun Y, Yu X-L, Yin WJ, Li WF, Chen YY, Mao YP, Liu LZ, Li L, Lin AH, Ma J (2012) Is primary tumor volume still a prognostic factor in intensity modulated radiation therapy for nasopharyngeal carcinoma? Radiother Oncol 104:294–299. doi:10.1016/j.radonc.2012.09.001 CrossRefPubMed

Hofbauer SL, Pantuck AJ, de Martino M, Lucca I, Haitel A, Shariat SF, Belldegrun AS, Klatte T (2015) The preoperative prognostic nutritional index is an independent predictor of survival in patients with renal cell carcinoma. Urol Oncol 33:68.e1–68.e7. doi:10.1016/j.urolonc.2014.08.005 CrossRef

Hong S, Zhou T, Fang W, Xue C, Hu Z, Qin T, Tang Y, Chen Y, Ma Y, Yang Y, Hou X, Huang Y, Zhao H, Zhao Y, Zhang L (2015) The prognostic nutritional index (PNI) predicts overall survival of small-cell lung cancer patients. Tumour Biol 36:3389–3397. doi:10.1007/s13277-014-2973-y CrossRefPubMed

Ikeya T, Shibutani M, Maeda K, Sugano K, Nagahara H, Ohtani H, Hirakawa K (2015) Maintenance of the nutritional prognostic index predicts survival in patients with unresectable metastatic colorectal cancer. J Cancer Res Clin Oncol 141:307–313. doi:10.1007/s00432-014-1799-8 CrossRefPubMed

Jiang N, Deng JY, Ding XW, Ke B, Liu N, Zhang RP, Liang H (2014) Prognostic nutritional index predicts postoperative complications and long-term outcomes of gastric cancer. World J Gastroenterol 20:10537–10544. doi:10.3748/wjg.v20.i30.10537 CrossRefPubMedPubMedCentral

Lee AW, Ng WT, Chan LK, Chan OS, Hung WM, Chan CC, Cheng PT, Sze H, Lam TS, Yau TK (2012) The strength/weakness of the AJCC/UICC staging system (7th edition) for nasopharyngeal cancer and suggestions for future improvement. Oral Oncol 48:1007–1013. doi:10.1016/j.oraloncology.2012.03.022 CrossRefPubMed

Lee AW, Ng WT, Chan LL, Hung WM, Chan CC, Sze HC, Chan OS, Chang AT, Yeung RM (2014) Evolution of treatment for nasopharyngeal cancer—success and setback in the intensity-modulated radiotherapy era. Radiother Oncol 110:377–384. doi:10.1016/j.radonc.2014.02.003 CrossRefPubMed

Li AC, Xiao W-W, Shen GZ, Wang L, Xu AA, Cao YQ, Huang SM, Lin CG, Han F, Deng XW, Zhao C (2015) Distant metastasis risk and patterns of nasopharyngeal carcinoma in the era of IMRT: long-term results and benefits of chemotherapy. Oncotarget 6:24511–24521. doi:10.18632/oncotarget.4312 CrossRefPubMedPubMedCentral

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

Peng G, Wang T, Yang KY, Zhang S, Zhang T, Li Q, Han J, Wu G (2012) A prospective, randomized study comparing outcomes and toxicities of intensity-modulated radiotherapy vs. conventional two-dimensional radiotherapy for the treatment of nasopharyngeal carcinoma. Radiother Oncol 104:286–293. doi:10.1016/j.radonc.2012.08.013 CrossRefPubMed

Qiu C, Yang N, Tian G, Liu H (2011) Weight loss during radiotherapy for nasopharyngeal carcinoma: a prospective study from Northern China. Nutr Cancer 63:873–879. doi:10.1080/01635581.2011.582223 CrossRefPubMed

Ravasco P, Grillo IM, Vidal PM, Camilo ME (2005) Impact of nutrition on outcome: a prospective randomised controlled trial in patients with head and neck cancer undergoing radiotherapy. Head Neck 27:659–668. doi:10.1002/hed.20221 CrossRefPubMed

Shen LJ, Chen C, Li BF, Gao J, Xia YF (2013) High weight loss during radiation treatment changes the prognosis in under-/normal weight nasopharyngeal carcinoma patients for the worse: a retrospective analysis of 2433 cases. PLOS One 8(7):e68660. doi:10.1371/journal.pone.0068660 CrossRefPubMedPubMedCentral

Sobin LH, Wittekind CH (2002) International Union Against Cancer (UICC): TNM classification of malignant tumors. Wiley-Liss, New York

Sobin LH, Gospodarowicz MK, Wittekind C (eds) (2009) TNM Classification of Malignant Tumours, 7th edn. Wiley-Blackwell, Oxford

Su SF, Han F, Zhao C, Huang Y, Chen CY, Xiao WW, Li JX, Lu TX (2011) Treatment outcomes for different subgroups of nasopharyngeal carcinoma patients treated with intensity-modulated radiation therapy. Chin J Cancer 30:565–573. doi:10.5732/cjc.010.10547 CrossRefPubMedPubMedCentral

Wang W, Feng M, Fan Z, Li J, Lang J (2014) Clinical outcomes and prognostic factors of 695 nasopharyngeal carcinoma patients treated with intensity-modulated radiotherapy. BioMed Res Int 2014:814948. doi:10.1155/2014/814948 PubMedPubMedCentral

Wei KR, Zheng RS, Zhang SW, Liang ZH, Ou ZX, Chen WQ (2014) Nasopharyngeal carcinoma incidence and mortality in China in 2010. Chin J Cancer 33:381–387. doi:10.5732/cjc.014.10086 PubMedPubMedCentral

Xiao WW, Huang SM, Han F, Wu SX, Lu LX, Lin CG, Deng XW, Lu TX, Cui NJ, Zhao C (2011) Local control, survival, and late toxicities of locally advanced nasopharyngeal carcinoma treated by simultaneous modulated accelerated radiotherapy combined with cisplatin concurrent chemotherapy: long-term results of a phase 2 study. Cancer 117:1874–1883. doi:10.1002/cncr.25754 CrossRefPubMed

Xiao W, Xu A, Fei Han, Lin X, Lu L, Shen G, Huang S, Fan W, Deng X, Zhao C (2015) Positron emission tomography-computed tomography before treatment is highly prognostic of distant metastasis in nasopharyngeal carcinoma patients after intensity-modulated radiotherapy treatment: a prospective study with long-term follow-up. Oral Oncol 51:363–369. doi:10.1016/j.oraloncology.2015.01.009 CrossRefPubMed

Yi J-L, Gao L, Huang X-D, Li SY, Luo JW, Cai WM, Xiao JP, Xu GZ (2006) Nasopharyngeal carcinoma treated by radical radiotherapy alone: ten-year experience of a single institution. Int J Radiat Oncol Biol Phys 65:161–168. doi:10.1016/j.ijrobp.2005.12.003 CrossRefPubMed

Yi J, Huang X, Gao L, Luo J, Zhang S, Wang K, Qu Y, Xiao J, Xu G (2014) Intensity-modulated radiotherapy with simultaneous integrated boost for locoregionally advanced nasopharyngeal carcinoma. Radiat Oncol 9:56. doi:10.1186/1748-717X-9-56 CrossRefPubMedPubMedCentral

Yin J, Samawi H, Linder D (2016) Improved nonparametric estimation of the optimal diagnostic cut-off point associated with the Youden index under different sampling schemes. Biom J. doi:10.1002/bimj.201500036 PubMed

Zhang MX, Li J, Shen GP, Zou X, Xu JJ, Jiang R, You R, Hua YJ, Sun Y, Ma J, Hong MH, Chen MY (2015) Intensity-modulated radiotherapy prolongs the survival of patients with nasopharyngeal carcinoma compared with conventional two-dimensional radiotherapy: a 10-year experience with a large cohort and long follow-up. Eur J Cancer 51:2587–2595. doi:10.1016/j.ejca.2015.08.006 CrossRefPubMed

Zhou GQ, Tang L-L, Mao YP, Chen L, Li WF, Sun Y, Liu LZ, Li L, Lin AH, Ma J (2012) Baseline serum lactate dehydrogenase levels for patients treated with intensity-modulated radiotherapy for nasopharyngeal carcinoma: a predictor of poor prognosis and subsequent liver metastasis. Int J Radiat Oncol Biol Phys 82:e359–e365. doi:10.1016/j.ijrobp.2011.06.1967 CrossRefPubMed

Zweig MH, Campbell G (1993) Receiver-operating characteristic (ROC) plots: a fundamental evaluation tool in clinical medicine. Clin Chem 39:561–577PubMed

Title: 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
Authors: Jingjing Miao
Weiwei Xiao
Lin Wang
Fei Han
Haijun Wu
Xiaowu Deng
Xiang Guo
Chong Zhao
Publication date: 01-07-2017
Publisher: Springer Berlin Heidelberg
Published in: Journal of Cancer Research and Clinical Oncology / Issue 7/2017
Print ISSN: 0171-5216
Electronic ISSN: 1432-1335
DOI: https://doi.org/10.1007/s00432-017-2360-3

ACC 2024 Congress Coverage

Heart Failure Video

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

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

Abstract

Purpose

Methods

Results

Conclusion

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 7/2017

Non-reproducible sequence artifacts in FFPE tissue: an experience report

Accuracy of pre-operative hysteroscopic guided biopsy for predicting final pathology in uterine malignancies

Effect of a patient-tailored integrative medicine program on gastro-intestinal concerns and quality of life in patients with breast and gynecologic cancer

Erratum to: Curcumin induces G2/M arrest, apoptosis, NF-κB inhibition, and expression of differentiation genes in thyroid carcinoma cells

Everolimus as first line therapy for pancreatic neuroendocrine tumours: current knowledge and future perspectives

Systematic review and meta-analysis of standard-dose imatinib vs. high-dose imatinib and second generation tyrosine kinase inhibitors for chronic myeloid leukemia

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page