Preoperative prognostic nutritional index level is associated with tumour-infiltrating lymphocyte status in patients with surgically resected lung squamous cell carcinoma

Abstract

OBJECTIVES The prognostic nutritional index (PNI) is an indicator of systemic immune-nutritional condition and is a well-known prognostic biomarker in lung cancer patients. Tumour-infiltrating lymphocytes (TILs) is a specific histological feature of cancers, influencing an individual’s immunological tumour responses. However, whether PNI can reflect lung cancer patients’ prognosis through local immunity such as TIL is unclear. METHODS We selected 64 lung squamous cell carcinoma patients who underwent curative operations. We investigated the significance of preoperative PNI level and evaluated the relationship between PNI and immune cells surrounding the lung cancer tissue using immunohistochemical analysis of a cluster of differentiation (CD)3, CD4, CD8 and CD68. RESULTS A low-PNI level was significantly associated with a worse postoperative prognosis (P = 0.042). The PNI (hazard ratio 2.768, 95% confidence interval 1.320–5.957; P = 0.007) was an independent prognostic factor. The low-PNI group had a significantly shorter recurrence-free survival and overall survival (P = 0.013 and P = 0.002, log-rank test) compared with the high-PNI group. A significant positive correlation between PNI components including preoperative peripheral blood lymphocyte count and serum albumin concentration, and TILs, was observed. Absolute numbers of TILs in the preoperative high-PNI group were significantly increased compared with those in the preoperative low-PNI group (CD3+ cells; P = 0.002, CD4+ cells; P = 0.049 and CD8+ cells; P = 0.024). CONCLUSIONS The preoperative PNI level was strongly associated with the postoperative outcome in lung cancer patients. Considering the positive relationship between preoperative PNI level and TIL status, preoperative immune-nutritional condition may influence lung cancer patients’ postoperative prognosis through local immunity as well as systemic immune response.

Association of the Geriatric Nutritional Risk Index With the Survival of Patients With Non–Small Cell Lung Cancer After Nivolumab Therapy

“… 30 Similarly, a positive association between PNI and TILs was reported in 64 patients with surgically resected lung squamous cell carcinoma. 31 Although the current study did not evaluate TILs, a good nutritional status may indicate activated anticancer immunity.…”

“…30 Similarly, a positive association between PNI and TILs was reported in 64 patients with surgically resected lung squamous cell carcinoma. 31 Although the current study did not evaluate TILs, a good nutritional status may indicate activated anticancer immunity. Recently, Sonehara et al 26 also reported that GNRI was associated with PFS and OS in 85 patients with advanced NSCLC who received ICI monotherapy.…”

“…Both body weight and serum albumin, the components of GNRI, are associated with cancer immunity, and thus, GNRI may have the potential to predict the efficacy of ICIs. [27][28][29][30][31] The current study evaluated pretreatment GNRI and its association with the efficacy of nivolumab in patients with previously treated NSCLC.…”

Association of the Geriatric Nutritional Risk Index with the survival of patients with non-small-cell lung cancer after platinum-based chemotherapy

“…Oxidative stress induces immunosuppression in tumor microenvironments by altering cytokine signaling, increasing immunosuppressive immune cell activity, and attenuating cytotoxic lymphocytes, resulting in tumor-favorable immunity [27,28]. It is reported that the Prognostic Nutritional Index, which is calculated using serum albumin and the peripheral blood lymphocyte count, is positively correlated with tumor-in ltrating lymphocyte counts in surgically resected esophageal cancer and squamous cell lung cancer specimens [29,30].…”

Association of the Geriatric Nutritional Risk Index with the survival of patients with non-small-cell lung cancer after platinum-based chemotherapy

“…Oxidative stress induces immunosuppression in tumor microenvironments by altering cytokine signaling, increasing immunosuppressive immune cell activity, and attenuating cytotoxic lymphocytes, resulting in tumor-favorable immunity [ 31 , 32 ]. It is reported that the Prognostic Nutritional Index, which is calculated using serum albumin and the peripheral blood lymphocyte count, is positively correlated with tumor-infiltrating lymphocyte counts in surgically resected esophageal cancer and squamous cell lung cancer specimens [ 33 , 34 ].…”