Clinical Impact of Prognostic Nutrition Index for Advanced Gastric Cancer Patients with Peritoneal Metastases Treated Nivolumab Monotherapy

Abstract

Although nivolumab shows survival benefits for patients with advanced gastric cancer (AGC), predictive biomarkers for nivolumab treatment in AGC remain unclear, especially in the case of peritoneal metastases. This study investigated the clinical significance of the prognostic nutrition index (PNI), reflecting the host nutritional status and immunity, in AGC patients undergoing nivolumab monotherapy. This study retrospectively analyzed 53 AGC patients who received nivolumab between October 2017 and February 2021. Among them, 35 patients with peritoneal metastases were reviewed to investigate the relationship between the PNI and oncological outcomes. The PNI was calculated as 10×serum albumin level (g/dl)+0.005×total lymphocyte count (per mm 3 ) at the first administration of nivolumab. With a median follow-up duration of 2.0 (0.3-13.5) months, the median overall survival (OS) was 2.0 months. The overall response and disease-control rates were 0.0% and 20.0%, respectively. Among the 35 patients, 13 patients were identified as a high-PNI group. In the univariate analysis, the high-PNI group showed a significantly longer PFS and OS than the low-PNI group. In the multivariate analysis, the high-PNI was independently associated with a longer PFS (p=0.021) and OS (p=0.022). The PNI can be useful for predicting PFS and OS in AGC patients with peritoneal metastases. However, further studies are required to validate these results in AGC and new strategies are needed to improve the outcome for AGC patients with peritoneal metastases.

High intramuscular adipose tissue content was a favorable prognostic factor in patients with advanced gastric cancer treated with nivolumab monotherapy

“…PNI has been used widely for predicting the survival outcomes of patients with various malignant tumors. The high PNI has been reported to be associated with response rates in the nivolumab treatment of AGC 11,44 . In our study, patients with high IMAT had better nutritional status such as high PNI.…”

“…The high PNI has been reported to be associated with response rates in the nivolumab treatment of AGC. 11,44 In our study, patients with high IMAT had better nutritional status such as high PNI. IMAT is an indicator of the muscle's nutritional status; therefore, a higher IMAT was associated with a better prognosis than a lower IMAT in patients with AGC treated with nivolumab.…”

Prognostic relevance of prognostic nutritional indices in gastric or gastro-esophageal junction cancer patients receiving immune checkpoint inhibitors: a systematic review and meta-analysis

“…We searched PubMed, Embase, and Web of Science SpringerLink as well as Cochrane Library databases to find a total of 572 relevant papers, firstly, Based on the inclusion and exclusion criteria, 49 duplicates were removed from the dataset and then 515 papers were excluded by reviewing their abstracts, titles and other abbreviations, and finally, 8 articles were included after full-text review ( 36 – 43 ), These were retrospective studies with a total of 813 patients receiving ICIs. articles, These were retrospective studies, and a total of 813 patients with (GC/GEJC) treated with ICIs were included, and the flow chart is shown in Figure 1 .…”

“…A sensitivity analysis was conducted to assess the influence of individual studies on overall survival (OS) and progression-free survival (PFS).To explore the origins of heterogeneity, subgroup analyses were conducted, considering treatment modalities, sample sizes, cutoff values, and analytical models. abbreviations, and finally, 8 articles were included after full-text review (36)(37)(38)(39)(40)(41)(42)(43), These were retrospective studies with a total of 813 patients receiving ICIs. articles, These were retrospective studies, and a total of 813 patients with (GC/GEJC) treated with ICIs were included, and the flow chart is shown in Figure 1.…”

Prognostic nutritional index as a prognostic biomarker for gastrointestinal cancer patients treated with immune checkpoint inhibitors

“…p < 0.05 was considered statistically significant. the eligibility criteria, resulting in a total of 2883 patients (18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34). The PRISMA flowchart in Figure 1 depicts the study selection process.…”