Impact of the pretreatment prognostic nutritional index on the survival after first‐line immunotherapy in non‐small‐cell lung cancer patients

Abstract

Background Immunotherapy has become a standard‐of‐care for patients with non‐small‐cell lung cancer (NSCLC). Although several biomarkers, such as programmed cell death‐1, have been shown to be useful in selecting patients likely to benefit from immune checkpoint inhibitors (ICIs), more useful and reliable ones should be investigated. The prognostic nutritional index (PNI) is a marker of the immune and nutritional status of the host, and is derived from serum albumin level and peripheral lymphocyte count. Although several groups reported its prognostic role in patients with NSCLC receiving a single ICI, there exist no reports which have demonstrated its role in the first‐line ICI combined with or without chemotherapy. Materials and Methods Two‐hundred and eighteen patients with NSCLC were included in the current study and received pembrolizumab alone or chemoimmunotherapy as the first‐line therapy. Cutoff value of the pretreatment PNI was set as 42.17. Results Among 218 patients, 123 (56.4%) had a high PNI (≥42.17), while 95 (43.6%) had a low PNI (<42.17). A significant association was observed between the PNI and both the progression‐free survival (PFS; hazard ratio [HR] = 0.67, 95% confidence interval [CI]: 0.51–0.88, p = 0.0021) and overall survival (OS; HR = 0.46, 95% CI: 0.32–0.67, p < 0.0001) in the entire population, respectively. The multivariate analysis identified the pretreatment PNI as an independent prognosticator for the PFS (p = 0.0011) and OS (p < 0.0001), and in patients receiving either pembrolizumab alone or chemoimmunotherapy, the pretreatment PNI remained an independent prognostic factor for the OS (p = 0.0270 and 0.0006, respectively). Conclusion The PNI might help clinicians appropriately identifying patients with better treatment outcomes when receiving first‐line ICI therapy.

Prognostic Role of Pretreatment Prognostic Nutritional Index in Advanced Lung Cancer Patients Receiving First-Line Immunotherapy: A Meta-Analysis

“…Nine studies clarified the predictive role of pretreatment PNI for PFS [15,[17][18][19][20][21][22][23][24]. Our pooled results manifested that a lower pretreatment PNI predicted worse PFS (HR=0.62, 95% CI: 0.48-0.80, P 0.001; I 2 =50.9%, P=0.026).…”

“…Besides, most patients received a combination of chemotherapy. Notably, in the studies by Yang et al [ 17 ] and Oku et al [ 22 ], two subgroups of individuals receiving single immunotherapy and combined therapy were analyzed separately. Therefore, in our meta-analysis, the two subgroups in their studies were also analyzed separately.…”

“…One hundred and eighty-seven records were identified from the five databases. After reviewing the titles, abstracts and full texts, 10 studies were included in this meta-analysis [15][16][17][18][19][20][21][22][23][24]. Detailed selection process is shown in Figure 1.…”

“…Seven studies explored the relationship of pretreatment PNI with OS [15,16,18,19,[21][22][23]. The pooled results…”

Association of Nutritional Indices With Adverse Effects and Time-to-Treatment-Failure in Triple Therapy for Lung Cancer

“…The PNI, first reported by Onodera et al in 1987, is a nutritional index based on albumin levels and peripheral lymphocyte counts that reflects the immune response and nutritional status of patients (11). Several previous studies had examined the relationship between PNI and treatment response in patients with non-small cell lung cancer, and reported a significant increase in OS and PFS in the high-PNI group before treatment (12,13). However, despite the reports examining the duration of treatment and occurrence of side effects, as indexed by GNRI and PNI, in cancer chemotherapy with ICI alone or in combination with cytotoxic agents in non-small cell lung cancer (14,15), recent treatment methods are increasingly combining ICI and platinum plus one more cytotoxic agent in a three-drug combination, and the relationship between the three-drug combination and GNRI/PNI is unknown.…”