Prognostic value of inflammation-based prognostic index in patients with nasopharyngeal carcinoma: a propensity score matching study

Abstract

PurposeThe aim of this article is to investigate the significance of pretreatment prognostic nutritional index (PNI), systemic immune-inflammation index (SII), and their combination in nasopharyngeal carcinoma (NPC) patients receiving intensity-modulated radiotherapy (IMRT).Materials and methodsA total of 585 patients were included. PNI and SII were calculated within 2 weeks prior to treatment. The optimal cutoff points were determined based on receiver operating characteristics curve analysis. The correlation between variables was analyzed. Kaplan–Meier method and Cox proportional hazards model were performed to evaluate the impact of both indices on overall survival (OS), progression-free survival (PFS) and distant metastasis-free survival (DMFS). Further propensity score matching (PSM) was carried out to minimize the effects of confounders.ResultsThe optimal cutoff point of 53.0 for PNI and 527.20 for SII were selected. Pearson correlation coefficient showed an inverse correlation between PNI and SII (r = −0.232, P < 0.001). Multivariate analysis demonstrated that pretreatment PNI was an independent prognostic factor for OS (P = 0.047) and DMFS (P = 0.002) while pretreatment SII was an independent prognostic factor for OS (P = 0.003), PFS (P = 0.002), and DMFS (P = 0.002). After PSM, both parameters remained as independent prognosticators of survival. Additional prognostic value was observed in the combined use of PNI and SII.ConclusionPretreatment PNI and SII are promising indicators of survival in NPC patients undergoing IMRT. They can be utilized to refine current TNM staging system in predicting prognosis and developing an individualized treatment in these patients.

Systemic Inflammation Response Index Is a Predictor of Poor Survival in Locally Advanced Nasopharyngeal Carcinoma: A Propensity Score Matching Study

“…Another study in NPC patients without distant metastasis reported that NLR≥ 2.28 and PLR≥174 were significantly associated with a shorter OS ( p <0.05), and NLR≥2.28 was associated with a shorter PFS ( p <0.05) ( 28 ). For NPC patients receiving intensity-modulated radiotherapy, Oei et al ( 29 ) reported that SII was an independent prognostic factor for OS ( p =0.003), PFS ( p =0.002), and distant metastasis-free survival ( p =0.002). Our results were consistent with the above findings, indicating that NLR, PLR, and SII may act as prognostic biomarkers for locally advanced NPC.…”

Baseline Low Prognostic Nutritional Index Predicts Poor Survival in Locally Advanced Nasopharyngeal Carcinomas Treated With Radical Concurrent Chemoradiotherapy

“…This finding accords well with the previous NPC studies proposing the low PNI levels (range: 49-55) as a predictor of poor prognosis with regard to the systemic disease control and survival end points. [19][20][21][22][23] Although our results appear to confirm these studies, yet we additionally demonstrated a notable prognostic worth for PNI in the prediction of the CSS outcomes alike with the recent study by Miao et al 20 The actuarial 89% locoregional tumor control rate at 10-year observed in our study and nearly 90% in other studies all together underline the critical importance of evaluation of CSS as a primary end point in patients with LA-NPC, as such cases achieve long-term locoregional control rates particularly with the use IMRT as a component of CCRT. Therefore, such analysis may prove valuable in-through evaluation of the exact value of novel prognostic markers in these patients populations by the elimination of the deaths related with the other causes rather than the index LA-NPC, which may account for as much as 40% of all deaths.…”

“…[12][13][14][15][16][17][18] However, to date, very few studies have been reported to assess the prognostic and/or predictive value of PNI in patients with LA-NPC. [19][20][21][22][23] In these studies, variable cutoffs those determined with various methodologies were utilized for discrimination of the outcomes usually with an end goal of 1 or 2 survival results. Hence, present retrospective study was designed to investigate the prognostic worth of pre-CCRT PNI values on the multiple survival end points of patients with LA-NPC and to determine the potential covariates which may correlate with PNI.…”

<p>Neutrophil-to-lymphocyte ratio predicts the prognosis of stage II nasopharyngeal carcinoma</p>

“…Thus, this study did not assess the prognostic implication of the EBV DNA titer. On the other hand, several inflammatory biomarkers, including the NLR,13–16 platelet-to-lymphocyte ratio (PLR),16 lymphocyte-to-monocyte ratio (LMR),26 prognostic nutritional index (PNI),27 and Glasgow Prognostic Score (GPS),15 were suggested to be associated with the prognosis of NPC patients. Among these inflammatory biomarkers, the NLR is simple to use in clinical practice, but the results varied between studies;13–16 thus, the NLR needs to be further investigated.…”