Baseline Low Prognostic Nutritional Index Predicts Poor Survival in Locally Advanced Nasopharyngeal Carcinomas Treated With Radical Concurrent Chemoradiotherapy.
BACKGROUND
To retrospectively assess the impact of prognostic nutritional index (PNI) on survival outcomes of patients with locoregionally advanced nasopharyngeal carcinoma (LA-NPC) treated with concurrent chemoradiotherapy (CCRT).


METHODS
This study incorporated 154 patients with LA-NPC who received exclusive cisplatinum-based CCRT. Receiver operating characteristic (ROC) curve analysis was utilized for accessibility of pretreatment PNI cutoffs influencing survival results. The primary end point was the interaction between the overall survival (OS) and PNI values, while cancer-specific survival (CSS) locoregional progression-free survival (LR-PFS), distant metastasis-free survival (DMFS), and PFS were the secondary end points.


RESULTS
A rounded PNI cutoff value of 51 was identified in ROC curve analyses to exhibit significant link with CSS, OS, DMFS, and PFS outcomes, but not LR-PFS. Patients grouping per PNI value (≥51 [N = 95] vs <51 [N = 49]) revealed that PNI < 51 group had significantly shorter median CSS (P < .001), OS (P < .001), DMFS (P < .001), and PFS (P < .001) times than the PNI ≥ 51 group, and the multivariate results confirmed the PNI < 51 as an independent predictor of poor outcomes for each end point (P < .05 for each). The unfavorable impact of the low PNI was also continued at 10-year time point with survival rates of 77.9% versus 42.4%, 73.6% versus 33.9%, 57.9% versus 27.1%, and 52.6% versus 23.7% for CSS, OS, DMFS, and PFS, respectively. Additionally, we found that PNI < 51 was significantly associated with higher rates of weight loss >5% over past 6 months (49.2% versus 11.6%; P = .002) compared to PNI < 51 group.


CONCLUSION
Low pre-CCRT PNI levels were independently associated with significantly reduced CSS, OS, DMFS, and PFS outcomes in patients with LA-NPC treated with definitive CCRT.
['Topkan|Erkan|E|https://orcid.org/0000-0001-8120-7123', 'Yucel Ekici|Nur|N|', 'Ozdemir|Yurday|Y|', 'Besen|Ali Ayberk|AA|', 'Mertsoylu|Huseyin|H|', 'Sezer|Ahmet|A|', 'Selek|Ugur|U|']
D000328:Adult D000368:Aged D000970:Antineoplastic Agents D059248:Chemoradiotherapy D002945:Cisplatin D005260:Female D006801:Humans D017567:Karnofsky Performance Status D008297:Male D008875:Middle Aged D015999:Multivariate Analysis D000077274:Nasopharyngeal Carcinoma D009303:Nasopharyngeal Neoplasms D009367:Neoplasm Staging D015596:Nutrition Assessment D009752:Nutritional Status D011237:Predictive Value of Tests D011379:Prognosis D012372:ROC Curve D012189:Retrospective Studies D016896:Treatment Outcome
nasopharyngeal carcinoma concurrent chemoradiotherapy survival outcomes weight loss prognosis prognostic nutritional ındex