Prognostic Nutritional Index as an independent prognostic factor in locoregionally advanced squamous cell head and neck cancer

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Abstract

Background

Locally advanced head and neck squamous cell carcinoma (LAHNSCC) is a heterogeneous disease in which better predictive and prognostic factors are needed. Apart from TNM stage, both systemic inflammation and poor nutritional status have a negative impact on survival.

Methods

We retrospectively analysed two independent cohorts of a total of 145 patients with LAHNSCC treated with induction chemotherapy followed by concurrent chemoradiotherapy at two different academic institutions. Full clinical data, including the Prognostic Nutritional Index (PNI), neutrophil to lymphocyte ratio and derived neutrophil to lymphocyte ratio, were analysed in a training cohort of 50 patients. Receiver operating characteristic curve analysis was used to establish optimal cut-off. Univariate and multivariate analyses of prognostic factors for overall survival (OS) were performed. Independent predictors of OS identified in multivariate analysis were confirmed in a validation cohort of 95 patients.

Results

In the univariate analysis, low PNI (PNI<45) (p=0.001), large primary tumour (T4) (p=0.044) and advanced lymph node disease (N2b-N3) (p=0.025) were significantly associated with poorer OS in the validation cohort. The independent prognostic factors in the multivariate analysis for OS identified in the training cohort were dRNL (p=0.030) and PNI (p=0.042). In the validation cohort, only the PNI remained as independent prognostic factor (p=0.007).

Conclusions

PNI is a readily available, independent prognostic biomarker for OS in LAHNSCC. Adding PNI to tumour staging could improve individual risk stratification of patients with LAHNSCC in future clinical trials.

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Most cited references 18

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Neutrophils in cancer: neutral no more.

Seth Coffelt, Max Wellenstein, Karin E de Visser (2016)

Neutrophils are indispensable antagonists of microbial infection and facilitators of wound healing. In the cancer setting, a newfound appreciation for neutrophils has come into view. The traditionally held belief that neutrophils are inert bystanders is being challenged by the recent literature. Emerging evidence indicates that tumours manipulate neutrophils, sometimes early in their differentiation process, to create diverse phenotypic and functional polarization states able to alter tumour behaviour. In this Review, we discuss the involvement of neutrophils in cancer initiation and progression, and their potential as clinical biomarkers and therapeutic targets.

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[Prognostic nutritional index in gastrointestinal surgery of malnourished cancer patients].

T. Onodera, N Goseki, G Kosaki (1984)

Based on assessment of 200 malnourished cancer patients of digestive organs, a multiparameter index of nutritional status was defined to relating the risk of postoperative complications to base line nutritional status. The linear predictive model relating the risk of operative complication, mortality or both to nutritional status is given by the relation: prognostic nutritional index (PNI) = 10 Alb. + 0.005 Lymph. C., where Alb. is serum albumin level (g/100 ml) and Lymph. C. is total lymphocytes count/mm3 peripheral blood. When applied prospectively to 189 gastrointestinal surgical patients those who were malnourished and treated by TPN preoperatively, this index provided an accurate, quantitative estimate of operative risk. In general, resection and anastomosis of gastrointestinal tract can be safely practiced when the index is over 45. The same procedure may be dangerous between 45 and 40. In below 40, this kind of operation may be contraindicated. The prognostic nutritional index is useful also to know the prognosis of patients with terminal cancer. Despite practicing TPN to cancer patients with near terminal stages, if the PNI remains below 40 and total lymphocytes count remains below 1,000/mm3, the patients has high possibility to die within the next two months.

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Smoking and drinking in relation to oral and pharyngeal cancer.

W J Blot, J McLaughlin, D M Winn … (1988)

A case-control study of oral and pharyngeal cancer conducted in four areas of the United States provided information on the tobacco and alcohol use of 1114 patients and 1268 population-based controls. Because of the large study size, it could be shown that the risks of these cancers among nondrinkers increased with amount smoked, and conversely that the risks among nonsmokers increased with the level of alcohol intake. Among consumers of both products, risks of oropharyngeal cancer tended to combine more in a multiplicative than additive fashion and were increased more than 35-fold among those who consumed two or more packs of cigarettes and more than four alcoholic drinks/day. Cigarette, cigar, and pipe smoking were separately implicated, although it was shown for the first time that risk was not as high among male lifelong filter cigarette smokers. Cessation of smoking was associated with a sharply reduced risk of this cancer, with no excess detected among those having quit for 10 or more years, suggesting that smoking affects primarily a late stage in the process of oropharyngeal carcinogenesis. The risks varied by type of alcoholic beverage, being higher among those consuming hard liquor or beer than wine. The relative risk patterns were generally similar among whites and blacks, and among males and females, and showed little difference when oral and pharyngeal cancers were analyzed separately. From calculations of attributable risk, we estimate that tobacco smoking and alcohol drinking combine to account for approximately three-fourths of all oral and pharyngeal cancers in the United States.

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Author and article information

Journal

Journal ID (nlm-ta): ESMO Open

Journal ID (iso-abbrev): ESMO Open

Journal ID (hwp): esmoopen

Journal ID (publisher-id): esmoopen

Title: ESMO Open

Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )

ISSN (Electronic): 2059-7029

Publication date Collection: 2018

Publication date (Electronic): 24 October 2018

Volume: 3

Issue: 6

Electronic Location Identifier: e000425

Affiliations

[1 ] departmentCIBERONC- Medical Oncology Department Biomedical Research Institute-INCLIVA - Hospital Clínico Universitario , University of Valencia , Valencia, Spain

[2 ] departmentMedical Oncology Department , Hospital Universitari i Politècnic La Fe , Valencia, Spain

[3 ] departmentEndocrinology and Nutrition Department , Hospital Clínico Universitario de Valencia , Valencia, Spain

[4 ] departmentRadiation Oncology Department , Hospital Clínico Universitario de Valencia , Valencia, Spain

Author notes

[Correspondence to ] Professor Andrés Cervantes; andres.cervantes@ 123456uv.es

Article

Publisher ID: esmoopen-2018-000425

DOI: 10.1136/esmoopen-2018-000425

PMC ID: 6212680

PubMed ID: 30426973

SO-VID: ae55c8a3-3dc6-4055-9ad4-5ee9dbb75d6c

License:

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, any changes made are indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

History

Date received : 19 July 2018

Date revision received : 20 August 2018

Date accepted : 22 August 2018

Funding

Funded by: Fondo de Investigaciones Sanitarias (Instituto de Salud Carlos III);

Award ID: PI15/02180

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Keywords: head and neck squamous cell carcinoma,prognostic nutritional index,inflammation-based prognostic scores,neutrophil-to-lymphocyte ratio,derived neutrophil-to-lymphocyte ratio,prognostic factors,overall survival

Prognostic Nutritional Index as an independent prognostic factor in locoregionally advanced squamous cell head and neck cancer

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Abstract

Background

Methods

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Conclusions

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Microbiology Independent Research Journal (MIR Journal)

Most cited references 18

Neutrophils in cancer: neutral no more.

[Prognostic nutritional index in gastrointestinal surgery of malnourished cancer patients].

Smoking and drinking in relation to oral and pharyngeal cancer.

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