The Prognostic Value Of Prognostic Nutritional Index In Patients With Advanced Cancer Treated With Immunotherapy

Part 1:Prognostic nutritional index predicting prognosis of advanced cancer patients treated with immunotherapy:a meta-analysisObjective:The purpose of this study is to investigate the relationship between pre-treatment prognostic nutritional index(PNI)and clinical survival outcomes for advanced-stage cancer patients treated with immune checkpoint inhibitors(ICIs).Methods:The eligible studies were searched using PubMed,EMbase and Web of Science databases from inception to 28 February 2023.The hazard ratios(HRs)and 95%confidence intervals(CIs)were combined to analyze the prognostic value the correlation of the pretreatment PNI with overall survival(OS)and progression-free survival(PFS)for advanced cancer patients treated with ICIs.Results:A total of 29 studies enrolling 4589 ICIS-treated cancer patients were included in our study.The analysis demonstrated low pre-treatment PNI was associated with worse OS(pHR=1.97,95%CI=1.57-2.48,P<0.001)and PFS(pHR=1.58,95%CI=1.33-1.86,P<0.001).In the subgroup analysis,low pre-treatment PNI was an independent predictor of poor outcome in patients with lung cancer(OS:pHR=2.32,95%CI=1.72-3.12;PFS:pHR=1.76,95%CI=1.36-2.28)and digestive system cancer(OS:pHR=1.65,95%CI=1.08-2.54;PFS:pHR=1.37,95%CI=1.12-1.66).Low-PNI level of patients treated with ICIS alone(OS:pHR=2.03,95%CI=1.49-2.77;PFS:pHR=1.71,95%CI=1.37-2.15)and combination prescription(OS:pHR=1.62,95%CI=1.17;PFS:pHR=1.21,95%CI=1.33-1.42)were both correlated with poor prognosis,In first-line immunotherapy patients,low pre-treatment PNI was also significantly associated with worse survival outcomes(OS:pHR=1.94,95%CI=1.522.47;PFS:pHR=1.26,95%CI=1.11-1.48).Conclusion:Low pre-treatment PNI might be an effective biomarker for poor prognosis of advanced cancer patients receiving ICIS therapy.Further studies are needed to verify the prognostic value of PNI in clinical practice.Part 2:The prognostic value of prognostic nutritional index in patients with advanced cancer treated with immunotherapyObjective:This study aimed to investigate the impact of prognostic nutritional index(PNI)on the efficacy of immunotherapy and prognosis of patients with advanced cancer receiving immunotherapy.Methods:The clinical data of 287 patients with advanced cancer who treated with PD-(L)1 inhibitors from January 1,2018 to November 30,2022 at the Department of Oncology were analyzed retrospectively.PNIs of patients within the week before treatment were collected.Chi-square test was used to analyze the correlation between PNI and clinical characteristics.Kaplan-Meier was used to calculate the survival analysis curve.Logistic regression model was used to analyze the objective response rate(ORR).Cox proportional hazards regression model was used to analyze the prognostic factors.The area under the curve(AUC)of the receiver operating characteristic(ROC)curve for PFS and OS was used to assess the accuracy of PNI,body mass index(BMI),and albumin(ALB)for prognosis.Results:According to the reference value 45,287 patients included in the study were divided into H-PNI group(PNI)45,n=139)and L-PNI group(PNI<45,n=148).Chi-square test showed that there were no significant differences in age,gender,smoking history,BMI,ECOG score,first-line treatment or not,medication and the occurrence of immune-related adverse events(irAEs)between the two groups.Logistic regression analysis showed that pre-treatment PNI was significantly associated with ORR(OR=0.56,95%CI=0.34-0.93,P=0.024).In the multivariate cox analysis,PNI was an independent adverse factor affecting PFS(HR=1.96,95%CI=1.48-2.58,P<0.001)and OS(HR=2.19,95%CI=1.60-2.98,P<0.001)of patients with advanced tumors treated with immunotherapy.In the subgroup analysis,lung cancer with low pre-treatment PNI(PFS:HR=2.15,95%CI=1.40-3.28,P<0.001;OS:HRF=2.63,95%CI=1.574.41,P<0.001)and digestive system cancer(PFS:HRF=1.92,95%CI=1.16-3.20,P=0.012;OS:HR=1.70,95%CI=1.01-2.88,P=0.047)patients had worse prognosis.The AUC of PNI,BMI and ALB for PFS were 0.664,0.574 and 0.640,and the AUC for OS were 0.669,0.632 and 0.633.Conclusion:The pre-treatment PNI might be an effective biomarker to evaluate the efficacy and prognosis of advanced tumor patients receiving immunotherapy.