Low Prognostic Nutritional Index Correlates with Worse Survival in Patients with Advanced NSCLC following EGFR-TKIs.
Low Prognostic Nutritional Index Correlates with Worse Survival in Patients with Advanced NSCLC following EGFR-TKIs.
复制标题
低预后营养指数与 EGFR-TKI 治疗后晚期 NSCLC 患者的较差生存率相关
DOI：
10.1371/journal.pone.0147226
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发表时间：
2016
期刊：
影响因子：
3.7
通讯作者：
Zhang L
中科院分区：
文献类型：
--
作者：
Sheng J;Yang YP;Ma YX;Qin T;Hu ZH;Hong SD;Zhou T;Huang Y;Zhao HY;Zhang L
目的探讨反映全身免疫营养状况的预后营养指数(PNI)对接受表皮生长因子受体(EGFR)酪氨酸激酶抑制剂(TKIs)治疗的患者长期生存的预测价值。方法对符合条件的EGFR敏感突变的晚期非小细胞肺癌患者(外显子19缺失或外显子21的L858R)进行研究，探讨PNI与总生存期(OS)的关系。PNI值为10×血清白蛋白(g/dl)+0.005×外周血淋巴细胞计数(每mm~3)。通过单因素和多因素分析确定PNI和其他临床病理因素对预后的意义。结果最终144例患者符合纳入标准。PNI为生存分层的最佳分界值为48.78。与高PNI组(n=81)相比，低PNI组(n=63)与C-反应蛋白(CRP)水平升高和TKI无反应显著相关。高PNI组的总体生存率(HR，0.44，p=0.004)高于19个缺失组(HR，0.69，p=0.401)，尤其是L858R缺失组(HR，0.37，p=0.009)。多因素分析验证了PNI的独立预后价值。结论这项初步研究表明，低预后营养指数与接受EGFR-TKIs治疗的晚期非小细胞肺癌患者的生存率较差相关。对于接受EGFR-TKIs治疗的患者来说，在常规临床实践中，对一项称为PNI的方便指标的评估值得关注。
Objective This study was designed to demonstrate the prognostic value of prognostic nutritional index (PNI), a reflection systemic immunonutritional status, on the long-term survival of patients taking epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitors (TKIs). Methods In this retrospective study, eligible advanced NSCLC patients with sensitive EGFR mutations (exon 19 deletion or L858R in exon 21) were included to investigate the correlation between the PNI and overall survival (OS). The PNI was calculated as 10 x serum albumin value (g/dl) + 0.005 x peripheral lymphocyte count (per mm3). The prognostic significance of PNI and other clinicopathologic factors was identified by univariate and multivariate analysis. Results Finally, 144 patients met the inclusion criteria. The optimal cut-off value of PNI for survival stratification was 48.78. Compared with high PNI group (n = 81), low PNI (n = 63) was significantly associated with elevated C-reactive protein (CRP) level and non-response to TKIs. Overall survival was superior in the high PNI group (HR, 0.44, p = 0.004), especially for patient with L858R (HR, 0.37, p = 0.009) rather than 19 deletion (HR, 0.69, p = 0.401). The independent prognostic value of PNI was validated by multivariate analysis. Conclusion This pilot investigation demonstrated that low prognostic nutritional index correlates with worse survival for patients with advanced NSCLC and taking EGFR-TKIs. The assessment of a convenient index, known as PNI, worth attention in routine clinical practice for patients following EGFR-TKIs treatment.