Prognostic Nutritional Index (PNI) in Patients With Breast Cancer Treated With Neoadjuvant Chemotherapy as a Useful Prognostic Indicator.
Prognostic Nutritional Index (PNI) in Patients With Breast Cancer Treated With Neoadjuvant Chemotherapy as a Useful Prognostic Indicator.
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DOI：
10.3389/fcell.2021.656741
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发表时间：
2021
影响因子：
5.5
通讯作者：
Wang J
中科院分区：
文献类型：
--
作者：
Chen L;Bai P;Kong X;Huang S;Wang Z;Wang X;Fang Y;Wang J
预后营养指数（PNI）计算为血清白蛋白（ALB） (g/L) + 5 ×总淋巴细胞计数（109/L），最初用于评估手术患者的营养状况，并可评估治疗效果和预测各种实体瘤的生存。本研究旨在评估PNI在接受新辅助化疗（NACT）的乳腺癌患者中的潜在预后意义。本回顾性研究共纳入785例接受新辅助化疗的乳腺癌患者。根据受试者工作特征曲线，PNI的最佳临界值将患者分为低PNI组（<51）和高PNI组（≥51）。PNI对乳腺癌与临床病理变量的相关性采用卡方检验或Fisher精确检验。采用Kaplan-Meier图和log-rank检验评价无病生存期（DFS）和总生存期（OS）的临床结果。采用单因素和多因素Cox比例风险回归模型分析PNI的预后价值。NACT的毒性根据美国国家癌症研究所共同毒性标准（NCI-CTC）进行评估。结果表明，在单因素和多因素Cox回归生存分析中，PNI对DFS和OS的最佳截止值为51，具有预后意义。PNI值高的乳腺癌患者的DFS和OS均长于PNI值低的乳腺癌患者[47.64 vs 36.60个月，P < 0.0001，风险比(HR) = 0.264, 95%CI = 0.160 ~ 0.435；73.61月vs. 64.97月，P < 0.0001, HR = 0.319, 95%CI = 0.207 ~ 0.491]。此外，研究结果表明，在早期和晚期乳腺癌，特别是晚期乳腺癌，高PNI患者的DFS和OS比低PNI患者更长。在不同分子亚型中，高PNI乳腺癌患者的平均DFS和OS时间均长于低PNI乳腺癌患者。此外，通过log-rank检验，高PNI患者的平均DFS和OS时间长于无或有淋巴管侵袭的低PNI患者。新辅助化疗后常见的毒副反应是血液学和胃肠道反应，PNI对所有入组患者的毒副反应均无显著影响，除了贫血、白细胞减少和骨髓抑制。预处理PNI具有方便、无创、可重复性等优点，是乳腺癌患者接受新辅助化疗的一个有用的预后指标，是乳腺癌治疗策略决策的一个有前景的生物标志物。
Prognostic nutritional index (PNI), calculated as serum albumin (ALB) (g/L) + 5 × total lymphocyte count (109/L), is initially used to evaluate nutritional status in patients undergoing surgery and may evaluate the therapeutic effects and predict the survival of various solid tumors. The present study aimed to evaluate the potential prognostic significance of PNI in breast cancer patients receiving neoadjuvant chemotherapy (NACT). A total of 785 breast cancer patients treated with neoadjuvant chemotherapy were enrolled in this retrospective study. The optimal cutoff value of PNI by receiver operating characteristic curve stratified patients into a low-PNI group (<51) and a high PNI group (≥51). The associations between breast cancer and clinicopathological variables by PNI were determined by chi-square test or Fisher’s exact test. Kaplan–Meier plots and log-rank test were used to evaluate the clinical outcomes of disease-free survival (DFS) and overall survival (OS). The prognostic value of PNI was analyzed by univariate and multivariate Cox proportional hazards regression models. The toxicity of NACT was accessed by the National Cancer Institute Common Toxicity Criteria (NCI-CTC). The results indicated that PNI had prognostic significance by an optimal cutoff value of 51 on DFS and OS in univariate and multivariate Cox regression survival analyses. Breast cancer patients with a high PNI value had longer DFS and OS than those with a low PNI value [47.64 vs. 36.60 months, P < 0.0001, hazard ratio (HR) = 0.264, 95%CI = 0.160–0.435; 73.61 vs. 64.97 months, P < 0.0001, HR = 0.319, 95%CI = 0.207–0.491, respectively]. Furthermore, the results indicated that patients with high PNI had longer DFS and OS than those with low PNI in early stage and advanced breast cancer, especially in advanced breast cancer. The mean DFS and OS times for breast cancer patients with high PNI by the log-rank test were longer than in those with low PNI in different molecular subtypes. Moreover, the mean DFS and OS times in patients with high PNI by the log-rank test were longer than in those patients with low PNI without or with lymph vessel invasion. The common toxicities after neoadjuvant chemotherapy were hematologic and gastrointestinal reaction, and the PNI had no significance on the toxicities of all enrolled patients, except in anemia, leukopenia, and myelosuppression. Pretreatment PNI with the advantages of being convenient, noninvasive, and reproducible was a useful prognostic indicator for breast cancer patients receiving neoadjuvant chemotherapy and is a promising biomarker for breast cancer on treatment strategy decisions.
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影响因子：
8.4
作者：
Eisenhauer, E. A.;Therasse, P.;Verweij, J.
通讯作者：
Verweij, J.
影响因子：
3
作者：
BUZBY, GP;MULLEN, JL;ROSATO, EF
通讯作者：
ROSATO, EF
影响因子：
1.6
作者：
He KW;Sun JJ;Liu ZB;Zhuo PY;Ma QH;Liu ZY;Yu ZY
通讯作者：
Yu ZY
DOI：
10.1016/s1470-2045(17)30192-4
发表时间：
2017-04
期刊：
The Lancet. Oncology
影响因子：
--
作者：
Fouad TM;Barrera AMG;Reuben JM;Lucci A;Woodward WA;Stauder MC;Lim B;DeSnyder SM;Arun B;Gildy B;Valero V;Hortobagyi GN;Ueno NT
通讯作者：
Ueno NT
影响因子：
3.9
作者：
Mendez JS;Govindan A;Leong J;Gao F;Huang J;Campian JL
通讯作者：
Campian JL