Predictive value of prognostic nutritional index in patients with oral squamous cell carcinoma

Pretreatment nutritional indices are associated with survival and T-cell exhaustion in recurrent or metastatic oral squamous cell carcinoma patients treated with immune checkpoint inhibitors: a retrospective cohort study

Pretreatment immune dynamics and nutritional status are important predictors of survival outcomes in various malignancies. This study was performed to evaluate the relationships between survival outcomes and the pretreatment nutritional indices - Onodera's prognostic nutritional index (OPNI) and neutrophil-to-lymphocyte ratio (NLR) - in 42 patients with recurrent or metastatic oral squamous cell carcinoma (OSCC) who underwent treatment with immune checkpoint inhibitors (ICI). Additionally, the relationships between these nutritional indices and T-cell exhaustion in the peripheral blood of the patients were analysed. As a result, the Kaplan-Meier method revealed that lower OPNI was significantly associated with poorer overall survival (OS) and progression-free survival (PFS) (both P < 0.001). Likewise, the results of the multivariate analysis showed that a low OPNI was independently associated with poor 5-year OS (hazard ratio 4.36, P = 0.008) and PFS (hazard ratio 4.04, P = 0.010). Patients with a low OPNI had a significantly higher frequency of PD-1+ CD8+ T-cells than those with a high OPNI (P = 0.009). These findings demonstrate that pretreatment OPNI is a valuable independent prognostic indicator of OS and PFS in OSCC patients following treatment with ICI. The OPNI might reflect T-cell exhaustion in the peripheral blood of OSCC patients.

The effectiveness of onodera`s prognostic nutritional in predicting the prognosis of tongue squamous cell carcinoma

PURPOSE

To clarify the effects of preoperative nutritional evaluation on the prognosis of patients with tongue squamous cell carcinoma.

METHODS

This retrospective cohort study involves 126 consecutive patients who underwent radical surgery as their initial treatment and received treatment for >3 years. The markers considered in this study are GGT (γ-GTP), CAR (C-reactive protein (CRP)-to-Alb Ratio), GLR (GGT-to-Lymphocytes Ratio), GPR (GGT-to-Platelet ratio), GNR (GGT-to-Neutrophil ratio), NLR (Neutrophil-to-Lymphocyte ratio), PLR (platelet-to-lymphocytes ratio), OPNI (Onodera`s prognostic nutritional index), PINI (Prognostic Immune and Nutritional Index) and Albumin (Alb). Each marker was calculated from blood test results up to one month before the initial surgery to assess overall survival (OS) and disease-free survival (DFS).

RESULTS

Univariate analysis of OS identified the depth of invasion (DOI P = 0.004), stage classification (P < 0.001), Body mass index (BMI) (P = 0.007), OPNI (P = 0.005), prognostic inflammatory and nutritional indices (PINI, P = 0.011), and albumin (Alb) (P = 0.006) as significant predictors. Cox regression analysis revealed significant differences in BMI, pathological grade, and OPNI. The OPNI cut-off value was 51.05, indicating its effectiveness in predicting tongue cancer prognosis. With regard to DFS, only BMI showed a significant difference, with no notable difference among other markers.

CONCLUSION

The OPNI may be a useful prognostic factor for tongue cancer.

Relationship of preoperative oral hypofunction with prognostic nutritional index in gastric cancer: A case-control retrospective study

Preoperative nutritional status is an important prognostic factor in gastric cancer patients. This study will evaluate whether preoperative oral dysfunction is associated with prognostic nutrition index (PNI). This case-control study analyzed 95 patients who underwent oral function management. We assessed the following parameters: body mass index, stage of gastric cancer, C-reactive protein, total lymphocyte count, albumin, and prognostic nutritional index. The patients were divided into groups with prognostic nutritional indexes <45 and >45. Logistic regression analysis was used to assess the association between the measurements of oral function and the prognostic nutritional index. Univariate analysis of factors associated with decreased oral function and prognostic nutritional index showed significant differences between the two groups in C-reactive protein, neutrophils, and tongue pressure (p<0.01). However, oral hygiene, oral dryness, occlusal force, tongue-lip motor function, masticatory function, and swallowing function were not significantly different. Multivariate analysis showed that C-reactive protein (odds ratio: 0.12, 95% confidence interval: 0.30-0.45, p<0.01) and tongue pressure (odds ratio: 3.62, 95% confidence interval: 1.04-12.60, p<0.05) were independent risk factors for oral hypofunction. Oral function decreased in perioperative patients with gastric cancer, and decreased tongue pressure is associated with a decreased prognostic nutritional index.

The prognostic-nutritional index in HPV-negative head and neck squamous cell carcinoma treated with upfront surgery: a multi-institutional series

Objectives

To evaluate the prognostic value of pre-treatment prognostic-nutritional index (PNI) in patients with HPV-negative head and neck squamous cell carcinoma (HNSCC).

Methods

A multi-institutional retrospective series of HPV-negative, Stages II-IVB, HNSCCs treated with upfront surgery was evaluated. Correlation of pre-operative blood markers and PNI with 5-year overall (OS) and relapse-free (RFS) survival was tested using linear and restricted cubic spline models, as appropriate. The independent prognostic effect of patient-related features was assessed with multivariable models.

Results

The analysis was conducted on 542 patients. PNI ≥ 49.6 (HR = 0.52; 95% CI, 0.37-0.74) and Neutrophil-to-Lymphocyte Ratio (NLR) > 4.2 (HR = 1.58; 95% CI, 1.06-2.35) confirmed to be independent prognosticators of OS, whereas only PNI ≥ 49.6 (HR = 0.44; 95% CI, 0.29-0.66) was independently associated with RFS. Among pre-operative blood parameters, only higher values of albuninaemia and lymphocyte count (> 1.08 x 10³/microL), and undetectable basophile count (= 0 10³/microL) were independently associated with better OS and RFS.

Conclusions

PNI represents a reliable prognostic tool providing an independent measure of pre-operative immuno-metabolic performance. Its validity is supported by the independent prognostic role of albuminaemia and lymphocyte count, from which it is derived.

Prognostic Nutritional Index in Patients With End-Stage Oral Cancer

PURPOSE

As the incidence of oral cancers is on the rise, we aimed to evaluate the usefulness of the prognostic nutritional index (PNI) as a predictor of survival in patients with terminal oral cancer.

METHODS

We evaluated the association between laboratory and PNI values and survival days in 33 patients who died of oral cancer between 2004 and 2019 ,excluding 4 patients who underwent gastric banding out of 39with gastric banding. The observation period was from the date of palliative care recommendation to the date of death.

RESULTS

A significant difference was observed between the PNI values recorded 3 months before death and those recorded 1 month before death (37.99 ± 6.50 vs 28.86 ± 6.01; P<.05). The median PNI value was associated with the timing of supportive care start and survival (days).

CONCLUSION

This study revealed that PNI values decreased toward the end of life and correlated with survival (days), independent of patient characteristics. These findings suggest that the PNI may be useful in the prognostication of end-stage oral cancer.

Prognostic and clinicopathological significance of prognostic nutritional index (PNI) in patients with oral cancer: a meta-analysis

Accumulating literature has explored how prognostically significant the prognostic nutritional index (PNI) was for the oral carcinoma population, but with inconsistent findings. Therefore, we retrieved the most recent data and carried out this meta-analysis to comprehensively analyze the prognostic performance of pretreatment PNI in oral cancer. The electronic databases of PubMed, Embase, China National Knowledge Infrastructure (CNKI), Cochrane Library and Web of Science were fully retrieved. PNI's prognostic value for survival outcomes in oral carcinoma was assessed by estimating pooled hazard ratios (HRs) plus 95% confidence intervals (CIs). We examined the correlation of PNI with clinicopathological traits of oral carcinoma by utilizing the pooled odds ratios (ORs) plus 95% CIs. According to the pooled results of the present meta-analysis, which enrolled 10 studies involving 3,130 patients, for oral carcinoma suffers whose PNI was low, their disease-free survival (DFS) (HR=1.92, 95%CI=1.53-2.42, p<0.001) and overall survival (OS) (HR=2.44, 95%CI=1.45-4.12, p=0.001) would be inferior. Nonetheless, cancer-specific survival (CSS) was not linked significantly to PNI for the oral carcinoma population (HR=1.89, 95%CI=0.61-5.84, p=0.267). Significant associations of low PNI with TNM stages III-IV (OR=2.16, 95%CI=1.60-2.91, p<0.001) and age ≥ 65 years (OR=2.29, 95%CI=1.76-2.98, p<0.001) were found. As suggested by the present meta-analysis, a low PNI was linked to inferior DFS and OS among oral carcinoma patients. Oral cancer patients with low PNI may have high-risk of tumor progression. PNI could be served as a promising and effective index to predict prognosis in patients with oral cancer.

The Predictive Significance of Prognostic Nutritional Index and Serum Albumin/Globulin Ratio on the Overall Survival of Penile Cancer Patients Undergoing Penectomy

Objective: To assess the value of using the prognostic nutritional index (PNI) and serum albumin/globulin ratio (AGR) in predicting the overall survival (OS) of patients with penile cancer (PC) undergoing penectomy. Materials and methods: A retrospective analysis of 123 patients who were admitted to our hospital due to PC from April 2010 to September 2021 and who underwent penectomy were included in the study. The optimal cut-off value of the PNI and AGR was determined by receiver operating characteristic curve analysis. Kaplan-Meier analysis and the Cox proportional hazard model were used to evaluate the correlation between the PNI, AGR, and OS in patients with PC. Results: A total of 16 of the 123 patients died during the follow-up period, and the median follow-up time was 58.0 months. The best cut-off values of the PNI and AGR were set to 49.03 (95% confidence interval 0.705-0.888, Youden index = 0.517, sensitivity = 57.9%, specificity = 93.7%, p < 0.001) and 1.28 (95% confidence interval 0.610-0.860, Youden index = 0.404, sensitivity = 84.1%, specificity = 56.2%, p = 0.003). The Kaplan-Meier analysis showed that the OS of the patients in the high PNI group and the high AGR group was significantly higher than that of the patients in the low PNI group and the low AGR group (p < 0.001). The univariable analysis showed that the aCCI, the clinical N stage, the pathological stage, and the PNI, AGR, SII, and PLR are all predictors of OS in patients with PC (p < 0.05). The multivariable analysis showed that the PNI (risk rate [HR] = 0.091; 95% CI: 0.010-0.853; p = 0.036) and the AGR (risk rate [HR] = 0.171; 95% CI: 0.043-0.680; p = 0.012) are independent prognostic factors for predicting OS in patients with PC undergoing penectomy. Conclusions: Both the PNI score and the serum AGR are independent prognostic factors for predicting OS in patients with PC undergoing penectomy.

Value of Preoperative Hematological Parameters in the Prognosis of Gastric Cancer Patients Undergoing a Total Gastrectomy

OBJECTIVE

This study aimed to evaluate the relationships between the albumin/globulin ratio (AGR), neutrophil/lymphocyte ratio (NLR), and platelet/lymphocyte ratio (PLR) and clinicopathological information for gastric cancer patients. In addition, the prognostic values of these hematological parameters for resectable gastric cancer patients undergoing a total gastrectomy were determined.

METHODS

A total of 245 patients with gastric cancer who underwent a total gastrectomy at our hospital between January 1, 2005, and December 30, 2015, were enrolled into this study. The preoperative AGR, NLR, and PLR in the serum samples of the patients were measured. The relationships between the hematological parameters and the disease-free survival (DFS) as well as overall survival (OS) were analyzed by statistical analysis.

RESULTS

The cutoff values of AGR, NLR, and PLR were 1.57, 3.5, and 193, respectively. Univariate analyses demonstrated that a low AGR, a high NLR, and a high PLR were significant risk factors for a poor prognosis. According to multivariate analysis, a high PLR was found to be independently associated with a poor survival. Additionally, when age was considered as a stratified factor, univariate analyses demonstrated that a low AGR had the tendency to be correlated with a shorter DFS in nonelderly patients (<65 years old). A low AGR was significantly correlated with a shorter DFS and OS in elderly patients (≥65 years old).

CONCLUSION

AGR, NLR, and PLR are independent risk factors associated with a poor gastric cancer survival by univariate analysis, and AGR is an independent risk factor for predicting DFS and OS in elderly patients (≥65 years old) with gastric cancer after total gastrectomy.

Correlation Between TCF7+ T Cells and Prognosis of Patients With Oral Squamous Cell Carcinoma

Objective

To investigate whether TCF7⁺ T cells constitute an important factor to improve the existing postoperative prediction model for patients with oral squamous cell carcinoma.

Method

TCF7⁺ T cells were detected in the tissues of 167 OSCC patients by multiplex immunofluorescence. The percentage of TCF7⁺ T cells was transformed into a dichotomous variable, combined with the clinicopathological data for the OSCC patients, and then subjected to univariate and multivariate analyses. The derived independent predictors were then incorporated into risk models to analyze their relationship with the prognosis of patients.

Results

The high TCF7⁺ group had a better prognosis than the low TCF7⁺ group (OS: p<0.001; RFS: p<0.001). Univariate and multivariate analyses showed that TCF7⁺ T cells serve as an independent predictor of OSCC (univariate/multivariate analysis: p<0.001). In Cox risk progression models, inclusion of the TCF7⁺ T cell percentage improved the predictive accuracy of Grade and TNM stage (Grade-OS/RFS: p<0.001; TNM-OS/RFS: p<0.001; TNM+Grade-OS: p<0.001, TNM+Grade-RFS: p=0.004). Inclusion of the TCF7⁺ T cell percentage improved the clinical utility.

Conclusions

TCF7⁺ T cells can act as an independent predictor for postoperative OSCC patients. The inclusion of TCF7⁺ T cells improved the predictive accuracy and clinical utility of the nomograms to different degrees.

The prognostic nutritional index predicts the biochemical recurrence of patients treated with robot-assisted laparoscopic radical prostatectomy

OBJECTIVE

To evaluate the prognostic nutritional index (PNI) in predicting the biochemical recurrence (BCR) of patients treated with robot-assisted laparoscopic radical prostatectomy (RALP).

METHODS

The clinical data of 136 patients treated with RALP in the Department of Urology, The Third Xiangya Hospital of Central South University were retrospectively analyzed. The endpoint of observation was BCR. The area under the receiver operating characteristic (ROC) curve was evaluated to determine the optimal cutoff value of PNI. The correlation of the PNI with BCR was estimated using Kaplan-Meier analysis and Cox proportional hazards model.

RESULTS

The optimal cutoff value of the PNI was 46.03 according to the ROC curve. (95% confidence interval: 0.604-0.805, Youden index = 0.401, sensitivity = 82.5%, specificity = 57.6%, p < 0.01). Multivariate Cox analysis showed that clinical staging, prostate-specific antigen, and PNI were independent prognostic factors for predicting BCR in patients treated with RALP.

CONCLUSION

PNI is an independent prognostic factor for predicting BCR in patients treated with RALP. The incorporation of the PNI into risk assessments may provide additional prognostic information.

Identification of diagnostic and prognostic signatures derived from preoperative blood parameters for oral squamous cell carcinoma

Background

We aimed to develop novel diagnostic and prognostic signatures based on preoperative inflammatory, immunological, and nutritional parameters in blood (PIINPBs) by machine learning algorithms for patients with oral squamous cell carcinoma (OSCC).

Methods

A total of 486 OSCC patients and 200 age and gender-matched non-OSCC patients who were diagnosed and treated at our institution for noninfectious, nontumor diseases were retrospectively enrolled and divided into training and validation cohorts. Based on PIINPB, 6 machine learning classifiers including random forest, support vector machine, extreme gradient boosting, naive Bayes, neural network, and logistic regression were used to derive diagnostic models, while least absolute shrinkage and selection operator (LASSO) analyses were employed to construct prognostic signatures. A novel prognostic nomogram integrating a PIINPB-derived prognostic signature and selected clinicopathological parameters was further developed. Performances of these signatures were assessed by receiver operating characteristic (ROC) curves, calibrating curves, and decision tree.

Results

Diagnostic models developed by machine learning algorithms from 13 PIINPBs, which included counts of white blood cells (WBC), neutrophils (N), monocytes (M), lymphocytes (L), platelets (P), albumin (ALB), and hemoglobin (Hb), along with albumin-globulin ratio (A/G), neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), lymphocyte-monocyte ratio (LMR), systemic immune-inflammation index (SII), and prognostic nutritional index (PNI), displayed satisfactory discriminating capabilities in patients with or without OSCC, and among OSCC patients with diverse pathological grades and clinical stages. A prognostic signature based on 6 survival-associated PIINPBs (L, P, PNI, LMR, SII, A/G) served as an independent factor to predict patient survival. Moreover, a novel nomogram integrating prognostic signature and tumor size, pathological grade, cervical node metastasis, and clinical stage significantly enhanced prognostic power [3-year area under the curve (AUC) =0.825; 5-year AUC =0.845].

Conclusions

Our results generated novel and robust diagnostic and prognostic signatures derived from PIINPBs by machine learning for OSCC. Performance of these signatures suggest the potential for PIINPBs to supplement current regimens and provide better patient stratification and prognostic prediction.

Pretreatment prognostic nutritional index as a prognostic marker in head and neck cancer: a systematic review and meta-analysis

The predictive value of the pretreatment prognostic nutritional index (PNI) for head and neck cancer (HNC) remains controversial. We conducted a meta-analysis to assess the predictive value of PNI in HNC patients. A systematic search through internet databases including PubMed, Embase, and Cochrane Library for qualified studies estimating the association of PNI with HNC patient survival was performed. Overall survival (OS), progression-free survival (PFS), disease-specific survival (DSS), disease-free survival (DFS) and distant metastasis-free survival (DMFS) data were collected and evaluated. A random-effects model was used to calculate the pooled hazard ratios (pHRs) and corresponding 95% confidence intervals (CIs). A total of 7815 HNC patients from 14 eligible studies were involved. Pooled analysis showed that low pretreatment PNI was correlated with poor OS (pHR: 1.93, 95% CI 1.62–2.30, p < 0.001), PFS (pHR: 1.51, 95% CI 1.19–1.92, p = 0.008), DSS (pHR: 1.98, 95% CI 1.12–3.50, p < 0.001), DFS (pHR: 2.20, 95% CI 1.66–2.91, p < 0.001) and DMFS (pHR: 2.04, 95% CI 1.74–2.38, p < 0.001). Furthermore, low pretreatment PNI was correlated with poor OS despite variations in the cancer site, sample size, PNI cut-off value, analysis method (multivariate analysis or univariate analysis) and treatment modality in subgroup analysis. Elevated pretreatment PNI is correlated with a superior prognosis in HNC patients and could be used as a biomarker in clinical practice for prognosis prediction and treatment stratification.

Preoperative prognostic nutritional index predicts prognosis of patients with oral cavity cancer

OBJECTIVE

To investigate whether prognostic nutritional index (PNI) predicts patient survival outcomes in oral cavity squamous cell carcinoma (OSCC).

MATERIALS AND METHODS

The data of a total of 360 patients subjected to primary surgery for OSCC were retrospectively analysed. Patients were categorised into high-PNI (≥51.75) and low-PNI (<51.75) groups based on the PNI cut-off value attained from receiver operating characteristic analyses (p < .001), and the intergroup differences in clinicopathological features were determined. The Kaplan-Meier method and Cox proportional hazard model were employed to determine the survival prediction ability of the PNI, and a nomogram based on the PNI was established for individualised survival prediction.

RESULTS

A low PNI was noted to exhibit a significant association with shorter overall survival (OS) and disease-free survival (DFS) (both p < .001). Multivariate Cox analyses showed that a lower PNI independently indicated shorter OS and DFS (hazard ratio [HR] = 2.187; p = .001 and HR = 1.459; p = .023, respectively). The concordance index and calibration plots of the PNI-based nomogram revealed the high discriminative ability for OS.

CONCLUSIONS

Preoperative PNI is a valuable biomarker for predicting OSCC prognosis, and the proposed PNI-based nomogram can provide individualised prognostic prediction.

A preoperative prognostic nutritional index is a prognostic indicator in oral squamous cell carcinoma patients undergoing radical surgery

The purpose of this study was to investigate the prognostic value of prognostic nutritional index (PNI) in oral squamous cell carcinoma (OSCC) patients and to undertake a comparative evaluation of the prognostic value of comparing PNI, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR) in terms of prognostic utility. A retrospective study was conducted involving 203 consecutive patients with OSCC who were treated with radical surgery with curative intent. The PNI and systemic inflammatory response were developed, and their prognostic utility was evaluated. Kaplan-Meier curve analysis and log-rank testing showed that PNI (P< 0.001), NLR (P=0.011), PLR (P=0.013), and LMR (P=0.014) were significantly associated with overall survival. Multivariate analysis identified PNI as an independent prognostic factor for OSCC patients (P=0.029). In time-dependent receiver operating characteristic curve analysis, PNI was continuously superior to that of NLR, PLR, and LMR. In conclusion, this study suggested that PNI offered an independent prognostic biomarker in OSCC patients undergoing radical surgery. However, this study was small and retrospective, thus further investigations are needed to clarify the utility of PNI for tailor-made treatments in clinical settings.

The role of prognostic nutritional index for clinical outcomes of gastric cancer after total gastrectomy

The purpose of this article is to evaluate the relationship between the nutrition-based microenvironment and clinicopathological information for gastric cancer patients and to investigate the prognostic value of nutrition index for gastric cancer patients undergoing total gastrectomy. We retrospectively collected clinical information of 245 gastric cancer patients who underwent total gastrectomy in our hospital between January 1st 2005 and December 30th 2015. According to the prognostic nutritional index (PNI) level, they were divided into low PNI (< 43) group and high PNI (≥ 43) group. The relationship between PNI and the disease-free survival (DFS) and overall survival (OS) were analyzed by statistical analysis. Univariate analyses demonstrated that TNM stage (p = 0.025), patients age (p = 0.042), lymph node metastasis (p = 0.028), tumor differentiation (p = 0.037) and a low PNI (p = 0.033) were closely correlated with a poor prognosis. In multivariate analysis, TNM stage (p = 0.027) and a low PNI (p = 0.041) were found to be independently associated with poor survival. Additionally, when age was considered as a stratified factor, univariate analyses demonstrated that low PNI correlated with shorter DFS in non-elderly (< 65) patients (p = 0.022) and shorter DFS (p = 0.036) and OS (p = 0.047) in elderly (≥ 65) patients. The low prognostic nutritional index is an independent risk factor associated with poor gastric cancer survival which represents the nutritional microenvironment. Patients with low pre-operative prognostic nutritional index levels should be observed more closely after surgery to prevent the occurrence of post-operative complications in the near future.

Onodera's prognostic nutritional index correlates with tumor immune environment and survival in patients with oral squamous cell carcinoma undergoing chemoradiotherapy

Pretreatment nutritional and immunological status is useful for predicting survival outcomes for various types of malignant tumors. Our objective was to determine the impact of the pretreatment Onodera's prognostic nutritional index (OPNI) on outcomes of patients who underwent definitive chemoradiotherapy for advanced oral squamous cell carcinoma (OSCC). We reviewed 47 patients treated for OSCC with definitive chemoradiotherapy (CRT) at our institution between January 2004 and December 2011. We determined the OPNI according to the following formula: 10 × serum albumin (g/dL) + 0.005 × total lymphocyte count (per μL). We determined the optimum OPNI cut-off through a receiver operating characteristic analysis. We analyzed the associations between OPNI status and various clinicopathological features and evaluated the effects of OPNI on the prognosis. We examined the relationships between OPNI and systemic inflammatory response parameters and analyzed intratumoral CD8+ T cells and their correlation with OPNI. The optimum OPNI cut-off was 42.7. A Kaplan–Meier curve analysis revealed that low OPNI was significantly associated with poor overall survival and cause-specific survival. The multivariate analysis revealed that low OPNI was independently correlated with poor 5 year overall survival and cause-specific survival. OPNI was significantly correlated with systemic inflammatory response parameters. Intratumoral CD8+ T cell counts in primary tumors were significantly lower for low OPNI than for high OPNI. The present data demonstrate that pretreatment OPNI is a valuable independent prognostic indicator of overall and cause-specific survival in advanced OSCC following definitive CRT. OPNI might reflect the tumor immune microenvironment characterization in OSCC.

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The optimum Onodera's prognostic nutritional index (OPNI) cut-off was 42.7 in OSCC patients who underwent definitive chemoradiotherapy

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Low OPNI was significantly associated with poor overall survival and cause-specific survival

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OPNI was significantly correlated with systemic inflammatory response parameters

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High-OPNI group showed significantly higher intratumoral CD8+ T cell counts in primary tumors