Cancer Medicine (Jul 2023)

Impact of the pretreatment prognostic nutritional index on the survival after first‐line immunotherapy in non‐small‐cell lung cancer patients

  • Yuka Oku,
  • Gouji Toyokawa,
  • Sho Wakasu,
  • Fumihiko Kinoshita,
  • Shinkichi Takamori,
  • Kenji Watanabe,
  • Naoki Haratake,
  • Taichi Nagano,
  • Keisuke Kosai,
  • Kazuki Takada,
  • Airi Fujimoto,
  • Kodo Higashijima,
  • Yoshimasa Shiraishi,
  • Kentaro Tanaka,
  • Hiroaki Takeoka,
  • Masaki Okamoto,
  • Takanori Yamashita,
  • Mototsugu Shimokawa,
  • Fumihiro Shoji,
  • Koji Yamazaki,
  • Tatsuro Okamoto,
  • Takashi Seto,
  • Hitoshi Ueda,
  • Sadanori Takeo,
  • Naoki Nakashima,
  • Isamu Okamoto,
  • Tomoyoshi Takenaka,
  • Tomoharu Yoshizumi

DOI
https://doi.org/10.1002/cam4.6110
Journal volume & issue
Vol. 12, no. 13
pp. 14327 – 14336

Abstract

Read online

Abstract Background Immunotherapy has become a standard‐of‐care for patients with non‐small‐cell lung cancer (NSCLC). Although several biomarkers, such as programmed cell death‐1, have been shown to be useful in selecting patients likely to benefit from immune checkpoint inhibitors (ICIs), more useful and reliable ones should be investigated. The prognostic nutritional index (PNI) is a marker of the immune and nutritional status of the host, and is derived from serum albumin level and peripheral lymphocyte count. Although several groups reported its prognostic role in patients with NSCLC receiving a single ICI, there exist no reports which have demonstrated its role in the first‐line ICI combined with or without chemotherapy. Materials and Methods Two‐hundred and eighteen patients with NSCLC were included in the current study and received pembrolizumab alone or chemoimmunotherapy as the first‐line therapy. Cutoff value of the pretreatment PNI was set as 42.17. Results Among 218 patients, 123 (56.4%) had a high PNI (≥42.17), while 95 (43.6%) had a low PNI (<42.17). A significant association was observed between the PNI and both the progression‐free survival (PFS; hazard ratio [HR] = 0.67, 95% confidence interval [CI]: 0.51–0.88, p = 0.0021) and overall survival (OS; HR = 0.46, 95% CI: 0.32–0.67, p < 0.0001) in the entire population, respectively. The multivariate analysis identified the pretreatment PNI as an independent prognosticator for the PFS (p = 0.0011) and OS (p < 0.0001), and in patients receiving either pembrolizumab alone or chemoimmunotherapy, the pretreatment PNI remained an independent prognostic factor for the OS (p = 0.0270 and 0.0006, respectively). Conclusion The PNI might help clinicians appropriately identifying patients with better treatment outcomes when receiving first‐line ICI therapy.

Keywords