Prognostic nutritional index predicts outcomes of malignant pleural mesothelioma

Our plain-English summary of Prognostic nutritional index predicts outcomes of malignant pleural mesothelioma, by Z.H. Yao, G.Y. Tian, Y.Y. Wan, et al (Journal of Cancer Research and Clinical Oncology, 2013).

The study

• Authors: Z.H. Yao, G.Y. Tian, Y.Y. Wan, Y.M. Kang, H.S. Guo, Q.H. Liu, D.J. Lin
• Journal: Journal of Cancer Research and Clinical Oncology
• Published: 2013;139(12):2117-23
• Cited by: 69 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Purpose: Nutritional status has been associated with long-time outcomes in cancer patients. We investigated whether the prognostic nutritional index (PNI), an indicator of nutritional status, affects overall survival in patients with malignant pleural mesothelioma (MPM).

Methods: We enrolled 121 patients with histologically confirmed MPM, who had successfully undergone biopsy by medical thoracoscopy in this study. Demographic, clinical and laboratory data were collected retrospectively. The PNI was calculated as 10× serum albumin value (g/dl) + 0.005 × total lymphocyte count (per mm(3)) in peripheral blood. Univariate and multivariate analyses were used to identify prognostic factors.

Results: Mean pretreatment PNI was 44.6. PNI was significantly associated with age (P = 0.031), smoking habits (P = 0.039) and weight loss (P = 0.029). Survival analysis showed PNI to be an independent prognostic factor in MPM. Patients with lower PNIs (PNI < 44.6) had greater risk of death than those with higher PNIs (PNI ≥ 44.6; hazard ratio: 2.290; 95 % confidence interval: 1.415-3.706; P = 0.001). These analyses were adjusted for patient age, gender, smoking habits, dyspnea, chest pain, weight loss, primary site of tumor, histology, platinum-based systemic chemotherapy, hospital and stage.

Conclusions: Pretreatment PNI is a novel independent prognostic factor in MPM.

In plain English

This retrospective study asked whether a blood-test score of nutrition and immune status, the prognostic nutritional index (PNI), was linked to survival in people with malignant pleural mesothelioma. The PNI combines serum albumin with the lymphocyte count. The authors reviewed records of 121 untreated patients diagnosed by thoracoscopic biopsy at three hospitals in Shandong Province, China, between 2001 and 2013. The article did not report asbestos exposure. The average PNI was 44.6. Patients were split into a low group (below 44.6, 60 patients) and a high group (44.6 or above, 61 patients). PNI was lower in patients aged 57 or older, in smokers, and in those with weight loss. Median survival was 18 months in the high group and 11 months in the low group. The authors adjusted for age, gender, smoking, symptoms, tumor side, tissue type, chemotherapy, hospital and stage. After this, the low group had a hazard ratio for death of 2.290 (95% confidence interval 1.415 to 3.706). The authors concluded the PNI is a useful predictor of outcome. They noted the study was retrospective and small.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: retrospective cohort study of patient records (survival and prognostic factor analysis)
• Who was studied: 121 patients with newly diagnosed, untreated malignant pleural mesothelioma, out of 134 consecutive patients biopsied by medical thoracoscopy. They were treated at three hospitals in Shandong Province, China, from October 2001 to January 2013, and followed until May 31, 2013 or death. Median age was 57 (range 18 to 81); 65 were male and 56 female.
• Exposure: The factor studied was the pretreatment prognostic nutritional index, calculated as 10 times serum albumin (g/dl) plus 0.005 times the peripheral blood lymphocyte count (per mm3). Asbestos exposure was not reported.
• Main results:
  • Mean pretreatment PNI for all 121 patients was 44.6 (SD 6.3).
  • Mean PNI was lower in patients aged 57 or older than in younger patients (43.4 vs. 45.9, P = 0.031).
  • Mean PNI was lower in smokers than in nonsmokers (43.0 vs. 45.5, P = 0.039).
  • Mean PNI was lower in patients with weight loss at diagnosis than in those who had kept their weight (42.6 vs. 45.4, P = 0.029).
  • By last follow-up, 77 of 121 patients (63.6%) had died: 31 in the PNI-high group and 46 in the PNI-low group. Median overall survival for all patients was 15 months.
  • Median overall survival was 18 months in the PNI-high group and 11 months in the PNI-low group (log-rank P = 0.003). One-year survival was 72.3% vs. 45.5%, and two-year survival was 38.7% vs. 18.4% (high vs. low).
  • In the adjusted (multivariate) analysis, patients with lower PNI had a higher risk of death than those with higher PNI: hazard ratio 2.290 (95% CI 1.415 to 3.706; P = 0.001).
  • In the multivariate analysis, nonepithelioid tissue type (HR 3.049, 95% CI 1.855 to 5.011) and chest pain (HR 1.649, 95% CI 1.041 to 2.611; P = 0.033) were also associated with worse survival.
• The authors' conclusion: The authors concluded that the PNI, a nutritional measure that is simple to calculate from routine laboratory tests, is a useful predictor of long-term outcome in malignant pleural mesothelioma.
• Limitations the authors state:
  • The study was retrospective and included a small number of patients. The authors said a larger prospective study is needed to validate the results.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Overall Survival, Biopsy, Medical Thoracoscopy, Habit, Hazard Ratio, confidence interval, Dyspnea.

Related studies

• Serum albumin as a significant prognostic factor in patients with malignant pleural mesothelioma — Z.H. Yao, G.Y. Tian, et al. (2014)
• The Controlling Nutritional Status Score Is a Significant Independent Predictor of Poor Prognosis in Patients With Malignant Pleural Mesothelioma — S. Takamori, G. Toyokawa, et al. (2017)
• Elevated PDGFRB gene copy number gain is prognostic for improved survival outcomes in resected malignant pleural mesothelioma — A.S. Tsao, N. Harun, et al. (2014)
• Prognostic significance of morphological growth patterns and mitotic index of epithelioid malignant peritoneal mesothelioma — A.M. Krasinskas, A.C. Borczuk, et al. (2016)
• A new prognostic index for overall survival in malignant pleural mesothelioma: the rPHS (regimen, PS, histology or stage) index — Y. Kataoka, Y. Yamamoto, et al. (2015)
• ASO Author Reflections: C-Reactive Protein/Albumin Ratio as a Prognostic Factor in Patients with Malignant Pleural Mesothelioma: What Does the Novel Index Represent? — S. Takamori, M. Takenoyama (2018)

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