Massimiliano Salati1, Roberto Filippi2,3, Caterina Vivaldi4, Francesco Caputo1, Francesco Leone2,5, Francesca Salani4, Krisida Cerma1, Massimo Aglietta2,3, Lorenzo Fornaro4, Elisa Sperti2,6, Massimo Di Maio2,6, Cinzia Ortega7, Elisabetta Fenocchio2,3, Pasquale Lombardi2,3, Celeste Cagnazzo8,9, Ilaria Depetris10, Fabio Gelsomino1, Andrea Spallanzani1, Daniele Santini11, Nicola Silvestris12,13, Giuseppe Aprile14, Giandomenico Roviello15, Mario Scartozzi16, Stefano Cascinu1, Andrea Casadei-Gardini1. 1. Department of Oncology and Hematology, Division of Oncology, University of Modena and Reggio Emilia, Modena, Italy. 2. Department of Oncology, University of Turin, Turin, Italy. 3. Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy. 4. Department of Oncology, University of Pisa, Pisa, Italy. 5. SC Oncologia ASL Biella, Biella, Italy. 6. Oncologia Medica AO Ordine Mauriziano, Turin, Italy. 7. Medical Oncology, ASL CN2 Alba Bra, Alba, Italy. 8. Department of Public Health and Pediatrics, University of Turin, Turin, Italy. 9. City of Health and Science Hospital of Turin, Pediatric Oncoematology, Regina Margherita Children's Hospital, Turin, Italy. 10. SC Medical Oncology 1, Istituto Oncologico Veneto - IRCCS, Padova, Italy. 11. Department of Medical Oncology, Università Campus Bio-Medico, Rome, Italy. 12. Department of Biomedical Sciences and Human Oncology, University of Bari Aldo Moro, Bari, Italy. 13. Medical Oncology Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy. 14. Department of Oncology, San Bortolo General Hospital, Vicenza, Italy. 15. Department of Health Sciences, University of Florence, Florence, Italy. 16. Medical Oncology Unit, University of Cagliari, Cagliari, Italy.
Abstract
BACKGROUND: An accurate risk-stratification is key to optimize the benefit-to-risk ratio of palliative treatment in advanced biliary cancer. We aimed at assessing the impact of the prognostic nutritional index (PNI) on survival and treatment response in advanced biliary cancer (ABC) receiving first-line chemotherapy. METHODS: Medical records of ABC treated with standard chemotherapy at the Modena Cancer Centre were retrospectively reviewed for variables deemed of potential interest, including the PNI. Univariate and multivariate analyses were performed to investigate the association between the covariates and overall survival (OS). RESULTS: 114 ABC fulfilled the inclusion criteria and made up the training cohort. A PNI cut-off value of 36.7 was established using the receiver operating characteristic (ROC) analysis. At both the univariate and the multivariate analysis, low PNI value (<36.7) was associated with shorter OS (P = .0011), together with increased NLR (P = .0046) and ECOG >1 (P < .0001). The median OS was 5.4 vs 12.1 months in the low- vs high PNI-group. Moreover, a PNI value >36.7 resulted in a higher disease control in patients treated with gemcitabine/platinum combination (61.4% vs 34.3%). These results were validated in an independent cohort of 253 ABC. CONCLUSIONS: We demonstrated and externally validated a prognostic role for the PNI in ABC treated with first-line chemotherapy. Although the PNI turned out to be predictive in the subset of patients receiving platinum/gemcitabine combination, future prospective confirmation is needed.
BACKGROUND: An accurate risk-stratification is key to optimize the benefit-to-risk ratio of palliative treatment in advanced biliary cancer. We aimed at assessing the impact of the prognostic nutritional index (PNI) on survival and treatment response in advanced biliary cancer (ABC) receiving first-line chemotherapy. METHODS: Medical records of ABC treated with standard chemotherapy at the Modena Cancer Centre were retrospectively reviewed for variables deemed of potential interest, including the PNI. Univariate and multivariate analyses were performed to investigate the association between the covariates and overall survival (OS). RESULTS: 114 ABC fulfilled the inclusion criteria and made up the training cohort. A PNI cut-off value of 36.7 was established using the receiver operating characteristic (ROC) analysis. At both the univariate and the multivariate analysis, low PNI value (<36.7) was associated with shorter OS (P = .0011), together with increased NLR (P = .0046) and ECOG >1 (P < .0001). The median OS was 5.4 vs 12.1 months in the low- vs high PNI-group. Moreover, a PNI value >36.7 resulted in a higher disease control in patients treated with gemcitabine/platinum combination (61.4% vs 34.3%). These results were validated in an independent cohort of 253 ABC. CONCLUSIONS: We demonstrated and externally validated a prognostic role for the PNI in ABC treated with first-line chemotherapy. Although the PNI turned out to be predictive in the subset of patients receiving platinum/gemcitabine combination, future prospective confirmation is needed.
Authors: Pedro Luiz Serrano Uson Junior; Umair Majeed; Jun Yin; Gehan Botrus; Mohamad Bassam Sonbol; Daniel H Ahn; Jason S Starr; Jeremy C Jones; Hani Babiker; Samantha R Inabinett; Natasha Wylie; Ashton W R Boyle; Tanios S Bekaii-Saab; Gregory J Gores; Rory Smoot; Michael Barrett; Bolni Nagalo; Nathalie Meurice; Natalie Elliott; Joachim Petit; Yumei Zhou; Mansi Arora; Chelsae Dumbauld; Oumar Barro; Alexander Baker; James Bogenberger; Kenneth Buetow; Aaron Mansfield; Kabir Mody; Mitesh J Borad Journal: JCO Precis Oncol Date: 2022-06