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Erschienen in: Wiener klinische Wochenschrift 11-12/2017

01.06.2017 | original article

Prognostic nutritional index as a predictor of prognosis in patients with diffuse large B cell lymphoma

verfasst von: Vlatka Periša, Lada Zibar, Ana Knezović, Igor Periša, Jasminka Sinčić-Petričević, Igor Aurer

Erschienen in: Wiener klinische Wochenschrift | Ausgabe 11-12/2017

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Summary

Background

The prognostic nutritional index (PNI), an indicator of nutritional status and systemic inflammation, is associated with short-term and long-term outcomes of various malignancies. The prognostic value of PNI in diffuse large B cell lymphoma (DLBCL) remains unknown. The aim of the present study was to determine the prognostic value of baseline PNI in DLBCL patients.

Methods

We retrospectively analyzed data from 103 DLBCL patients treated with R‑CHOP or R‑CHOP-like regimens. We evaluated the significance of PNI as a predictor of response to treatment, overall survival (OS) and event-free survival (EFS).

Results

Patients with a PNI ≤ 44.55, where the cut-off was calculated by receiver operating characteristics (Youden index) and the same was obtained for response to treatment with 76.2 % sensitivity and a specificity of 85.4 %, for OS with 72.4 % sensitivity and a specificity of 90.5 % and for EFS with 65.6 % sensitivity and a specificity of 90.1 %, had significantly worse 5‑year OS (18.3 % vs 86.4 %, P < 0.001, log rank test) and 5‑year EFS (15.1 % vs 82.3 %, P < 0.001, log rank test). Regression analysis showed that PNI ≤ 44.55 was an independent prognostic factor for response to treatment with an odds ratio (OR) of 4.88 for treatment failure, 95 % confidence interval (CI) 1.077–22.105, OS hazard ratio (HR) 4.24, 95 % CI 1.451–12.392 and EFS HR 4.007, 95 % CI 1.48–10.852. Lower PNI levels were found in patients with advanced Ann Arbor clinical stage (46.6 ± 7.77 vs. 52.7 ± 5.43) and in those with poor response to therapy (40.58 ± 7.26 vs. 50.67 ± 6.26).

Conclusions

The PNI is a simple and useful marker to predict long-term survival outcome in DLBCL patients. Low PNI predicted poor outcome. A limitation of the study is its retrospective design in which the prognostic value was tested in the derivation cohort only. Notwithstanding, this is the first study suggesting that PNI is an important prognostic factor in DLBCL.
Literatur
1.
Zurück zum Zitat Swerdlow SH, Campo E, Harris NL. et al. WHO classification of tumours of Haematopoietic and lymphoid tissues, 4th ed. Lyon: IARC Press; 2008. Swerdlow SH, Campo E, Harris NL. et al. WHO classification of tumours of Haematopoietic and lymphoid tissues, 4th ed. Lyon: IARC Press; 2008.
2.
Zurück zum Zitat Morton LM, Wang SS, Devess SS, Hartage P, Weisenburger DD, Linet MS. Lymphoma incidence patterns by WHO subtype in the United States, 1992–2001. Blood. 2006;107(1):265.CrossRefPubMedPubMedCentral Morton LM, Wang SS, Devess SS, Hartage P, Weisenburger DD, Linet MS. Lymphoma incidence patterns by WHO subtype in the United States, 1992–2001. Blood. 2006;107(1):265.CrossRefPubMedPubMedCentral
3.
Zurück zum Zitat The International Non-Hodgkin’s Lymphoma Prognostic Factors Project. A predictive model for aggressive non-Hodgkin’s lymphoma. N Engl J Med. 1993;329(14):987–94.CrossRef The International Non-Hodgkin’s Lymphoma Prognostic Factors Project. A predictive model for aggressive non-Hodgkin’s lymphoma. N Engl J Med. 1993;329(14):987–94.CrossRef
4.
Zurück zum Zitat Sehn LH, Berry B, Chhanabhai M, et al. The revised International Prognostic Index (R-IPI) is a better predictor of outcome than the standard IPI for patients with diffuse large B‑cell lymphoma treated with R‑CHOP. Blood. 2007;109(5):1857–61.CrossRefPubMed Sehn LH, Berry B, Chhanabhai M, et al. The revised International Prognostic Index (R-IPI) is a better predictor of outcome than the standard IPI for patients with diffuse large B‑cell lymphoma treated with R‑CHOP. Blood. 2007;109(5):1857–61.CrossRefPubMed
5.
Zurück zum Zitat Oki Y, Yamamoto K, Kato H, et al. Low absolute lymphocyte count is a poor prognostic marker in patients with diffuse large B‑cell lymphoma and suggests patients survival benefit from rituximab. Eur J Haematol. 2008;81(6):448–53.CrossRefPubMed Oki Y, Yamamoto K, Kato H, et al. Low absolute lymphocyte count is a poor prognostic marker in patients with diffuse large B‑cell lymphoma and suggests patients survival benefit from rituximab. Eur J Haematol. 2008;81(6):448–53.CrossRefPubMed
6.
Zurück zum Zitat Kim DH, Baek JH, Chae YS, et al. Absolute lymphocyte count predicts response to chemotherapy and survival in diffuse large B‑cell lymphoma. Leukemia. 2007;21:2227–30.CrossRefPubMed Kim DH, Baek JH, Chae YS, et al. Absolute lymphocyte count predicts response to chemotherapy and survival in diffuse large B‑cell lymphoma. Leukemia. 2007;21:2227–30.CrossRefPubMed
7.
Zurück zum Zitat Porrata LF, Ristow K, Habermann TM, Witzig TE, Inwards DJ, Markovic SN. Absolute lymphocyte count at the time of first relapse predicts survival in patients with diffuse large B‑cell lymphoma. Am J Hematol. 2009;84(2):93–7.CrossRefPubMed Porrata LF, Ristow K, Habermann TM, Witzig TE, Inwards DJ, Markovic SN. Absolute lymphocyte count at the time of first relapse predicts survival in patients with diffuse large B‑cell lymphoma. Am J Hematol. 2009;84(2):93–7.CrossRefPubMed
8.
Zurück zum Zitat Aoki K, Tabata S, Yonetani N, Matsushita A, Ishikawa T. The prognostic impact of absolute lymphocyte and monocyte counts at diagnosis of diffuse large B‑cell lymphoma in the rituximab era. Acta Haematol. 2013;130(4):242–6.CrossRefPubMed Aoki K, Tabata S, Yonetani N, Matsushita A, Ishikawa T. The prognostic impact of absolute lymphocyte and monocyte counts at diagnosis of diffuse large B‑cell lymphoma in the rituximab era. Acta Haematol. 2013;130(4):242–6.CrossRefPubMed
9.
Zurück zum Zitat Dalia S, Chavez J, Little B, et al. Serum albumin retains independent prognostic significance in diffuse large B‑cell lymphoma in the post-rituximab era. Ann Hematol. 2014;93(8):1305–12.CrossRefPubMed Dalia S, Chavez J, Little B, et al. Serum albumin retains independent prognostic significance in diffuse large B‑cell lymphoma in the post-rituximab era. Ann Hematol. 2014;93(8):1305–12.CrossRefPubMed
10.
Zurück zum Zitat Buzby GP, Mullen JL, Matthews DC, Hobbs CL, Rosato EF. Prognostic nutritional index in gastrointestinal surgery. Am J Surg. 1980;139(1):160–7.CrossRefPubMed Buzby GP, Mullen JL, Matthews DC, Hobbs CL, Rosato EF. Prognostic nutritional index in gastrointestinal surgery. Am J Surg. 1980;139(1):160–7.CrossRefPubMed
11.
Zurück zum Zitat Onodera T, Goseki N, Kosaki G. Prognostic nutritional index in gastrointestinal surgery of malnourished cancer patients. Nihon Geka Gakkai Zasshi. 1984;85(9):1001–5.PubMed Onodera T, Goseki N, Kosaki G. Prognostic nutritional index in gastrointestinal surgery of malnourished cancer patients. Nihon Geka Gakkai Zasshi. 1984;85(9):1001–5.PubMed
12.
Zurück zum Zitat Sun K, Chen S, Xu J, Li G, He Y. The prognostic significance of the prognostic nutritional index in cancer: a systematic review and meta analysis. J Cancer Res Clin Oncol. 2014;140(9):1537–49.CrossRefPubMed Sun K, Chen S, Xu J, Li G, He Y. The prognostic significance of the prognostic nutritional index in cancer: a systematic review and meta analysis. J Cancer Res Clin Oncol. 2014;140(9):1537–49.CrossRefPubMed
13.
Zurück zum Zitat Wang SH, Zhai ST, Lin H. Prognostic value of prognostic nutritional index for patients with gastric cancer: a meta-analysis. Minerva Med. 2016; Epub ahead of print. Wang SH, Zhai ST, Lin H. Prognostic value of prognostic nutritional index for patients with gastric cancer: a meta-analysis. Minerva Med. 2016; Epub ahead of print.
14.
Zurück zum Zitat Pinato DJ, North BV, Sharma R. A novel, externally validated inflammation-based prognostic algorithm in hepatocellular carcinoma: the prognostic nutritional index (PNI). Br J Cancer. 2012;106(8):1439–45.CrossRefPubMedPubMedCentral Pinato DJ, North BV, Sharma R. A novel, externally validated inflammation-based prognostic algorithm in hepatocellular carcinoma: the prognostic nutritional index (PNI). Br J Cancer. 2012;106(8):1439–45.CrossRefPubMedPubMedCentral
15.
Zurück zum Zitat Chen KL, Liu YH, Li WY, et al. The prognostic nutritional index predicts survival for patients with extranodal natural killer/T cell lymphoma, nasal type. Ann Hematol. 2015;94(8):1389–400.CrossRefPubMed Chen KL, Liu YH, Li WY, et al. The prognostic nutritional index predicts survival for patients with extranodal natural killer/T cell lymphoma, nasal type. Ann Hematol. 2015;94(8):1389–400.CrossRefPubMed
16.
Zurück zum Zitat Raffeti E, Donato F, Castelnuovo F, MASTER Cohort, et al. The prognostic role of systemic inflammatory markers on HIV-infected patients with non-Hodgkin lymphoma, a multicenter cohort study. J Transl Med. 2015;13(1):89. doi:10.1186/s12967-015-0446-8.CrossRef Raffeti E, Donato F, Castelnuovo F, MASTER Cohort, et al. The prognostic role of systemic inflammatory markers on HIV-infected patients with non-Hodgkin lymphoma, a multicenter cohort study. J Transl Med. 2015;13(1):89. doi:10.​1186/​s12967-015-0446-8.CrossRef
17.
Zurück zum Zitat Cheson BD, Pfistner B, Juweid ME, et al. International Harmonization Project on Lymphoma: Revised response criteria for malignant lymphoma. J Clin Oncol. 2007;25(5):579–86.CrossRefPubMed Cheson BD, Pfistner B, Juweid ME, et al. International Harmonization Project on Lymphoma: Revised response criteria for malignant lymphoma. J Clin Oncol. 2007;25(5):579–86.CrossRefPubMed
19.
Zurück zum Zitat Kanda M, Fujii T, Kodera Y, Nagai S, Takeda S, Nakao A. Nutritional predictors of postoperative outcome in pancreatic cancer. Br J Surg. 2011;98(2):268–74.CrossRefPubMed Kanda M, Fujii T, Kodera Y, Nagai S, Takeda S, Nakao A. Nutritional predictors of postoperative outcome in pancreatic cancer. Br J Surg. 2011;98(2):268–74.CrossRefPubMed
20.
Zurück zum Zitat Nozoe T, Kimura Y, Ishida M, Saeki H, Korenaga D, Sugimachi K. Correlation of pre-operative nutritional condition with post-operative complications in surgical treatment for oesophageal carcinoma. Eur J Surg Oncol. 2002;28(4):396–400.CrossRefPubMed Nozoe T, Kimura Y, Ishida M, Saeki H, Korenaga D, Sugimachi K. Correlation of pre-operative nutritional condition with post-operative complications in surgical treatment for oesophageal carcinoma. Eur J Surg Oncol. 2002;28(4):396–400.CrossRefPubMed
21.
Zurück zum Zitat Nozoe T, Ninomiya M, Maeda T, Matsukuma A, Nakashima H, Ezaki T. Prognostic nutritional index: a tool to predict the biological aggressiveness of gastric carcinoma. Surg Today. 2010;40(5):440–3.CrossRefPubMed Nozoe T, Ninomiya M, Maeda T, Matsukuma A, Nakashima H, Ezaki T. Prognostic nutritional index: a tool to predict the biological aggressiveness of gastric carcinoma. Surg Today. 2010;40(5):440–3.CrossRefPubMed
22.
Zurück zum Zitat McMillan DC. Systemic inflammation, nutritional status and survival in patinets with cancer. Curr Opin Clin Nutr Metab Care. 2009;12(3):223–6.CrossRefPubMed McMillan DC. Systemic inflammation, nutritional status and survival in patinets with cancer. Curr Opin Clin Nutr Metab Care. 2009;12(3):223–6.CrossRefPubMed
23.
Zurück zum Zitat Aviles A, Yanez J, Lopez T, Garcia EL, Guzman R, Diaz-Maqueo JC. Malnutrition as an adverse prognostic factor in patients with diffuse large cell lymphoma. Arch Med Res. 1995;26(1):31–4.PubMed Aviles A, Yanez J, Lopez T, Garcia EL, Guzman R, Diaz-Maqueo JC. Malnutrition as an adverse prognostic factor in patients with diffuse large cell lymphoma. Arch Med Res. 1995;26(1):31–4.PubMed
24.
Zurück zum Zitat Gupta D, Lis CG. Pretreatment serum albumin as a predictor of cancer survival: a systemic review of the epidemiological literature. Nutr J. 2012;22(9):69. doi:10.1186/1475-2891-9-69. Gupta D, Lis CG. Pretreatment serum albumin as a predictor of cancer survival: a systemic review of the epidemiological literature. Nutr J. 2012;22(9):69. doi:10.​1186/​1475-2891-9-69.
25.
Zurück zum Zitat Ray-Coquard I, Cropet C, Van Glabbeke M, European Organization for Research and Treatment of Cancer Soft Tissue and Bone Sarcoma Group, et al. Lymphopenia as a prognostic factor for overall survival in advanced carcinomas, sarcomas, and lymphomas. Cancer Res. 2009;69(13):5383–91.CrossRefPubMedPubMedCentral Ray-Coquard I, Cropet C, Van Glabbeke M, European Organization for Research and Treatment of Cancer Soft Tissue and Bone Sarcoma Group, et al. Lymphopenia as a prognostic factor for overall survival in advanced carcinomas, sarcomas, and lymphomas. Cancer Res. 2009;69(13):5383–91.CrossRefPubMedPubMedCentral
26.
Zurück zum Zitat Henning B, Honchel R, Goldblum SE, MaClain CJ. Tumor necrosis factor-mediated hypoalbuminemia in rabbits. J Nutr. 1988;118(12):1586–90. Henning B, Honchel R, Goldblum SE, MaClain CJ. Tumor necrosis factor-mediated hypoalbuminemia in rabbits. J Nutr. 1988;118(12):1586–90.
27.
Zurück zum Zitat McMillan DC, Watson WS, O’Gorman P, Preston T, Scott HR, McArdle CS. Albumin concentration are primarily determined by the body cell mass and the systemic inflammatory response in cancer patients with weight loss. Nutr Cancer. 2001;39(2):210–3.CrossRefPubMed McMillan DC, Watson WS, O’Gorman P, Preston T, Scott HR, McArdle CS. Albumin concentration are primarily determined by the body cell mass and the systemic inflammatory response in cancer patients with weight loss. Nutr Cancer. 2001;39(2):210–3.CrossRefPubMed
28.
Zurück zum Zitat Zhou K, Xu D, Cao Y, Wang J, Yang Y, Huang M. C‑MYC aberrations as prognostic factors in diffuse large B‑cell Lymphoma: A meta-analysis of epidemiological studies. PLOS ONE. 2014;9(4):e95020.CrossRefPubMedPubMedCentral Zhou K, Xu D, Cao Y, Wang J, Yang Y, Huang M. C‑MYC aberrations as prognostic factors in diffuse large B‑cell Lymphoma: A meta-analysis of epidemiological studies. PLOS ONE. 2014;9(4):e95020.CrossRefPubMedPubMedCentral
29.
Zurück zum Zitat Kawamoto K, Miyoshi H, Yoshida N, et al. MYC translocation and/or BCL 2 protein expression are associated with poor prognosis in diffuse large B‑cell lymphoma. Cancer Sci. 2016;107(6):853–61.CrossRefPubMedPubMedCentral Kawamoto K, Miyoshi H, Yoshida N, et al. MYC translocation and/or BCL 2 protein expression are associated with poor prognosis in diffuse large B‑cell lymphoma. Cancer Sci. 2016;107(6):853–61.CrossRefPubMedPubMedCentral
30.
Zurück zum Zitat Bodoor K, Matalka I, Hayajneh R, Haddad Y, Gharaibeh W. Evaluation of BCL-6, CD10, CD138 and MUM-1 expression in diffuse large B‑cell lymphoma patients: CD138 is a marker of poor prognosis. Asian Pac J Cancer Prev. 2012;13(7):3037–46.CrossRefPubMed Bodoor K, Matalka I, Hayajneh R, Haddad Y, Gharaibeh W. Evaluation of BCL-6, CD10, CD138 and MUM-1 expression in diffuse large B‑cell lymphoma patients: CD138 is a marker of poor prognosis. Asian Pac J Cancer Prev. 2012;13(7):3037–46.CrossRefPubMed
31.
Zurück zum Zitat Xie Y, Bulbul MA, Ji L, et al. p53 expression is a strong marker of inferior survival in de novo diffuse large B‑cell lymphomaand may have enhanced negative effect with MYC coexpression: a single institutional clinicopathologic study. Am J Clin Pathol. 2014;141(4):593–604.CrossRefPubMed Xie Y, Bulbul MA, Ji L, et al. p53 expression is a strong marker of inferior survival in de novo diffuse large B‑cell lymphomaand may have enhanced negative effect with MYC coexpression: a single institutional clinicopathologic study. Am J Clin Pathol. 2014;141(4):593–604.CrossRefPubMed
Metadaten
Titel
Prognostic nutritional index as a predictor of prognosis in patients with diffuse large B cell lymphoma
verfasst von
Vlatka Periša
Lada Zibar
Ana Knezović
Igor Periša
Jasminka Sinčić-Petričević
Igor Aurer
Publikationsdatum
01.06.2017
Verlag
Springer Vienna
Erschienen in
Wiener klinische Wochenschrift / Ausgabe 11-12/2017
Print ISSN: 0043-5325
Elektronische ISSN: 1613-7671
DOI
https://doi.org/10.1007/s00508-016-1077-7

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