Identification of prognostic nutritional index as a reliable prognostic indicator for advanced lung cancer patients receiving immune checkpoint inhibitors

Xuebing Yan; Jiaxin Wang; Jingxian Mao; Ying Wang; Xiangjun Wang; Mengxue Yang; Hong Qiao

doi:10.3389/fnut.2023.1213255

Identification of prognostic nutritional index as a reliable prognostic indicator for advanced lung cancer patients receiving immune checkpoint inhibitors

Front Nutr. 2023 Jul 28:10:1213255. doi: 10.3389/fnut.2023.1213255. eCollection 2023.

Authors

Xuebing Yan^#¹, Jiaxin Wang^#¹, Jingxian Mao^#¹, Ying Wang¹, Xiangjun Wang¹, Mengxue Yang², Hong Qiao³

Affiliations

¹ Department of Oncology, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China.
² Department of Oncology, Hefei Cancer Hospital, Chinese Academy of Sciences, Hefei, China.
³ Department of Oncology, Baoying Traditional Chinese Medicine Hospital, Yangzhou, China.

^# Contributed equally.

Abstract

Background: Prognostic nutritional index (PNI) has been identified as a reliable prognostic factor for cancer adjuvant therapy. However, its prognostic value in lung cancer patients receiving immune checkpoint inhibitors (ICIs) remains inconclusive.

Method: A systematic literature review and meta-analysis was performed based on online databases before March 1th 2023. The correlation of PNI with overall survival (OS) or progression-free survival (PFS) was determined using the hazard ratios (HRs) coupled with 95% confidence intervals (CIs). Then, a retrospective cohort enrolling 123 ICI-treated lung cancer patients from two hospitals was utilized for validation and further investigation.

Results: A total of 14 studies enrolling 1,260 lung cancer patients were included in the meta-analysis. The high PNI level was significantly correlated with better OS (HR = 2.56, 95% CI = 1.86-3.54) and PFS (HR = 1.91, 95% CI = 1.53-2.40) of the lung cancer patients. The subgroup analysis confirmed the results except for the PFS in patients receiving anti-PD-1 therapy (HR = 1.51, 95% CI = 0.86-2.65). In the retrospective study, the high PNI level was identified as a favorable factor for OS and PFS not only in the whole cohort but also in the subgroups stratified by non-small cell lung cancer and small cell lung cancer. The high PNI was also correlated with better anti-cancer therapy response and performed better than body mass index and serum albumin level in OS prediction. Finally, we established a novel prognostic nomogram based on PNI and other clinical parameters. The nomogram was found to perform well in predicting the 1-year OS of ICI-treated lung cancer patients.

Conclusion: Both the meta-analysis and retrospective work demonstrate the PNI is a reliable prognostic factor for advanced lung cancer patients receiving ICI-based therapies. Our study further highlights the crucial role of nutrition assessment and intervention in cancer immunotherapy.

Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier: CRD42023424146.

Keywords: immune checkpoint inhibitors; lung cancer; nomogram; prognosis; prognostic nutritional index.

Publication types

Systematic Review

Grants and funding

This research was financially supported by the China National Natural Science Foundation (No. 81902422), Program of Jiangsu Commission of Health (No. M2020024), and Clinical Translational Foundation of Yangzhou University (No. AHYZUZHXM 202104).