High prognostic nutritional index (PNI) as a positive prognostic indicator for non-small cell lung cancer patients with bone metastasis

Lung Cancer
11/10/2020

Clin Respir J. 2020 Oct 9. doi: 10.1111/crj.13288. Online ahead of print.

ABSTRACT

INTRODUCTION: Increasing evidence shows the close association between prognostic nutritional index (PNI) and overall survival (OS) of solid cancers including lung cancer. However, the role of PNI in non-small cell lung cancer patients (NSCLC) with bone metastasis remains unclear.

OBJECTIVE: To explore the prognostic role of PNI in NSCLC patients with bone metastasis.

METHODS: A retrospective analysis of 259 initially diagnosed NSCLC with bone metastasis was conducted. Uni- and multivariate analysis were used to assess the potential prognostic roles of parameters.

RESULTS: The most common symptoms initially presented were cough and chest pain. Two hundred patients (77.2%) received the treatment of bisphosphonates. Patients with low PNI were found in 154 (59.5%) patients. Median survival time for all cases was 286 days. The median OS for patients with low and high PNI was 227 and 389 days, respectively. The 6-month, 1-year, and 2-year survival rates for patients with low PNI were 66.2%, 29.9% and 10.4% compared to 79.0%, 52.4% and 26.7% in patients with high PNI level. On univariate analysis, female patients, non smokers, high PNI and systematic chemotherapy (P<0.05) were shown to be closely correlated with a better prognosis of NSCLC patients with bone metastasis. Only PNI (P=0.002), systematic chemotherapy (P=0.026) and distant metastasis number (P=0.044) held statistical significance on multivariate analysis.

CONCLUSIONS: PNI represents a noninvasive, efficiency and convenient biomarker of NSCLC patients with bone metastasis. High PNI, systematic chemotherapy and distant metastasis number<2 are independent positive prognostic factors of NSCLC patients with bone metastasis.