Prognostic values of geriatric nutritional risk index (GNRI) and prognostic nutritional index (PNI) in elderly patients with Diffuse Large B-Cell Lymphoma

Abstract Background: Systemic inflammation and cachexia are associated with adverse clinical outcomes in diffuse large B-cell lymphoma (DLBCL). The Geriatric Nutritional Risk Index (GNRI) is one of the main parameters used to assess these conditions, but its efficacy in DLBCL is inconclusive.Methods: We retrospectively reviewed 228 DLBCL patients who were treated with R-CHOP immunochemotherapy (rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone). The patients were stratified according to GNRI score (> 98, 92 to 98, 82 to < 92, and < 82) as defined in previous studies. Additionally, the extent of sarcopenia was categorized as sarcopenia-both, sarcopenia-L3/PM alone, and non-sarcopenia-both according to skeletal muscle index.Results: Survival curves plotted against a combination of GNRI and sarcopenia scores revealed two clear groups as follows: high cachexia risk (HCR) group (GNRI < 82, sarcopenia-both, or GNRI 82-92 with sarcopenia-L3/PM alone) and low cachexia risk (LCR) group (others). The HCR group had a lower complete response rate (46.5% vs. 86.6%) and higher frequency of treatment-related mortality (19.7% vs. 3.8%) and early treatment discontinuation (43.7% vs. 8.3%) compared with the LCR group. The median progression-free survival (PFS) (not reached vs. 10.3 months, p < 0.001) and overall survival (OS) (not reached vs. 12.9 months, p < 0.001) were much shorter in the HCR group than in the LCR group. On multivariable analyses, the HCR group was shown to be an independent negative prognostic factor for PFS and OS after adjusting the National Comprehensive Cancer Network-International Prognostic Index (NCCN-IPI).Conclusions: A combined model of GNRI and sarcopenia may provide prognostic information independently of the NCCN-IPI in DLBCL.

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Prognostic model based on the Geriatric Nutritional Risk Index and sarcopenia in patients with diffuse large B-cell lymphoma

10.21203/rs.3.rs-16671/v1 ◽

2020 ◽

Author(s):

Se-Il Go ◽

Hoon-Gu Kim ◽

Myoung Hee Kang ◽

Sungwoo Park ◽

Gyeong-Won Lee

Keyword(s):

B Cell ◽

Cell Lymphoma ◽

Risk Index ◽

B Cell Lymphoma ◽

Nutritional Risk ◽

Geriatric Nutritional Risk Index ◽

Skeletal Muscle Index ◽

Large B Cell Lymphoma ◽

Nutritional Risk Index ◽

Large B Cell

Abstract Background Systemic inflammation and cachexia are associated with adverse clinical outcomes in diffuse large B-cell lymphoma (DLBCL). The Geriatric Nutritional Risk Index (GNRI) is one of the main parameters used to assess these conditions, but its efficacy in DLBCL is inconclusive. Methods We retrospectively reviewed 228 DLBCL patients who were treated with R-CHOP immunochemotherapy (rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone). The patients were stratified according to GNRI score (> 98, 92 to 98, 82 to < 92, and < 82) as defined in previous studies. Additionally, the extent of sarcopenia was categorized as sarcopenia-both, sarcopenia-L3/PM alone, and non-sarcopenia-both according to skeletal muscle index. Results Survival curves plotted against a combination of GNRI and sarcopenia scores revealed two clear groups as follows: high cachexia risk (HCR) group (GNRI < 82, sarcopenia-both, or GNRI 82-92 with sarcopenia-L3/PM alone) and low cachexia risk (LCR) group (others). The HCR group had a lower complete response rate (46.5% vs. 86.6%) and higher frequency of treatment-related mortality (19.7% vs. 3.8%) and early treatment discontinuation (43.7% vs. 8.3%) compared with the LCR group. The median progression-free survival (PFS) (not reached vs. 10.3 months, p < 0.001) and overall survival (OS) (not reached vs. 12.9 months, p < 0.001) were much shorter in the HCR group than in the LCR group. On multivariable analyses, the HCR group was shown to be an independent negative prognostic factor for PFS and OS after adjusting the National Comprehensive Cancer Network-International Prognostic Index (NCCN-IPI). Conclusions A combined model of GNRI and sarcopenia may provide prognostic information independently of the NCCN-IPI in DLBCL.

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Low Geriatric Nutritional Risk Index Is Associated with Poorer Prognosis in Elderly Diffuse Large B-cell Lymphoma Patients Unfit for Intensive Anthracycline-Containing Therapy: A Real-World Study

Nutrients ◽

10.3390/nu13093243 ◽

2021 ◽

Vol 13 (9) ◽

pp. 3243

Author(s):

Tzer-Ming Chuang ◽

Yi-Chang Liu ◽

Hui-Hua Hsiao ◽

Hui-Ching Wang ◽

Jeng-Shiun Du ◽

...

Keyword(s):

B Cell ◽

Cell Lymphoma ◽

Risk Index ◽

B Cell Lymphoma ◽

Nutritional Risk ◽

Geriatric Nutritional Risk Index ◽

Predictive Tool ◽

Large B Cell Lymphoma ◽

Nutritional Risk Index ◽

Large B Cell

Nutritional assessments, including the Geriatric Nutritional Risk Index (GNRI), have emerged as prediction tools for long-term survival in various cancers. This study aimed to investigate the therapeutic strategy and explore the prognostic factors in the elderly patients (≥ 65 years) with diffuse large B cell lymphoma (DLBCL). The cutoff value of the GNRI score (92.5) was obtained using the receiver operating characteristic curve. Among these patients (n = 205), 129 (62.9%) did not receive standard R–CHOP chemotherapy. Old age (≥80 years), poor performance status, low serum albumin level, and comorbidities were the major factors associated with less intensive anti-lymphoma treatment. Further analysis demonstrated that a lower GNRI score (<92.5) was linked to more unfavorable clinical features. In the patients who received non-anthracycline-containing regimens (non-R–CHOP), multivariate analysis showed that a low GNRI can serve as an independent predictive factor for worse progression-free (HR, 2.85; 95% CI, 1.05–7.72; p = 0.039) and overall survival (HR, 2.98; 95% CI, 1.02–8.90; p = 0.045). In summary, nutritional evaluation plays a role in DLBCL treatment and the GNRI score can serve as a feasible predictive tool for clinical outcomes in frail elderly DLBCL patients treated with non-anthracycline-containing regimens.

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Prognostic model based on the geriatric nutritional risk index and sarcopenia in patients with diffuse large B-cell lymphoma

BMC Cancer ◽

10.1186/s12885-020-06921-2 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Se-Il Go ◽

Hoon-Gu Kim ◽

Myoung Hee Kang ◽

Sungwoo Park ◽

Gyeong-Won Lee

Keyword(s):

B Cell ◽

Prognostic Model ◽

Cell Lymphoma ◽

Risk Index ◽

B Cell Lymphoma ◽

Nutritional Risk ◽

Geriatric Nutritional Risk Index ◽

Large B Cell Lymphoma ◽

Nutritional Risk Index ◽

Large B Cell

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Geriatric nutritional risk index is not an independent predictor in patients with diffuse large B-cell lymphoma

Cancer Biomarkers ◽

10.3233/cbm-170754 ◽

2018 ◽

Vol 21 (4) ◽

pp. 813-820 ◽

Cited By ~ 9

Author(s):

Zhongqi Li ◽

Qi Guo ◽

Juying Wei ◽

Jie Jin ◽

Jinghan Wang

Keyword(s):

B Cell ◽

Cell Lymphoma ◽

Independent Predictor ◽

Risk Index ◽

B Cell Lymphoma ◽

Nutritional Risk ◽

Geriatric Nutritional Risk Index ◽

Large B Cell Lymphoma ◽

Nutritional Risk Index ◽

Large B Cell

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Prognostic nutritional index and the prognosis of diffuse large b-cell lymphoma: a meta-analysis

Cancer Cell International ◽

10.1186/s12935-020-01535-x ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Chunyan Luan ◽

Fei Wang ◽

Ning Wei ◽

Baoan Chen

Keyword(s):

B Cell ◽

Prognostic Value ◽

Cell Lymphoma ◽

Meta Analysis ◽

Prognostic Nutritional Index ◽

B Cell Lymphoma ◽

Cochrane Library ◽

Large B Cell Lymphoma ◽

Nutritional Index ◽

Large B Cell

Abstract Background Some studies have investigated the prognostic value exhibited by the Prognostic Nutritional Index (PNI) in patients suffering diffuse large B-cell lymphoma (DLBCL), but varying results were obtained. In order to determine the specific prognostic value more accurately, a meta-analysis was conducted in this study. Methods Literatures were searched from the China National Knowledge Infrastructure (CNKI), Wanfang, PubMed, Embase, the Cochrane Library, and Web of Science. Pooled hazard ratio (HR) and the 95% confidence interval (CI) were calculated to assess the association between PNI and the overall survival (OS) and the progression-free survival (PFS) of patients with DLBCL. Results Based on seven studies with a total number of 1311 patients, our meta-analysis revealed that low PNI may meant poor OS (HR = 2.14, 95% CI 1.66–2.75, p < 0.001) and poor PFS (HR = 1.75, 95% CI 1.36–2.25, p = 0.438). Subgroup analysis showed that, in Asians, low PNI was correlated to poor OS (pooled HR = 2.06 95% CI 1.59–2.66) and poor PFS (pooled HR = 1.66, 95% CI 1.28–2.15). Similar results were obtained from one European study, which is the only study performed outside of Asia from our literature search. Conclusion For patients with DLBCL, low PNI may be interpreted as adverse prognosis. More data from European patients are required in this study to avoid analysis bias.

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