Prognostic Nutrition Index as Predictor for Nivolumab Monotherapy in Advanced Gastric Cancer Patients with Peritoneal Metastases.

Although nivolumab shows survival benefits for patients with advanced gastric cancer (AGC), predictive biomarkers for nivolumab treatment in AGC remain unclear, especially in the case of peritoneal metastases. Therefore, this study investigated the clinical significance of the prognostic nutrition index (PNI), reflecting the host nutritional status and immunity, in AGC patients undergoing nivolumab monotherapy. This study retrospectively analyzed 53 AGC patients who received nivolumab between October 2017 and February 2021. Among them, 35 patients with peritoneal metastases were reviewed to investigate the relationship between the PNI and oncological outcomes. The PNI was calculated as 10 × serum albumin level (g/dl) + 0.005× total lymphocyte count (per mm3) at the first administration of nivolumab. With a median follow-up duration of 2.0 (0.3 − 13.5) months, the median overall survival (OS) was 2.0 months. The overall response and disease-control rates were 0.0% and 20.0%, respectively. Among the 35 patients, 13 patients were identified as a high-PNI group. In the univariate analysis, the high-PNI group showed a significantly longer PFS and OS than the low-PNI group. In the multivariate analysis, the high-PNI was independently associated with a longer PFS (p = 0.021) and OS (p = 0.022). The PNI can be useful for predicting PFS and OS in AGC patients with peritoneal metastases. However, further studies are required to validate these results in AGC and new strategies are needed to improve the outcome for AGC patients with peritoneal metastases.

Prognostic nutrition index may predict cerebral embolic events following carotid artery stenting procedure

Objectives: Cerebral embolism after carotid artery stenting (CAS) remains a matter of concern in frailty patients. Prognostic nutrition index (PNI), which provides an objective assessment of nutritional status, is a useful prognostic indicator in cardiovascular diseases. We aim to determine the value of pre-procedural PNI in predicting cerebral embolism including stroke, transient ischemic attack (TIA), and silent new ischemic cerebral lesions (SNICLs). Patients and Methods: We retrospectively evaluated 138 patients (mean age: 70.6±6.7 years, male:99) who underwent CAS. Inclusion criteria were as follows: I) availability of all medical records including albumin value and lymphocyte count, II) having cranial imaging after CAS, III) having symptomatic carotid stenosis 50-99% or asymptomatic carotid stenosis≥60-99%. The study population was divided into two subgroups according to the presence of cerebral embolism as cerebral embolism (+) cerebral embolism (-) groups. Results: Among the study population, 22 patients (16%) had at least 1 SNICL, seven patients (5.0%) had ischemic stroke, and five patients (3.6%) had TIA. The cerebral embolism (+) group had a significantly lower PNI, older age, more frequent history of stroke, a higher proportion of type III aortic arch, and longer fluoroscopy time than the cerebral embolism (-) group. Low PNI was identified as one of the independent predictors of cerebral embolism (OR=0.808; 95%CI: 0.670-0.975; p=0.026), and PNI lower than 44.7 predicted cerebral embolism with a sensitivity of 70.6% and a specificity of 61.1% (AUC: 0.739; 95% CI: 0.651 to 0.827; p<0.001). Conclusion: The current data suggest that PNI is an independent prognostic factor for cerebral embolic complications after CAS procedures.

The Diagnostic Value of Preoperative Hematology Makers in the Classification and Molecular Subtypes of Newly Diagnosed High-Grade Gliomas

Objective The purpose of our study is to explore the diagnostic value of the single and combined hematological maker for the classification and isocitrate dehydrogenase (IDH)-1/2 mutations molecular subtypes of high-grade gliomas (HGGs). Methods A total of 354 newly diagnosed HGGs patients were included in this study. Firstly, we compared the levels of hematology indicators in the classification and molecular subtypes of HGGs. Next, the correlation between the levels of hematology indicators with basic clinical features was analyzed. Finally, the diagnostic value of the single and combined hematology indicator for identifying the classification and molecular subtypes from HGGs was performed. Results The level of fibrinogen (FIB) was higher in higher grade gliomas and glioblastoma multiforme IDH wild type (GBM IDH-wt). Nutrition-related indicators such as serum albumin (ALB), albumin/globulin ratio (AGR), and prognostic nutrition index (PNI) were negatively correlated with age, whereas FIB was positively associated with age. Compared with women, men with GBM had significantly higher AGR and lower serum globulin (GLOB). We found that the best single and combined indicator for identifying GBM and GBM IDH-wt from HGGs were FIB [0.595 (0.519–0.672) and 0.615 (0.546–0.684)] and age + FIB [0.712 (0.642–0.783) and 0.726 (0.662–0.791)], respectively. Conclusions Preoperative hematological indicators have high diagnostic value for GBM and GBM IDH-wt from HGGs, especially FIB combined age.

The Diagnostic Value of Preoperative Hematology Makers in the Classification and Molecular Subtypes of Newly Diagnosed High-Grade Gliomas

Purpose: The purpose of our study is to explore the diagnostic value of the single and combined hematological maker for the classification and isocitrate dehydrogenase (IDH)-1/2 mutations (IDH) molecular subtypes of high-grade gliomas (HGGs).Methods: A total of 354 newly diagnosed HGGs patients were included in this study. Firstly, we compared the levels of hematology indicators in the classification and molecular subtypes of HGGs. Next, the correlation between the levels of hematology indicators with basic clinical features was analyzed. Finally, the diagnostic value of the single and combined hematology indicator for identifying the classification and molecular subtypes from HGGs was performed.Results: The level of fibrinogen (FIB) was higher in higher grade gliomas and glioblastoma multiforme IDH wild type (GBM IDH-wt). Nutrition-related indicators such as serum albumin (ALB), albumin/globulin ratio (AGR), and prognostic nutrition index (PNI) were negatively correlated with age, whereas FIB was positively associated with age. Compared with women, men with GBM had significantly higher AGR and lower serum globulin (GLOB). We found that the best single and combined indicator for identifying GBM and GBM IDH-wt from HGGs were FIB [0.595 (0.519-0.672) and 0.615 (0.546-0.684)] and age+FIB [0.712 (0.642-0.783) and 0.726 (0.662-0.791)], respectively.Conclusions: Preoperative hematological indicators have high diagnostic value for GBM and GBM IDH-wt from HGGs, especially FIB combined age.

Effects of prognostic nutrition index on side effects and prognosis of radiotherapy and chemotherapy after radical gastrectomy.

e16002 Background: To investigate the impact of preoperative prognostic nutritional index (PNI) on the severity of radiotherapy and chemotherapy toxicity and survival prognosis in patients with gastric cancer through retrospective analysis and research in order to guide clinical nutritional support treatment for patients with gastric cancer. Methods: Through a retrospective cohort study，we analyzed the data of 191 patients with gastric cancer in the Department of Gastrointestinal Surgery of the Affiliated Hospital of Guizhou Medical University and Guizhou Cancer Hospital from January 2008 to December 2018. According to the cut-off value, the patients were divided into high PNI group (PNI≥47.7) and low PNI group (PNI < 47.7). We Compared the incidences of severe radiotherapy and chemotherapy toxicities and overall survival in high PNI group and low PNI group. and make Analysis of prognostic factors. Results: The low PNI group was more prone to severe radiochemotherapy hematological side effects than the high PNI group, and the postoperative survival time was shorter. Multivariate analysis showed that: TNM stage (P = 0.000) and PNI (P = 0.001) were Independent risk factors in predicting overall survival rate. Conclusions: The preoperative prognostic nutrition index is a useful factor for predicting the incidence of radiotherapy and chemotherapy toxicities in patients after gastric cancer surgery.It is one of the important factors affecting the prognosis of gastric cancer and helps to guide the nutritional support treatment of gastric cancer patients.

Impact of the preoperative prognostic nutritional index as a predictor for postoperative complications after resection of locally recurrent rectal cancer

Background Local recurrence is common after curative resections for rectal cancer. Surgical intervention is among the best treatment choices. However, achieving a negative resection margin often requires extensive pelvic organ resections; thus, the postoperative complication rate is quite high. Recent studies have reported that the inflammatory index could predict postoperative complications. This study aimed to validate the correlation between clinical factors, including inflammatory markers, and severe complications after surgery for local recurrent rectal cancer. Methods This retrospective study included 99 patients that underwent radical resections for local recurrences of rectal cancer. Postoperative complications were graded according to the Clavien-Dindo classification. Grades ≥3 were defined as severe complications. Risk factors for severe complications were identified with univariate and multivariate logistic regression models and assessed with receiver-operating characteristic curves. Results Severe postoperative complications occurred in 38 patients (38.4%). Analyses of correlations between inflammatory markers and severe postoperative complications revealed that the strongest correlation was found between the prognostic nutrition index and severe postoperative complications. The receiver-operating characteristic analysis showed that the optimal prognostic nutrition index cut-off value was 42.2 (sensitivity: 0.790, specificity: 0.508). In univariate and multivariate analyses, a prognostic nutrition index ≤44.2 (Odds ratio: 3.007, 95%CI:1.171–8.255, p = 0.02) and a blood loss ≥2850 mL (Odds ratio: 2.545, 95%CI: 1.044–6.367, p = 0.04) were associated with a significantly higher incidence of severe postoperative complications. Conclusions We found that a low preoperative prognostic nutrition index and excessive intraoperative blood loss were risk factors for severe complications after surgery for local recurrent rectal cancer.

Prognostic Nutritional Index Considering Resection Range Is Useful for Predicting Postoperative Morbidity of Hepatectomy

Background Poor preoperative nutritional and immunological status are major risk factors for postoperative complications in patients with various malignancies. Lower preoperative prognostic nutrition index (PNI) is associated with higher rates of postoperative complications and poorer prognosis in those patients. The aim of this study was to analyze the predictive value of the PNI for post-hepatectomy complications in patients with hepatocellular carcinoma (HCC), and evaluate its utility in the surgical procedure. Methods This retrospective study included 510 patients who underwent open hepatectomies for HCC. The predictive value of the preoperative nutritional and immunological status for postoperative complications was assessed using the PNI. Postoperative complications were defined as grade II or higher per the Clavien-Dindo classification. Postoperative complication rates were compared according to surgical procedure (major hepatectomy vs minor hepatectomy). Results Patients with postoperative complications had significantly lower PNIs than those without (43.1 ± 5.5 vs 47.0 ± 5.7, P < 0.001). In the multivariate analysis, low preoperative PNI (< 45) was an independent risk factor for postoperative complications after hepatectomy (hazard ratio, 3.85). When patients were classified per their PNI (high vs low) and extent of surgical procedures (major vs minor), there were more complications among patients with low PNI than those with high PNI, regardless of the extent of surgical procedures. Specifically, the group of patients with low PNI who underwent major hepatectomy had significantly higher rates of postoperative complications than the other groups. Conclusions Adding the resection range to the PNI is useful for predicting the postoperative morbidities of hepatectomy patients.