The prognostic nutritional index predicts survival and response to first-line chemotherapy in advanced biliary cancer

Massimiliano Salati, Roberto Filippi, Caterina Vivaldi, Francesco Caputo, Francesco Leone, Francesca Salani, Krisida Cerma, Massimo Aglietta, Lorenzo Fornaro, Elisa Sperti, Massimo Di Maio, Cinzia Ortega, Elisabetta Fenocchio, Pasquale Lombardi, Celeste Cagnazzo, Ilaria Depetris, Fabio Gelsomino, Andrea Spallanzani, Daniele Santini, Nicola SilvestrisGiuseppe Aprile, Giandomenico Roviello, Mario Scartozzi, Stefano Cascinu, Andrea Casadei-Gardini

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Abstract

BACKGROUND: An accurate risk-stratification is key to optimize the benefit-to-risk ratio of palliative treatment in advanced biliary cancer. We aimed at assessing the impact of the prognostic nutritional index (PNI) on survival and treatment response in advanced biliary cancer (ABC) receiving first-line chemotherapy.

METHODS: Medical records of ABC treated with standard chemotherapy at the Modena Cancer Centre were retrospectively reviewed for variables deemed of potential interest, including the PNI. Univariate and multivariate analyses were performed to investigate the association between the covariates and overall survival (OS).

RESULTS: 114 ABC fulfilled the inclusion criteria and made up the training cohort. A PNI cut-off value of 36.7 was established using the receiver operating characteristic (ROC) analysis. At both the univariate and the multivariate analysis, low PNI value (<36.7) was associated with shorter OS (P = .0011), together with increased NLR (P = .0046) and ECOG >1 (P < .0001). The median OS was 5.4 vs 12.1 months in the low- vs high PNI-group. Moreover, a PNI value >36.7 resulted in a higher disease control in patients treated with gemcitabine/platinum combination (61.4% vs 34.3%). These results were validated in an independent cohort of 253 ABC.

CONCLUSIONS: We demonstrated and externally validated a prognostic role for the PNI in ABC treated with first-line chemotherapy. Although the PNI turned out to be predictive in the subset of patients receiving platinum/gemcitabine combination, future prospective confirmation is needed.

Original languageEnglish
JournalLiver international : official journal of the International Association for the Study of the Liver
DOIs
Publication statusE-pub ahead of print - Nov 27 2019

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Salati, M., Filippi, R., Vivaldi, C., Caputo, F., Leone, F., Salani, F., Cerma, K., Aglietta, M., Fornaro, L., Sperti, E., Di Maio, M., Ortega, C., Fenocchio, E., Lombardi, P., Cagnazzo, C., Depetris, I., Gelsomino, F., Spallanzani, A., Santini, D., ... Casadei-Gardini, A. (2019). The prognostic nutritional index predicts survival and response to first-line chemotherapy in advanced biliary cancer. Liver international : official journal of the International Association for the Study of the Liver. https://doi.org/10.1111/liv.14314