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The prognostic nutritional index predicts survival and response to first‐line chemotherapy in advanced biliary cancer
Author(s) -
Salati Massimiliano,
Filippi Roberto,
Vivaldi Caterina,
Caputo Francesco,
Leone Francesco,
Salani Francesca,
Cerma Krisida,
Aglietta Massimo,
Fornaro Lorenzo,
Sperti Elisa,
Di Maio Massimo,
Ortega Cinzia,
Fenocchio Elisabetta,
Lombardi Pasquale,
Cagnazzo Celeste,
Depetris Ilaria,
Gelsomino Fabio,
Spallanzani Andrea,
Santini Daniele,
Silvestris Nicola,
Aprile Giuseppe,
Roviello Giandomenico,
Scartozzi Mario,
Cascinu Stefano,
CasadeiGardini Andrea
Publication year - 2020
Publication title -
liver international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.873
H-Index - 110
eISSN - 1478-3231
pISSN - 1478-3223
DOI - 10.1111/liv.14314
Subject(s) - medicine , gemcitabine , multivariate analysis , oncology , cohort , chemotherapy , univariate analysis , receiver operating characteristic , prospective cohort study , univariate , cancer , multivariate statistics , statistics , mathematics
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.