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. 2021 Oct 11;12(23):7010-7017.
doi: 10.7150/jca.62340. eCollection 2021.

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

Dongmei Yan  1 , Ziyuan Shen  2 , Shuo Zhang  1 , Lingling Hu  1 , Qian Sun  1 , Kailin Xu  1 , Yingliang Jin  3 , Wei Sang  1
Affiliations

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

Dongmei Yan et al. J Cancer. .

Abstract

Background: Geriatric nutritional risk index (GNRI) and prognostic nutritional index (PNI) are associated with prognosis of various malignancies. Although GNRI and PNI indicates prognosis in some clinical settings, the values of GNRI and PNI on the prognosis of geriatric patients with Diffuse Large B-Cell Lymphoma (DLBCL) is unclear. This retrospective analysis aimed to explore the prognostic values of GNRI and PNI in elderly DLBCL patients. Methods: A total of 133 geriatric patients with DLBCL were recruited from Affiliated Hospital of Xuzhou Medical University, and clinicopathological variables were analyzed. X-Tile program, restricted cubic spline (RCS) and time-dependent receiver operating characteristic (ROC) analysis were used to determine optimal cut-off points of GNRI, PNI and other continuous variables; univariate and multivariate Cox proportional hazards analyses were used for variables selection; Kaplan-Meier curve was utilized to analyze the influence of variables on prognosis; log-rank test was performed for difference evaluation between groups. Results: The optimal cut-off points for GNRI and PNI were 106.26 and 47 by using RCS. Multivariate analysis showed that PNI, age, hemoglobin, liver invasion and central nervous system invasion were independent prognostic factors for elderly patients with DLBCL, and PNI was (P = 0.001, HR = 0.413, 95% CI (0.240-0.710) a stronger predictor. Low PNI could predict worse prognosis independently of elderly patients of DLBCL and could re-stratify patients in GCB group, CD5 positive group BCL-2 positive group, and BCL-6 positive group. Conclusions: PNI was an independent adverse factor for elderly DLBCL and patients with low PNI in GCB group, CD5 positive group and BCL-6 positive group were with poor survival.

Keywords: DLBCL; GNRI; PNI; Prognosis; elderly patients.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interest exists.

Figures

Figure 1
Figure 1
Association between GNRI, PNI and the risk of DLBCL by using restricted cubic spline (RCS), allowing for nonlinear effects.
Figure 2
Figure 2
Receiver operating characteristic curves for age, WBC and Neu.
Figure 3
Figure 3
X-Tile analysis of survival data based on DLBCL patients reveals a continuous distribution based on hemoglobin. The plots show the χ2 log-rank values produced when dividing the patients with two cut-points, producing high, middle, and low subsets.
Figure 4
Figure 4
Poor nutritional status predicting an inferior survival based on (A) PNI, (B) GNRI (four groups).
Figure 5
Figure 5
Kaplan-Meier survival analysis of OS based on PNI of elderly patients with DLBCL in different IPI groups.
Figure 6
Figure 6
Kaplan‐Meier survival curves of PNI in elderly DLBCL patients among different subgroups; (A): GCB; (B): CD5+; (C): BCL-2+; (D): BCL-6+.
Figure 7
Figure 7
KM analysis of patients in different nutritional status groups.
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