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. 2023 Mar 2:10:1000326.
doi: 10.3389/fnut.2023.1000326. eCollection 2023.

Prognostic values of the prognostic nutritional index, geriatric nutritional risk index, and systemic inflammatory indexes in patients with stage IIB-III cervical cancer receiving radiotherapy

Hong-Bing Wang  1 , Xin-Tian Xu  2 , Meng-Xing Tian  3 , Chen-Chen Ding  3 , Jing Tang  4 , Yu Qian  5 , Xin Jin  3
Affiliations

Prognostic values of the prognostic nutritional index, geriatric nutritional risk index, and systemic inflammatory indexes in patients with stage IIB-III cervical cancer receiving radiotherapy

Hong-Bing Wang et al. Front Nutr. .

Abstract

Background: Growing evidence suggests that nutritional status and inflammation are associated with survival in various cancers. This study aimed to evaluate the prognostic value of the prognostic nutritional index (PNI), geriatric nutritional risk index (GNRI), and systemic inflammatory indexes (neutrophil/lymphocyte ratio [NLR], monocyte/lymphocyte ratio [MLR], and platelet/lymphocyte ratio [PLR]) in patients with stage IIB-III cervical cancer receiving radiotherapy.

Results: The ideal cutoff values for the PNI, GNRI, NLR, MLR, and PLR were 48.3, 97.04, 2.8, 0.41, and 186.67, respectively. Low PNI and GNRI scores were associated with poor OS and PFS. High NLR, MLR, and PLR also predicted inferior 5-year OS and PFS rates in patients with stage IIB-III cervical cancer. Multivariate Cox regression analysis identified tumor size, histological type, stage, number of metastatic lymph nodes, PNI, GNRI, NLR, PLR, and MLR as significant prognostic factors for OS and PFS.

Conclusions: The current findings suggest that the PNI, GNRI, NLR, PLR, and MLR are essential parameters for predicting prognosis in patients with stage IIB-III cervical cancer receiving radiotherapy.

Keywords: cervical cancer; geriatric nutritional risk index; overall survival; prognostic nutritional index; systemic inflammatory indexes.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Receiver operating characteristic curves for the use of nutritional indicators to predict life expectancy in patients with stage IIB–III cervical cancer receiving radiotherapy based on: (A) prognostic nutritional index (PNI) and (B) geriatric nutritional risk index (GNRI). Cut-off points with the highest combined sensitivity and specificity were used.
Figure 2
Figure 2
Receiver operating characteristic curves for the use of inflammatory indicators to predict life expectancy in patients with stage IIB–III cervical cancer receiving radiotherapy based on: (A) neutrophil/lymphocyte ratio (NLR), (B) monocyte/lymphocyte ratio (MLR), and (C) platelet/lymphocyte ratio (PLR). Cut-off points with the highest combined sensitivity and specificity were used.
Figure 3
Figure 3
Kaplan–Meier curves of overall survival according to the nutritional indicators. (A) Low prognostic nutritional index (PNI) vs. high PNI (low PNI: ≤ 48.3, high PNI: > 48.3) and (B) low geriatric nutritional risk index (GNRI) vs. high GNRI (low GNRI: ≤ 97.04, high GNRI: > 97.04). The Kaplan–Meier method was used to calculate the survival rate, and the log-rank test was used to compare survival distributions between the groups.
Figure 4
Figure 4
Kaplan–Meier curves of progression-free survival according to the nutritional indicators. (A) Low prognostic nutritional index (PNI) vs. high PNI (low PNI: ≤ 48.3, high PNI: > 48.3) and (B) low geriatric nutritional risk index (GNRI) vs. high GNRI (low GNRI: ≤ 97.04, high GNRI: > 97.04). The Kaplan–Meier method was used to calculate the survival rate, and the log-rank test was used to compare survival distributions between the groups.
Figure 5
Figure 5
Kaplan–Meier curves of overall survival according to the inflammatory indicators. (A) Low neutrocyte/lymphocyte ratio (NLR) vs. high NLR (low NLR: ≤ 2.8, high NLR: > 2.8), (B) low monocyte/lymphocyte ratio (MLR) vs. high MLR (low MLR: ≤ 0.41, high MLR: > 0.41), and (C) low platelet lymphocyte ratio (PLR) vs. high PLR (low PLR: ≤ 186.67, high PLR: > 186.67). The Kaplan–Meier method was used to calculate the survival rate, and the log-rank test was used to compare survival distributions between the groups.
Figure 6
Figure 6
Kaplan–Meier curves of progression-free survival according to the inflammatory indicators. (A) Low neutrocyte/lymphocyte ratio (NLR) vs. high NLR (low NLR: ≤ 2.8, high NLR: > 2.8), (B) low monocyte/lymphocyte ratio (MLR) vs. high MLR (low MLR: ≤ 0.41, high MLR: > 0.41), and (C) low platelet/lymphocyte ratio (PLR) vs. high PLR (low PLR: ≤ 186.67, high PLR: > 186.67). The Kaplan–Meier method was used to calculate the survival rate, and the log-rank test was used to compare survival distributions between the groups.
Figure 7
Figure 7
Prognostic nomograms for overall survival prediction according to the prognostic nutritional index (PNI) (A) and geriatric nutritional risk index (GNRI) (B). Points were assigned for age before treatment, and for tumor size, histological type, stage, number of metastatic lymph nodes, and nutritional indicators. The score of each predictor was determined by drawing a vertical line from the value to the score scale. The total score was summed up by the scores of these predictors, which correspond to overall survival rate.
Figure 8
Figure 8
Prognostic nomograms for overall survival prediction according to the neutrophil/lymphocyte ratio (NLR) (A), monocyte/lymphocyte ratio (MLR) (B), and platelet/lymphocyte ratio (PLR) (C). Points were assigned for age before treatment, and for tumor size, histological type, stage, number of metastatic lymph nodes, and inflammatory indicators. The score of each predictor was determined by drawing a vertical line from the value to the score scale. The total score was summed up by the scores of these predictors, which correspond to overall survival rate.
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