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. 2025 Aug 15:15:1534545.
doi: 10.3389/fonc.2025.1534545. eCollection 2025.

PNI as a predictive biomarker: a novel nomogram of immunotherapy efficacy in advanced breast cancer

Xinyang Li #  1 , Xiang Cheng #  1 , Yikai Han  1 , Xiaodan Liu  1 , Yujin Fang  1 , Shengju Ren  1 , Xiangwen Dong  1 , Ziwen Lei  1 , Yue Zhang  2 , Tengfei Zhang  1   3
Affiliations

PNI as a predictive biomarker: a novel nomogram of immunotherapy efficacy in advanced breast cancer

Xinyang Li et al. Front Oncol. .

Abstract

Purpose: There has been a persistent upward trend in breast cancer (BC) incidence in recent years. The advancement of immunotherapy has introduced promising therapeutic options. This study focuses on identify potential biomarkers to predict clinical outcomes in advanced BC patients receiving immunotherapy.

Patients and methods: In accordance with the predefined inclusion and exclusion criteria, a cohort of 154 patients were enrolled in this study. Progression-free survival (PFS) and overall survival (OS) were the primary endpoints. The end of follow-up is October 2024. Statistical analyses were performed utilizing IBM SPSS Statistics, version 26.0, and R software, version 4.3.1.

Results: Univariate Cox regression analysis demonstrated a statistically significant association between the prognostic nutritional index (PNI) and both PFS and OS (p<0.05). Kaplan-Meier survival analysis, complemented by log-rank tests, revealed statistically differences in survival outcomes stratified by PNI levels (p<0.05). After adjusting for potential confounders in multivariate Cox regression analysis, PNI remained an independent prognostic factor in advanced BC patients undergoing immunotherapy. The predictive accuracy of the nomograms, as measured by the concordance indices (C-indices), was 0.710 for PFS and 0.705 for OS. The area under the ROC (AUC) for the predicted model at 6-, 12-, 18- and 24- months were 0.756, 0.761, 0.684, and 0.779. For OS, the AUC values were 0.753, 0.722, 0.641 and 0.576. The calibration curves revealed good concordance between the observed outcomes and the predicted probabilities.

Conclusions: PNI is an independent prognostic factor for advanced BC receiving immunotherapy and the prognostic model based on PNI has good discrimination, authenticity and consistency.

Keywords: breast cancer; immunotherapy; nomogram; prognosis; prognostic nutritional index.

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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
Kaplan–Meier survival curve of PNI associated with PFS and OS. (A) Kaplan–Meier survival curve of PNI associated with PFS, (B) Kaplan–Meier survival curve of PNI associated with OS.
Figure 2
Figure 2
Nomogram for predicting progression-free survival (PFS) probabilities.
Figure 3
Figure 3
ROC curves of the nomogram model. (A) ROC curve and AUCs of the PFS nomogram model, (B) ROC curve and AUCs of the OS nomogram model.
See this image and copyright information in PMC

References

    1. Santucci C, Carioli G, Bertuccio P, Malvezzi M, Pastorino U, Boffetta P, et al. Progress in cancer mortality, incidence, and survival: a global overview. Eur J Cancer Prev. (2020) 29:367–81. doi: 10.1097/CEJ.0000000000000594, PMID: - DOI - PubMed
    1. Harbeck N, Gnant M. Breast cancer. Lancet. (2017) 389:1134–50. doi: 10.1016/S0140-6736(16)31891-8, PMID: - DOI - PubMed
    1. Januskeviciene I, Petrikaite V. Heterogeneity of breast cancer: The importance of interaction between different tumor cell populations. Life Sci. (2019) 239:11709. doi: 10.1016/j.lfs.2019.117009, PMID: - DOI - PubMed
    1. Abbott M, Ustoyev Y. Cancer and the immune system: the history and background of immunotherapy. Semin Oncol Nurs. (2019) 35(5):150923. doi: 10.1016/j.soncn.2019.08.002, PMID: - DOI - PubMed
    1. Yu WD, Sun G, Li J, Xu J, Wang XC. Mechanisms and therapeutic potentials of cancer immunotherapy in combination with radiotherapy and/or chemotherapy. Cancer Lett. (2019) 452:66–70. doi: 10.1016/j.canlet.2019.02.048, PMID: - DOI - PubMed

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