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The Value of Prognostic Nutritional Index in Follicular Lymphoma

Lee, Shing Fung, MBBS, FRCR; Ng, Ting Ying, MBBS, FRCR; Wong, Frank Chi Sing, MB ChB, FRCR

American Journal of Clinical Oncology: February 2019 - Volume 42 - Issue 2 - p 202–207
doi: 10.1097/COC.0000000000000493
Original Articles: Hematopoietic

Objectives: Previous studies reported that prognostic nutritional index (PNI), a marker of host inflammatory and nutritional status, is associated with prognoses in a number of cancer types. Thus, we investigated PNI at diagnosis as a prognostic factor in FL.

Methods: We reviewed FL patients in Tuen Mun Hospital, Hong Kong from 2000 to 2014 (n=88). PNI was calculated by serum albumin (g/L)+5×absolute lymphocyte count (109/L). We determined the best PNI cut-off value using receiver-operating characteristic curves. The extent to which progression-free survival (PFS) and overall survival differed by PNI cut-off was assessed using Kaplan-Meier and log-rank tests. Cox proportional hazards model was utilized to adjust for covariates.

Results: The best cut-off value for PNI was determined to be 45. Patients with high PNI (>45) had a higher complete response (CR) rate after primary treatment, 46 of 61 (75.4%) patients with high PNI had CR, compared with 10 of 23 (43.5%) for low PNI (2-sample test of proportions P-value=0.006). Further, higher PNI at relapse as a continuous variable was associated with superior postprogression survival with a hazard ratio (HR) 0.88 (95% confidence interval [CI], 0.81-0.96). In multivariate analysis, high PNI at diagnosis had superior PFS (adjusted HR of 0.37; 95% CI, 0.15-0.93).

Conclusions: PNI was shown to be independent prognostic factor of PFS in FL. It is a cheap and widely available biomarker. Future study is needed to validate its prognostic value and clinical utility in a prospective cohort.

Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hong Kong

The study protocol was approved by the New Territories West Cluster Clinical & Research Ethics Committee of Tuen Mun Hospital (Tuen Mun, Hong Kong). Informed consent from patients was not required because clinical data were retrieved from a computer database.

S.F.L.: developed the concept and design of the study, also analyzed the data and wrote the manuscript. All authors interpreted the data, drafted and revised the manuscript critically and approved the final version of the manuscript. S.F.L.: is the guarantor of the paper.

The authors declare no conflicts of interest.

Reprints: Shing Fung Lee, MBBS, FRCR, Department of Clinical Oncology, Tuen Mun Hospital, 23 Tsing Chung Koon Road, Tuen Mun, Hong Kong. E-mail:

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