Clinical significance of modified prognostic nutritional index in predicting adverse reactions and prognosis related to radical radiotherapy for nasopharyngeal carcinoma
WEN Yuhua
SHEN Niping
ZENG Miao
TANG Xiaohui
Abstract：Objective To evaluate the clinical value of the modified prognostic nutritional index(mPNI)in predicting intensity-modulated radiotherapy(IMRT)-related adverse reactions and survival prognosis in patients with nasopharyngeal carcinoma.Methods A retrospective collection was made of 128 patients with non-keratinized nasopharyngeal carcinoma who received radical IMRT at Yongzhou Central Hospital from January 2020 to June 2022.The clinical medical records and pre-treatment hematological indicators of the patients were collected,and the scores of the Global Leadership in Malnutrition Initiative(GLIM),Controlled Nutritional Status(CONUT),Nutritional Risk Index(NRI),Prognostic Nutritional Index(PNI),and Modified Prognostic Nutritional Index(mPNI)were calculated.The calculation formula of mPNI is:4.8×total cholesterol(mmol/L)-1.5×albumin(g/L)-7.7×total lymphocyte count(×109/L)+126.The adverse reactions of IMRT were evaluated using the Common Adverse Events Evaluation Criteria(CTCAE)version 5.0 standard.The receiver operating characteristic(ROC)curve was used to evaluate the efficacy of each nutritional index in predicting serious adverse reactions.The overall survival(OS)and progression-free survival(PFS)curves were plotted using Kaplan-Meier survival analysis,and the survival differences were subjected to Log-rank test.The Cox proportional hazards regression model was used to analyze the factors influencing the OS and PFS of patients.Results The median follow-up time for all patients in the group was 44.5 months.The 5-year PFS rate and 5-year OS rate of the patients were 70.31%and 86.72%respectively,and the incidence of grade 3 and above adverse reactions was 33.59%.Among GLIM,CONUT,NRI,PNI and mPNI,mPNI has the best efficacy in predicting adverse reactions.The area under the ROC curve(AUC)is 0.794,the optimal cut-off value is 82.608,and the sensitivity and specificity are 81.40%and 74.12%,respectively.In the high mPNI group,the age was≥50 years old(58.73%vs.40.0%,P=0.034),N2-N3(28.57%vs.13.85%,P=0.041),and skull base invasion(61.90%vs.43.08%)The proportion(P=0.033)and the median platelet count/total lymphocyte count ratio(144.38 vs.120.39,P=0.005)were both higher than those in the low mPNI group.The incidences of grade 3 and above adverse reactions(P<0.001),hematological toxicity(P<0.001),oral mucositis(P=0.038),elevated liver enzymes(P=0.023),and nausea/vomiting(P<0.001)were also significantly higher in the high mPNI group.The results of the multivariate Cox model showed that mPNI>92.06 was a risk factor affecting PFS(HR=1.088-1.158,P<0.001).The Kaplan-Meier results showed that the PFS and OS of patients in the high mPNI group were significantly lower than those in the low mPNI group(P<0.01).Conclusion As a comprehensive indicator integrating nutritional and inflammatory status,mPNI can effectively predict radiotherapy-related serious adverse reactions and survival prognosis in patients with nasopharyngeal carcinoma,and has high clinical application value.
Keywords：Nasopharyngeal carcinomaModified prognostic nutritional inde(mPNI)Intensity-modulated radiotherapy(IMRT)Treatment-related toxicityPrognosis
Publication Date：2025-09-28
Online Publishing Date：2025-10-28(First online date of this platform, not the publication date of the document)
Pages：9( 847-855 )