PRETREATMENT PROGNOSTIC NUTRITIONAL INDEX AND ALBUMIN/GLOBULIN RATIO ASSESSMENT AS A LARYNGEAL CANCER SURVIVAL PREDICTOR

Berrin Yalçin^*, Ozlem Mermut

University of Health Sciences, Istanbul Training and Research Hospital, Department of Radiation Oncology, Istanbul, TR-34098, Turkey

Objective: The study intended to evaluate the impact of prognostic nutritional index (PNI) and albumin/ globulin ratio (AGR) on survival in patients with laryngeal squamous cell carcinoma.

Methods: In total, 204 patients who underwent surgery and/or biopsy after radiotherapy and/or chemotherapy between 2011 and 2019 were included in the study. Patient and treatment data and follow-up data were obtained from the patients’ files. 

Results: The median follow-up period of the patients was 40 (range: 6-115) months. During the final analysis, 89 (43%) patients died, while 115 (57%) patients were alive. The PNI and AGR cut-off values determined the ROC curve analysis. The PNI and AGR cut-off values were calculated to be 40.01 [area under the curve (AUC): 0.666, sensitivity: 0.675, specificity: 0.472, p = 0.001] and 1.39 (AUC: 0.555, sensitivity: 0.617, specificity: 0.555 p=0.175), respectively. The median overall survival (OS), metastasis-free survival (MFS), and local recurrence-free survival (LRFS) were 69%, 78%, and 83%, respectively. The estimated 5-year OS rate for patients with PNI ≤ 40.01 vs. >40.01 was 56% and 81% (p<0.001), respectively. There was no statistically significant difference between 5-year MFS and LRFS rates for PNI. Moreover, there was no statistically significant difference between 5-year OS, MFS, and LRFS rates for AGR. In multivariate analyses, we found age ( ≥60) and low PNI ( ≤40.01) as a prognostic factor for OS (p=0.043, and p=0.042). In the multivariate analysis for MFS, only low PNI was a prognostic factor (p=0.011). No predictive factor was found in the univariate analysis for LRFS.

Conclusion: The PNI ratio, one of the pretreatment nutritional parameters, has a superior prognostic value in patients with laryngeal squamous cell carcinoma as compared to the AGR ratio.