The role of prognostic nutritional index in the management of pulmonary
sarcomatoid carcinoma
Abstract
Introduction: Pulmonary sarcomatoid carcinoma is characterized by poor
survival rates compared with other non-small cell lung cancer.
Prognostic nutritional index has significant prognostic value in many
malignant tumors. We conducted this retrospective study to investigate
the role of prognostic nutritional index in patients with pulmonary
sarcomatoid carcinoma and to determine prognostic factors. Methods: Of
8176 patients with resected lung cancer in a single high-volume
institution between 2008 and 2015, 91 patients with pathologically
diagnosed sarcomatoid carcinoma were included in our study and
evaluated. Kaplan-Meier analysis and Cox regression analysis were
conducted to analyze clinicopathologic data. Subgroup analysis of
overall survival and recurrence-free survival among pulmonary
sarcomatoid carcinoma patients were also conducted. Results: Univariate
and multivariate analysis showed that, for OS, the pathological stage
(HR: 2.464; 95%CI: 1.388-4.376; P=0.002) nodal metastasis (HR: 0.432;
95%CI: 0.201-0.927; P=0.031) and PNI (HR: 0.102; 95%CI: 0.050-0.207;
P<0.001) were independent prognostic factors. And for RFS, We
found PNI as an independent prognostic factor (HR: 0.078; 95% CI,
0.036–0.169; P<0.001), along with nodal metastasis (HR:
0.418; 95%CI, 0.193-0.906; P=0.027) and the pathological stage (HR:
2.448; 95%CI, 1.364-4.393; P=0.003). In the subgroup of patients with
PNI≥49.4, univariate analysis showed treatment modality was a
significant factor of overall survival (P=0.001); multivariate analysis
showed patients received postoperative chemotherapy (HR: 0.288; 95%CI,
0.095-0.874; P=0.028) or postoperative chemotherapy with targeted
therapy (HR: 0.148; 95%CI, 0.030-0.726; P=0.019) has better overall
survival rates. Conclusion: The PNI and the pathological TNM stage are
independent prognostic factors for pulmonary sarcomatoid carcinoma. PNI
is an important indicator for the selection of postoperative adjuvant
therapy. Patients with PNI ≥ 49.4 may benefit from postoperative
chemotherapy and targeted therapy. We still need further prospective
studies to confirm these results