# Predictive Value of Prognostic Nutritional Index in Prognosis and Spontaneous Pleurodesis of Patients with Advanced Non-small Cell Lung Cancer and Malignant Pleural Effusion

## TL;DR

This study shows that a nutritional and inflammation-based score called PNI can predict survival and spontaneous pleurodesis in advanced lung cancer patients with pleural effusion.

## Contribution

The study demonstrates PNI as a novel predictor for prognosis and spontaneous pleurodesis in non-small cell lung cancer patients with malignant pleural effusion.

## Key findings

- Higher PNI scores correlate with longer survival (36.5 vs 24.3 months) in MPE patients.
- PNI is an independent predictor of spontaneous pleurodesis and better prognosis in MPE patients.
- PNI-based models show moderate predictive accuracy (AUC 0.67-0.69) for survival and pleurodesis.

## Abstract

基于营养状况和炎症的预后营养指数（prognostic nutritional index, PNI）已被开发并证明与恶性肿瘤不良预后密切相关。然而，PNI在恶性胸腔积液（malignant pleural effusion, MPE）患者中的预测作用仍不确定。本研究旨在探究PNI在MPE患者预后和胸膜自发固定中的预测价值。

回顾性分析2015年1月至2022年12月于四川大学华西医院诊断为晚期非小细胞肺癌（non-small cell lung cancer, NSCLC）伴MPE患者病例资料，并将患者随机分配到训练集（60%）和验证集（40%）。收集患者的临床数据和外周血炎症指标并计算全身炎症系数，使用Cox比例风险模型、Kaplan-Meier法、Nelson-Aalen累积风险曲线分析PNI对MPE患者预后和胸膜自发固定的影响。

本研究最终纳入261例晚期NSCLC伴MPE患者（训练集157例，验证集104例），其中年龄<65岁占58.2%，男性患者占53.6%，腺癌占95.8%。PNI的二分类截断值为44.1，与PNI较低（PNI<44.1）的患者相比，PNI高（PNI≥44.1）的患者中位生存期明显延长（36.5 vs 24.3个月，P=0.02），胸膜自发固定发生率更高（P=0.009）。多因素Cox分析发现，较高的PNI是患者良好预后和胸膜自发固定的独立影响因素（P<0.05）。根据Cox回归分析结果确定PNI-预后和PNI-胸膜自发固定预测模型，绘制受试者工作特征（receiver operating characteristic, ROC）曲线，训练集的曲线下面积（area under the curve, AUC）分别为0.694（95%CI: 0.620-0.776）和0.673（95%CI: 0.590-0.737）。

PNI是衡量MPE患者预后和胸膜自发固定的可靠生物标志物，关注患者的营养状况和免疫状态可能会改善患者的预后和胸腔积液的控制。

Baseline demographics for NSCLC with MPE

Univariate and multivariate Cox regression of clinical factors for OS in patients with NSCLC and MPE in the development set

Univariate and multivariate Cox regression of clinical factors for spontaneous pleurodesis in patients with NSCLC and MPE in the development set