# Role of Prognostic Nutritional Index and C-Reactive Protein/Albumin Ratio in Prognosis of Locally Advanced Nasopharyngeal Carcinoma

## TL;DR

This study shows that nutritional and inflammatory markers can predict outcomes in patients with advanced nasopharyngeal cancer.

## Contribution

The study identifies PNI and CRP/Albumin ratio as independent prognostic markers in locally advanced nasopharyngeal carcinoma.

## Key findings

- Lower PNI and CRP/Albumin ratio are significantly associated with higher mortality risk in NPC patients.
- CCRT combined with adjuvant chemotherapy improves survival outcomes compared to induction chemotherapy plus CCRT.
- Tumor size is a significant prognostic factor for patient outcomes.

## Abstract

Background and Objectives: Nasopharyngeal carcinoma (NPC) is a distinct type of head and neck cancer with unique epidemiological and pathological characteristics. Inflammatory and nutritional markers have been increasingly recognized as prognostic indicators in cancer. In this study, we aim to evaluate the significance of the prognostic nutritional index (PNI) and C-reactive protein/albumin ratio (CRP/Alb) in the prognosis of patients with locally advanced nasopharyngeal carcinoma (NPC). Materials and Methods: We retrospectively analyzed a total of 78 patients diagnosed with locally advanced NPC who received chemoradiotherapy (CCRT) with or without induction or adjuvant chemotherapy between January 2010 and April 2024. Patient characteristics, treatment modalities, inflammatory and nutritional markers, overall survival (OS), and progression-free survival (PFS) were assessed. Kaplan–Meier survival analysis and Cox regression models were used to evaluate the prognostic impact of PNI and CRP/Alb. Results: A lower PNI (≤52.90) and lower CRP/Alb ratio (≤0.14) were significantly associated with higher mortality risk (p = 0.043 and 0.023, respectively). Tumor size (≥32.85 mm) was also found to be a significant prognostic factor (p = 0.041). Patients receiving CCRT alone or with adjuvant chemotherapy had a better OS and PFS compared to those who received induction chemotherapy plus CCRT (p = 0.028 and 0.002, respectively). Multivariate Cox regression analysis indicated that CCRT + AC (HR: 0.17, p = 0.029) and CCRT (HR: 0.25, p = 0.049) significantly reduced the risk of death. Conclusions: PNI and CRP/Alb ratio are independent prognostic markers in locally advanced NPC, providing valuable insights into patient stratification and treatment optimization. These findings support their integration into routine clinical practice for risk assessment. Future large-scale, multicenter studies are warranted to confirm these findings.