title: Prognostic nutritional index as a predictor of prognosis in patients with diffuse large B cell lymphoma.
abstract: BACKGROUND
  The prognostic nutritional index (PNI), an indicator of nutritional status and systemic inflammation, is associated with short-term and long-term outcomes of various malignancies. The prognostic value of PNI in diffuse large B cell lymphoma (DLBCL) remains unknown. The aim of the present study was to determine the prognostic value of baseline PNI in DLBCL patients.
  
  
  METHODS
  We retrospectively analyzed data from 103 DLBCL patients treated with R‑CHOP or R‑CHOP-like regimens. We evaluated the significance of PNI as a predictor of response to treatment, overall survival (OS) and event-free survival (EFS).
  
  
  RESULTS
  Patients with a PNI ≤ 44.55, where the cut-off was calculated by receiver operating characteristics (Youden index) and the same was obtained for response to treatment with 76.2 % sensitivity and a specificity of 85.4 %, for OS with 72.4 % sensitivity and a specificity of 90.5 % and for EFS with 65.6 % sensitivity and a specificity of 90.1 %, had significantly worse 5‑year OS (18.3 % vs 86.4 %, P < 0.001, log rank test) and 5‑year EFS (15.1 % vs 82.3 %, P < 0.001, log rank test). Regression analysis showed that PNI ≤ 44.55 was an independent prognostic factor for response to treatment with an odds ratio (OR) of 4.88 for treatment failure, 95 % confidence interval (CI) 1.077-22.105, OS hazard ratio (HR) 4.24, 95 % CI 1.451-12.392 and EFS HR 4.007, 95 % CI 1.48-10.852. Lower PNI levels were found in patients with advanced Ann Arbor clinical stage (46.6 ± 7.77 vs. 52.7 ± 5.43) and in those with poor response to therapy (40.58 ± 7.26 vs. 50.67 ± 6.26).
  
  
  CONCLUSIONS
  The PNI is a simple and useful marker to predict long-term survival outcome in DLBCL patients. Low PNI predicted poor outcome. A limitation of the study is its retrospective design in which the prognostic value was tested in the derivation cohort only. Notwithstanding, this is the first study suggesting that PNI is an important prognostic factor in DLBCL.
authors.affiliation: Department of Hematology, Clinic of Internal Medicine, Osijek University Hospital, Josipa Huttlera 4, HR-31000, Osijek, Croatia. vlatkaperisa@gmail.com.|Department for Pathophysiology, Faculty of Medicine, University of Osijek, Josipa Huttlera 4, HR-31000, Osijek, Croatia. vlatkaperisa@gmail.com.
authors.forename: Vlatka
authors.initials: V
authors.lastname: Periša
authors.affiliation: Department for Pathophysiology, Faculty of Medicine, University of Osijek, Josipa Huttlera 4, HR-31000, Osijek, Croatia.|Department of Nephrology, Clinic of Internal Medicine, Osijek University Hospital, Josipa Huttlera 4, HR-31000, Osijek, Croatia.
authors.forename: Lada
authors.initials: L
authors.lastname: Zibar
authors.affiliation: Community Health Centre Đakovo, P. Preradovića 2, HR-31400, Đakovo, Croatia.
authors.forename: Ana
authors.initials: A
authors.lastname: Knezović
authors.affiliation: Community Health Centre Vinkovci, Ul. kralja Zvonimira 53, HR-32100, Vinkovci, Croatia.
authors.forename: Igor
authors.initials: I
authors.lastname: Periša
authors.affiliation: Department of Hematology, Clinic of Internal Medicine, Osijek University Hospital, Josipa Huttlera 4, HR-31000, Osijek, Croatia.
authors.forename: Jasminka
authors.initials: J
authors.lastname: Sinčić-Petričević
authors.affiliation: Division of Hematology, Department of Internal Medicine, University Hospital Centre Zagreb and School of Medicine, University of Zagreb, Kišpatićeva 12, HR-10000, Zagreb, Croatia.
authors.forename: Igor
authors.initials: I
authors.lastname: Aurer
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D015984:Causality; D015897:Comorbidity; D017523:Croatia / Q000453:epidemiology; D003520:Cyclophosphamide / Q000627:therapeutic use; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000627:therapeutic use; D005260:Female; D006801:Humans; D016393:Lymphoma, B-Cell / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality*; D008297:Male; D015596:Nutrition Assessment; D009748:Nutrition Disorders; D009752:Nutritional Status; D011241:Prednisone / Q000627:therapeutic use; D015995:Prevalence; D011379:Prognosis; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D015996:Survival Rate; D014750:Vincristine / Q000627:therapeutic use
chemical_list: D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone
keywords: Lymphoma, large B-cell, diffuse; Prognosis; Prognostic marker; Prognostic nutritional index