Prognostic nutritional index of early post-pembrolizumab therapy predicts long-term survival in patients with advanced urothelial carcinoma

• Published in: Oncology letters Vol. 25; no. 2; p. 49
• Main Authors: Kageyama, Susumu, Yoshida, Tetsuya, Kobayashi, Kenichi, Wada, Akinori, Nagasawa, Masayuki, Kubota, Shigehisa, Kusaba, Takuto, Jo, Fumiyasu, Nakagawa, Shota, Johnin, Kazuyoshi, Narita, Mitsuhiro, Kawauchi, Akihiro
• Format: Journal Article
• Language: English
• Published: Greece Spandidos Publications 01.02.2023; Spandidos Publications UK Ltd; D.A. Spandidos
• Subjects: Albumin; Biomarkers; Bladder cancer; Cancer; Cancer patients; Cancer therapies; Carcinoma; Chemotherapy; Development and progression; Disease control; Hematology; Immunotherapy; Medical prognosis; Medical research; Medicine, Experimental; Metastasis; Monoclonal antibodies; Observational studies; Oncology; Patient outcomes; Prognosis; Response rates; Targeted cancer therapy; Tomography; Japan; pembrolizumab; prognostic nutritional index; urothelial carcinoma; oncological outcome; immunotherapy
• ISSN: 1792-1074; 1792-1082
• DOI: 10.3892/ol.2022.13635

Pembrolizumab has been widely used to treat advanced urothelial carcinoma that has progressed after first-line platinum-based chemotherapy. Because its clinical benefits are limited, biomarkers that can predict a good response to pembrolizumab are required. The prognostic nutritional index (PNI), calculated using the serum albumin level and peripheral lymphocyte count, has been evaluated as a predictive biomarker in cancer immunotherapy. The present study investigated the application of PNI as a predictive biomarker for pembrolizumab response in patients with advanced urothelial cancer. A retrospective study was conducted on 34 patients treated with pembrolizumab at Shiga University of Medical Science Hospital between January 2018 and July 2022. The posttreatment PNI (post-PNI) was calculated within 2 months of starting pembrolizumab. The present study investigated the association between post-PNI and objective response, overall survival (OS) and progression-free survival (PFS). The patient cohort was stratified into two categories, high and low post-PNI groups, with a cutoff value of post-PNI at 40. The higher post-PNI group demonstrated a better disease control rate than the lower post-PNI group (complete response + partial response + stable disease, 75 vs. 21%, P=0.004). Regarding median OS, the higher post-PNI group exhibited a significantly longer survival time than the lower post-PNI group (23.1 vs. 2.9 months, P<0.001). Similarly, the higher post-PNI group exhibited a significantly longer PFS than the lower post-PNI group (10.2 vs.1.9 months, P<0.001). Multivariate analysis showed that a higher post-PNI value was an independent predictor for OS (hazard ratio, 0.04; 95% confidence interval, 0.01-0.14; P<0.001) and PFS (hazard ratio, 0.12; 95% confidence interval, 0.04-0.35; P<0.001). The present study indicated that the post-PNI was a predictor of favorable clinical outcomes in patients treated with pembrolizumab for advanced urothelial carcinoma.