Prognostic Nutritional Index (PNI) and prognostic significance of PNI change in breast cancer patients receiving neoadjuvant chemotherapy

Objective: Prognostic Nutritional Index(PNI) is a widely used standard in cancer patients to determine nutritional status due to simplicity and practicality.PNI change is another indicator that has been found significant in recent studies, and is thought to be a more reliable and dynamic variable.It was aimed to evaluate;pathologic complete response(pCR), disease-free survival(DFS) and side effects caused by chemotherapy in breast cancer patients who is receiving neoadjuvant chemotherapy(NACT) by using PNI and PNI change(ΔPNI). Method: The data of breast cancer patients who received neoadjuvant chemotherapy and subsequently underwent surgery at the Medical Oncology outpatient clinic of Akdeniz University Hospital between 2014 and 2021 were retrospectively scanned. PNI score was calculated as =[10xserum albumin(g/dl)]+[0.005x total lymphocyte count mm3)].PNI measured before NACT was shown as Pre NACT PNI, PNI measured after the operation following NACT was shown as PostNACT PNI, ΔPNI parameters were considered as PreNACT PNI-PostNACT PNI. Kaplan-Meier analysis and log-rank test were used for survival analysis.ROC analysis was performed and AUC was calculated for PNI cut-off points. Cox Regression Model was used for factors affecting DFS.PNI could be used as prognostic factors and the effects of PNI and other parameters on treatment response and DFS were evaluated. Results: 192 patients with complete medical records were included in this study. Median overall survival time was found to be 25.5 months.Factors affecting DFS were low ΔPNI in univariate analysis and the presence of recurrence in multivariate analysis.Longer DFS was observed in the low ΔPNI, high preNACT PNI and high postNACT PNI groups. No relationship was found between PNI scores and hematological toxicities and pathologic complete response. Conclusion: Low preNACT PNI, low postNACT PNI, high ΔPNI predict poor disease-free survival in breast cancer patients receiving NACT.There was no significant relationship between PNI and pathological complete response and hematological toxicities. Key words: Prognostic Nutrional İndex, Breast Cancer, Neoadjuvant Chemotherapy, Disease Free Survival