Low Prognostic Nutritional Index Indicates Dismal Prognosis in Patients with Diffuse Large B Cell Lymphoma

Background: Prognostic nutritional index (PNI) is calculated based on serum albumin concentration and absolute lymphocyte count, and its prognostic value has been established in various human malignancies. However, whether PNI can be applied in predicting the prognosis of patients with diffuse large B-cell lymphoma (DLBCL) remains to be clarified. The aim of the present study is to explore the prognostic value of baseline PNI in DLBCL. Methods: We retrospectively reviewed the medical records of 98 patients with DLBCL treated at the Southeast University-affiliated Zhongda Hospital between January 2013 and November 2019. The optimal cut-off value of PNI was determined using a receiver operating characteristic (ROC) curve and the Youden index. The relationship of high and low PNI with the clinical characteristics of the patients and prognosis were analyzed. Results: Patients with low PNI tended to have a worse event-free survival (EFS) and overall survival (OS) (EFS, P=0.029; OS, P<0.001). For patients treated with R-CHOP（Rituximab-cyclophosphamide, doxorubicin, vincristine, and prednisone), PNI proved to be predictive for survival (EFS, P= 0.020; OS, P<0.001), while no significant effect was found in DLBCL patients who received CHOP chemotherapy (EFS, P=0.639; OS, P=0.114). Multivariate analysis showed that PNI was an independent risk factor for OS and EFS of all 98 DLBCL patients after adjusting for model a (OS: adjust for age, gender, body mass index, performance status, B symptoms, international prognostic index, hemoglobin；EFS：adjust for age, gender, Ann Arbor stage, international prognostic index, lactate dehydrogenase, treatment, absolute lymphocyte count, hemoglobin). PNI remained an independent risk factor for both OS and EFS in patients after adjusting for model b (adjust for all items). Conclusion: PNI is a simple and useful marker to predict survival outcome in DLBCL patients, and low PNI is an independent predictor of a better outcome in terms of EFS and OS outcome in DLBCL, suggesting that PNI is an effective prognostic factor in patients with DLBCL.