Yüksek dereceli seröz over kanserinde prognostik nutrisyonel indeksin prognostik önemi: diğer prognostik faktörlerle karşılaştırmalı analizi
Öz
Amaç: Yüksek grade seröz over kanseri (HGSOC), tedavisindeki gelişmelere rağmen yüksek rekürrens ve ölüm oranlarına sahiptir. Prognostik nütrisyonel indeks (PNI)’in prognostik önemi diğer kanserlerde umut verici görünse de, HGSOC'daki rolü belirsizdir. Çalışmamız, HGSOC’ de PNI' in prognostik anlamını ve mortalite için optimal cutoff değerini belirlemeyi hedeflemiştir.
Gereç ve Yöntem: Bu retrospektif kohort çalışmada; 2010-2020 yılları arasında HGSOC tanılı, 332 hasta değerlendirdi. Hastaların yaş aralığı, vücut kitle indeksi (VKİ), menopoz durumu, parite durumu, komorbidite varlığı, Amerikan Anestezistler Derneği (ASA) skorları, asit varlığı, kanser antijeni 125 (CA-125), nötrofil-lenfosit oranı, trombosit-lenfosit oranı, hastalık evresi, nüks durumu, platin direnci, optimal sitoredüksiyon elde edilmesi ve PNI değerlendirildi. PNI' in prognozu etkileyen diğer faktörlerle ilişkisi değerlendirildi.
Bulgular: Ortalama PNI 41.8±8.7 idi. Mortalite tahmini için eşik değer ≤44.6 alındığında %96.84 sensitivite, %81.69 spesifite belirlendi. PNI, CA-125'e (AUC=0.588) göre daha güçlü tahmin edici olarak bulundu (AUC=0.932). Düşük PNI (≤44.6) değeri; ileri evre hastalık, platin direnci, ≥1L pre-operatif asit varlığı, daha fazla nüks, daha düşük 5 yıllık sağkalım ve daha yüksek mortalite ile anlamlı olarak ilişkili bulundu. Çok değişkenli analizde mortalite öngörüsünde >1L preoperatif asit varlığı, hastalık nüksü, düşük PNI'nın (OR: 136.82, %95 CI: 54.6-342.4) bağımsız prediktif faktörler olarak saptandı.
Sonuç: HGSOC hastalarında düşük preoperatif PNI değeri mortaliteyi güçlü bir şekilde tahmin etmektedir ve CA-125'ten daha iyi sonuçlar vermektedir. Bu sonuçların çeşitli popülasyonlarda doğrulanması için daha fazla çalışmalara ihtiyaç vardır.
Anahtar Kelimeler
CA125 Yüksek dereceli seröz over kanseri Prognostik nütrisyonel indeks
Kaynakça
- Lheureux S, Gourley C, Vergote I, Oza AM. Epithelial ovarian cancer. Lancet. 2019;393:1240-53.
- Penn CA, Alvarez RD. Current issues in the management of patients with newly diagnosed advanced-stage high-grade serous carcinoma of the ovary. JCO Oncol Pract. 2023;19:116-22.
- Polajžer S, Černe K. Precision medicine in high-grade serous ovarian cancer: targeted therapies and the challenge of chemoresistance. Int J Mol Sci. 2025;26.
- Miao Y, Li S, Yan Q, Li B, Feng Y. Prognostic significance of preoperative prognostic nutritional index in epithelial ovarian cancer patients treated with platinum-based chemotherapy. Oncol Res Treat. 2016;39:712-19.
- Liu X, Li M, Zhao Y, Jiao X, Yu Y, Li R et al. The impact of preoperative immunonutritional status on prognosis in ovarian cancer: a multicenter real-world study. J Ovarian Res. 2025;18:30.
- Menon U, Gentry-Maharaj A, Burnell M, Ryan A, Singh N, Manchanda R et al. Tumour stage, treatment, and survival of women with high-grade serous tubo-ovarian cancer in UKCTOCS: an exploratory analysis of a randomised controlled trial. Lancet Oncol. 2023;24:1018-28.
- Zhang Y, Xing W, Liang X, Yang Z, Ma Y, Chen Y et al. Relationship between nutritional-inflammatory markers and postoperative outcomes in ovarian cancer: a retrospective study. Front Oncol. 2025;15:1531987.
- Huo C, Wu B, Ye D, Xu M, Ma S, Cheng A et al. New prognostic index for neoadjuvant chemotherapy outcome in patients with advanced high-grade serous ovarian cancer. BMC Cancer. 2024;24:1536.
- Chen J, Jin L, Luo R, Zhang X, Chen Y, Han Z et al. Predictive value of preoperative systemic immune-inflammation index and prognostic nutrition index in patients with epithelial ovarian cancer. J Ovarian Res. 2025;18:45.
- Dai Y, Liu M, Lei L, Lu S. Prognostic significance of preoperative prognostic nutritional index in ovarian cancer: a systematic review and meta-analysis. Medicine (Baltimore). 2020;99:e21840.
- Liu Y, Chen S, Zheng C, Ding M, Zhang L, Wang L et al. The prognostic value of the preoperative c-reactive protein/albumin ratio in ovarian cancer. BMC Cancer. 2017;17:285.
- Laky B, Janda M, Cleghorn G, Obermair A. Comparison of different nutritional assessments and body-composition measurements in detecting malnutrition among gynecologic cancer patients. Am J Clin Nutr. 2008;87:1678-85.
- Nie D, Gong H, Mao X, Li Z. Systemic immune-inflammation index predicts prognosis in patients with epithelial ovarian cancer: a retrospective study. Gynecol Oncol. 2019;152:259-64.
- Zhang CL, Jiang XC, Li Y, Pan X, Gao MQ, Chen Y et al. Independent predictive value of blood inflammatory composite markers in ovarian cancer: recent clinical evidence and perspective focusing on NLR and PLR. J Ovarian Res. 2023;16:36.
- Tan X, Chen H. The prognostic value of prognostic nutritional index in patients with ovarian cancer: a systematic review and meta-analysis. Nutr Cancer. 2023;75:73-81.
- Feng Z, Wen H, Ju X, Bi R, Chen X, Yang W et al. The preoperative prognostic nutritional index is a predictive and prognostic factor of high-grade serous ovarian cancer. BMC Cancer. 2018;18:883.
- Komura N, Mabuchi S, Yokoi E, Shimura K, Kawano M, Matsumoto Y et al. Prognostic significance of the pretreatment prognostic nutritional index in patients with epithelial ovarian cancer. Oncotarget. 2019;10:3605-13.
- Zhang W, Ye B, Liang W, Ren Y. Preoperative prognostic nutritional index is a powerful predictor of prognosis in patients with stage III ovarian cancer. Sci Rep. 2017;7:9548.
- Shen-Gunther J, Mannel RS. Ascites as a predictor of ovarian malignancy. Gynecol Oncol. 2002;87:77-83.
- Yılmaz A, Tekin SB, Bilici M, Yılmaz H. Clinical significance of inflammatory indexes in patients with epithelial ovarian cancer. Acta Haematol Oncol Turc. 2020;53:402-9.
- Keskin S, Altın D. Predictor role of systemic inflammation in ovarian cancer. Middle Black Sea Journal of Health Science. 2021;7:282-88.
- Komura N, Mabuchi S, Yokoi E, Shimura K, Kawano M, Matsumoto Y et al. Pre-treatment prognostic nutritional index is superior to platelet count in predicting disease-specific survival in patients with epithelial ovarian cancer. Int J Gynecol Cancer. 2019;29:1057-63.
Prognostic significance of prognostic nutritional index in high-grade serous ovarian cancer: a comparative analysis with other prognostic factors
Öz
Purpose: High-grade serous ovarian cancer (HGSOC) has high recurrence and mortality rates despite treatment advances. The prognostic nutritional index (PNI) shows promise in other cancers, but its role in HGSOC is unclear. This study aimed to evaluate PNI's prognostic value in HGSOC and establish an optimal cutoff for mortality prediction.
Materials and Methods: This retrospective cohort evaluated 332 patients with HGSOC from 2010-2020. The age range, body mass index (BMI), menopausal status, parity status, presence of comorbidities, American Society of Anesthesiologists (ASA) scores, the presence of ascites, cancer antigen 125 (CA-125), neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, disease stage, recurrence status, platinum resistance, attainment of optimal cytoreduction, and PNI were evaluated. PNI relationship with other factors affecting prognosis was evaluated.
Results: The Mean PNI was 41.8±8.7, with a cutoff of ≤44.6 (96.84% sensitivity, 81.69% specificity) for mortality prediction. PNI was a stronger predictor (AUC=0.932) than CA-125 (AUC=0.588). Low PNI (≤44.6) was significantly linked with advanced disease, platinum resistance, preoperative ascites ≥ 1 L, more recurrences, lower 5-year survival, and higher mortality. Multivariate analysis showed low PNI as an independent mortality predictor (OR: 136.82, 95% CI: 54.6-342.4), along with preoperative ascites > 1 L and disease recurrence.
Conclusion: A low preoperative PNI strongly predicts higher mortality in HGSOC patients than in CA-125 patients. This accessible and cost-effective biomarker may aid in assessing risks, guiding increased monitoring, and customizing treatments. Further studies are necessary to confirm these results in various populations.
Anahtar Kelimeler
Cancer antigen 125 (CA-125) high-grade serous ovarian cancer (HGSOC) prognostic nutrition index (PNI)
Etik Beyan
Ethics approval This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Non-Interventional Clinical Research Ethics Committee of University Cukurova, Faculty of Medicine with number 118, 07.01.2022.
Kaynakça
- Lheureux S, Gourley C, Vergote I, Oza AM. Epithelial ovarian cancer. Lancet. 2019;393:1240-53.
- Penn CA, Alvarez RD. Current issues in the management of patients with newly diagnosed advanced-stage high-grade serous carcinoma of the ovary. JCO Oncol Pract. 2023;19:116-22.
- Polajžer S, Černe K. Precision medicine in high-grade serous ovarian cancer: targeted therapies and the challenge of chemoresistance. Int J Mol Sci. 2025;26.
- Miao Y, Li S, Yan Q, Li B, Feng Y. Prognostic significance of preoperative prognostic nutritional index in epithelial ovarian cancer patients treated with platinum-based chemotherapy. Oncol Res Treat. 2016;39:712-19.
- Liu X, Li M, Zhao Y, Jiao X, Yu Y, Li R et al. The impact of preoperative immunonutritional status on prognosis in ovarian cancer: a multicenter real-world study. J Ovarian Res. 2025;18:30.
- Menon U, Gentry-Maharaj A, Burnell M, Ryan A, Singh N, Manchanda R et al. Tumour stage, treatment, and survival of women with high-grade serous tubo-ovarian cancer in UKCTOCS: an exploratory analysis of a randomised controlled trial. Lancet Oncol. 2023;24:1018-28.
- Zhang Y, Xing W, Liang X, Yang Z, Ma Y, Chen Y et al. Relationship between nutritional-inflammatory markers and postoperative outcomes in ovarian cancer: a retrospective study. Front Oncol. 2025;15:1531987.
- Huo C, Wu B, Ye D, Xu M, Ma S, Cheng A et al. New prognostic index for neoadjuvant chemotherapy outcome in patients with advanced high-grade serous ovarian cancer. BMC Cancer. 2024;24:1536.
- Chen J, Jin L, Luo R, Zhang X, Chen Y, Han Z et al. Predictive value of preoperative systemic immune-inflammation index and prognostic nutrition index in patients with epithelial ovarian cancer. J Ovarian Res. 2025;18:45.
- Dai Y, Liu M, Lei L, Lu S. Prognostic significance of preoperative prognostic nutritional index in ovarian cancer: a systematic review and meta-analysis. Medicine (Baltimore). 2020;99:e21840.
- Liu Y, Chen S, Zheng C, Ding M, Zhang L, Wang L et al. The prognostic value of the preoperative c-reactive protein/albumin ratio in ovarian cancer. BMC Cancer. 2017;17:285.
- Laky B, Janda M, Cleghorn G, Obermair A. Comparison of different nutritional assessments and body-composition measurements in detecting malnutrition among gynecologic cancer patients. Am J Clin Nutr. 2008;87:1678-85.
- Nie D, Gong H, Mao X, Li Z. Systemic immune-inflammation index predicts prognosis in patients with epithelial ovarian cancer: a retrospective study. Gynecol Oncol. 2019;152:259-64.
- Zhang CL, Jiang XC, Li Y, Pan X, Gao MQ, Chen Y et al. Independent predictive value of blood inflammatory composite markers in ovarian cancer: recent clinical evidence and perspective focusing on NLR and PLR. J Ovarian Res. 2023;16:36.
- Tan X, Chen H. The prognostic value of prognostic nutritional index in patients with ovarian cancer: a systematic review and meta-analysis. Nutr Cancer. 2023;75:73-81.
- Feng Z, Wen H, Ju X, Bi R, Chen X, Yang W et al. The preoperative prognostic nutritional index is a predictive and prognostic factor of high-grade serous ovarian cancer. BMC Cancer. 2018;18:883.
- Komura N, Mabuchi S, Yokoi E, Shimura K, Kawano M, Matsumoto Y et al. Prognostic significance of the pretreatment prognostic nutritional index in patients with epithelial ovarian cancer. Oncotarget. 2019;10:3605-13.
- Zhang W, Ye B, Liang W, Ren Y. Preoperative prognostic nutritional index is a powerful predictor of prognosis in patients with stage III ovarian cancer. Sci Rep. 2017;7:9548.
- Shen-Gunther J, Mannel RS. Ascites as a predictor of ovarian malignancy. Gynecol Oncol. 2002;87:77-83.
- Yılmaz A, Tekin SB, Bilici M, Yılmaz H. Clinical significance of inflammatory indexes in patients with epithelial ovarian cancer. Acta Haematol Oncol Turc. 2020;53:402-9.
- Keskin S, Altın D. Predictor role of systemic inflammation in ovarian cancer. Middle Black Sea Journal of Health Science. 2021;7:282-88.
- Komura N, Mabuchi S, Yokoi E, Shimura K, Kawano M, Matsumoto Y et al. Pre-treatment prognostic nutritional index is superior to platelet count in predicting disease-specific survival in patients with epithelial ovarian cancer. Int J Gynecol Cancer. 2019;29:1057-63.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Klinik Onkoloji, Kadın Hastalıkları ve Doğum |
| Bölüm | Araştırma |
| Yazarlar | |
| Yayımlanma Tarihi | 30 Haziran 2025 |
| Gönderilme Tarihi | 13 Şubat 2025 |
| Kabul Tarihi | 25 Mayıs 2025 |
| Yayımlandığı Sayı | Yıl 2025 Cilt: 50 Sayı: 2 |
