Prognostic value of the nutritional risk index and prognostic nutritional index for immunotherapy outcomes in cervical Cancer

Abstract

Objective(s): To evaluate the association of the Prognostic Nutritional Index (PNI) and Nutritional Risk Index (NRI) with immune-related adverse events, immunotherapy response, and oncologic outcomes. Methods: This study is an IRB-approved retrospective, single-institution cohort study in patients with CC treated with IO from January 1, 2017 to January 1, 2023. Clinical, oncologic, and nutritional parameters were collected from patient charts. The NRI and the PNI are validated composite prognostic indices derived from routinely collected laboratory and anthropometric parameters to evaluate nutritional status. Factors associated with NRI and PNI were evaluated. Progression-free survival (PFS) was defined from the start date of IO until progression of disease, and overall survival (OS) from time of diagnosis to death, with censoring at last follow-up. Kaplan Meier methods were used to assess survival outcomes. Results: 71 patients with CC were treated with IO during the study period. 61% (n = 43) of patients met criteria for low-risk NRI prior to receiving IO, with the remaining 39% (n = 27) meeting criteria for high-risk NRI. Low-risk NRI scores were associated with lower ECOG scores, increased grade 3/4 immune-related adverse events (G3/4 irAEs), and an improvement in OS, p < 0.05. Low-risk post-IO NRI scores were associated with a significant improvement in PFS and OS, p < 0.05. High-risk PNI scores were associated with higher ECOG scores, fewer G3/4 irAEs, and increased hospitalizations during IO, p < 0.05. Low-risk PNI scores were associated with improved response to IO as well as prolonged PFS and OS, p < 0.05. Conclusion(s): In this cohort of CC patients treated with IO, approximately 39% and 55% of patients were categorized as high risk according to pre-treatment NRI and PNI, respectively. High-risk PNI and NRI classifications were associated with differences in irAEs, IO response, and oncologic outcomes.