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Objective evaluation of nutritional status using the prognostic nutritional index during and after chemoradiotherapy in Japanese patients with head and neck cancer: a retrospective study
  1. Daichiro Fujiwara1,2,
  2. Masanobu Tsubaki2,
  3. Tomoya Takeda2,
  4. Makoto Miura3,
  5. Shozo Nishida2,
  6. Katsuhiko Sakaguchi1
  1. 1 Department of Pharmacy, Japanese Red Cross Society Wakayama Medical Center, Wakayama, Japan
  2. 2 Division of Pharmacotherapy, School of Pharmacy, Kindai University, Higashi-Osaka, Japan
  3. 3 Department of Otolaryngology, Japanese Red Cross Society Wakayama Medical Center, Wakayama, Japan
  1. Correspondence to Daichiro Fujiwara, Pharmacy, Japanese Red Cross Society Wakayama Medical Center, Wakayama 640-8558, Japan; d.fujiwara68{at}gmail.com

Abstract

Objectives The incidence of severe mucosal damage due to low nutritional status is high in patients receiving concurrent chemoradiotherapy (CCRT) for head and neck cancer. Objective assessments do not exist for discharge criteria after completion of CCRT. Although the prognostic nutritional index (PNI) is an objective indicator of postoperative outcomes in patients undergoing cancer surgery, the prognostic impact of the PNI in patients with head and neck cancer receiving CCRT is unexplored. We investigated whether the PNI could be an objective criterion for nutritional status and a discharge criterion after completion of CCRT.

Methods We assessed the medical records of 23 patients with head and neck cancer who received triweekly cisplatin +radiotherapy (2 Gy ×35 fractions). We evaluated whether the PNI could be a useful evaluation indicator in patients with head and neck cancer receiving CCRT and determined the cut-off PNI value by receiver operating characteristic (ROC) curve analysis as a criterion for hospital discharge.

Results The PNI pre-treatment and post-treatment values were 51.0 and 38.0, respectively (p<0.05). The median length of hospitalisation after therapy was 5 days in patients with grades 1 and 2 and 10 days in patients with grade 3 oral and pharyngeal mucositis (p<0.05). The optimal cut-off PNI value as a criterion for hospital discharge was found to be 40.4 (grades 1 and 2 mucositis) and 38.6 (grade 3 mucositis) by the ROC analysis.

Conclusions The PNI is a simple, objective and temporal indicator which is useful in assessing the nutritional status of patients with head and neck cancer. The PNI could be used as an objective indicator to determine the time of discharge after CCRT completion.

  • prognostic nutritional index
  • head and neck cancer
  • concurrent chemoradiotherapy
  • mucositis
  • nutritional status

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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