Evaluation of prognostic factors using nutritional indicators in extensive-stage small cell lung cancer

The Glasgow Prognostic Score (GPS), Prognostic Nutritional Index (PNI), and Neutrophil-to-Lymphocyte Ratio (NLR) have been shown to predict the prognosis of various cancer types. However, the prognostic roles of GPS, PNI, and NLR in patients with extensive-stage small cell lung cancer (ES-SCLC) remain controversial. This study aimed to assess the prognostic value of these three immunonutritional indicators in patients with ES-SCLC.

We retrospectively analyzed 102 ES-SCLC patients who received first-line platinum-doublet chemotherapy. The GPS, PNI, and NLR were assessed before the initiation of first-line chemotherapy. Based on previous reports, the optimal cut-off levels were 40 for PNI and 3 for NLR. The Kaplan-Meier method and Cox proportional hazards models were used to evaluate progression-free survival (PFS) and overall survival (OS).

Of the total participants, 102 had ES-SCLC. Patients with a GPS of 0/1 showed significantly longer PFS than those with a GPS of 2 (133 vs. 63 days, P<0.001), and a high PNI was also associated with longer PFS (133 vs. 80 days, P=0.007). No significant difference in PFS was observed between the low and high NLR groups (P=0.471). Similarly, OS was significantly longer in patients with a GPS of 0/1 than in those with a GPS of 2 (300 vs. 117 days, P<0.001) and in those with a high PNI than in those with a low PNI (296 vs. 136 days, P<0.001). The OS did not differ significantly in the NLR group (P=0.303). Multivariate analyses revealed that the GPS and PNI were independently associated with worse PFS and OS.

Our study demonstrated that both the GPS and PNI were significantly associated with PFS and OS in patients with ES-SCLC. The GPS may be a simple and reliable immunonutritional marker for predicting outcomes in patients with ES-SCLC treated with platinum doublet chemotherapy.