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August 17, 2025Open Access

Association Between Prognostic Nutritional Index and Clinical Outcomes in Advanced Non-Small Cell Lung Cancer Treated with Immune Checkpoint Inhibitors

YAYunus Emre AltıntaşDr Lütfi Kırdar Kartal Eğitim ve Araştırma Hastanesi OKOğuzcan KınıkoğluDr Lütfi Kırdar Kartal Eğitim ve Araştırma Hastanesi DIDeniz IşıkDr Lütfi Kırdar Kartal Eğitim ve Araştırma Hastanesi

Key Points

Patients with a high prognostic nutritional index showed significantly better overall survival compared to those with a low index.
The median overall survival was 14.17 months in the high PNI group, versus 6.07 months in the low group (P < .001).
Cox regression analysis identified a high prognostic nutritional index as an independent predictor of improved overall survival.
Integrating the prognostic nutritional index could refine risk stratification and enhance supportive care for patients with NSCLC.

Abstract

Objective: The Prognostic Nutritional Index (PNI), an inflammation-based biomarker derived from serum albumin and lymphocyte count, reflects both nutritional and immunological status. Although widely studied in gastrointestinal malignancies, its prognostic value in non-small cell lung cancer (NSCLC) patients receiving immune checkpoint inhibitors (ICIs) remains insufficiently explored. Methods: A retrospective cohort of 263 patients diagnosed with stage IV non-small-cell lung cancer (NSCLC) who received ICIs (ICIs) between March 2018 and May 2024 at a single tertiary institution was evaluated. The PNI was computed using pre-treatment laboratory data obtained prior to immunotherapy initiation. Patients were categorized into high (≥45.32) and low (<45.32) PNI groups, with the cut-off value determined through receiver operating characteristic (ROC) curve analysis. Survival outcomes were assessed using Kaplan–Meier and Cox regression analyses. Radiological responses were also compared between groups. Results: Patients in the high PNI group demonstrated a markedly prolonged median overall survival (OS) compared to those in the low PNI group (14.17 vs. 6.07 months; log-rank test, P < .001). In multivariate Cox regression analysis, a high PNI was identified as an independent predictor of improved OS (hazard ratio HR = 0.48; 95% CI: 0.34-0.67; P < .001). While patients with elevated PNI also exhibited a trend toward longer progression-free survival (6.80 vs. 5.03 months), this finding did not reach statistical significance (P = .14). Radiologic response rates were more favorable in the high PNI group, with higher rates of partial and complete response. Conclusion: Pretreatment PNI is an independent prognostic factor for OS in patients with advanced NSCLC treated with ICIs. Its ease of calculation, low cost, and reflection of host immune-nutritional status support its potential integration into routine clinical practice to refine risk stratification and guide supportive interventions.Cite this article as: Altıntaş YE, Kınıkoğlu O, Işık D, et al. Association between prognostic nutritional index and clinical outcomes in advanced non-small-cell lung cancer treated with immune checkpoint inhibitors. Cerrahpaşa Med J 2025, 49, 0030, doi: 10.5152/ cjm.2025.25030.

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