Gestational trophoblastic neoplasia (GTN) is a rare tumor with an excellent prognosis. Despite the International Federation of Gynecology and Obstetrics (FIGO) risk score, other factors that may influence survival remain unknown. We evaluated the association of nutritional predictors as body mass index (BMI), prognostic nutritional index (PNI), anemia and neutrophil/lymphocyte index (NLI) with complete response (CR) to chemotherapy and overall survival (OS).
This is a retrospective analysis of women with newly diagnosed GTN between 2005 and 2019 at Instituto Nacional de Enfermedades Neoplasicas (INEN), Lima- Peru who received chemotherapy. Clinical and baseline nutritional factors were obtained from patient files. To evaluate association with CR, we performed a Student t test and ROC curves to determine the cutoff value of variables that significantly predicted CR. Cox proportional hazards regression models were used to identify independent variables with significant influence on the OS.
166 patients with GTN were included, median age was 30 years (range 18-54 y) and median FIGO risk score was 10 points (range 2-21). Accordingly, 16% and 84% of patients belong to low-risk and high-risk groups, respectively. 17 patients were lost to follow up and CR was reported in 73% of patients after first-line chemotherapy. 3y-OS was 80%, after excluding early deaths, the survival rate was 83%. About nutritional predictors, the median for BMI was 23.28, for PNI was 36.01, for hemoglobin was 10.0 and for NLI was 2.69. There was a positive association between CR with PNI and NLI (p = 0.001), no association with BMI (p = 0.389) and hemoglobin (p = 0.23) were founded. Analysis of the ROC curve for PNI demonstrated an optimal cut off value of 32.5 (p < 0.05, sensitivity 66.7, and specificity 60.6) and for NLI was 3.74 (p < 0.05, sensitivity 31.5, and specificity 51.3); the area under the ROC curve was 0.709 and 0.312 for PNI and NLI, respectively. In addition, we found a significant association with PNI (HR 0.008- CI 0.865-0.978) and NLI (HR 0.029- CI 0.807-0.989) with OS.
Nutritional factors such as high PNI and low NLI showed an association with OS and CR after chemotherapy.
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All authors have declared no conflicts of interest.