Background: a low PNI in patients with NPC is linked to poor survival, but prior studies have focused on single-timepoint measurements. Our study aims to employ joint modeling to analyze longitudinal PNI data from each routine visit, exploring its relationship with overall survival. Methods: In this retrospective study using data from the Chang Gung Research Database (2007–2019), we enrolled patients with NPC undergoing curative treatment. We analyzed the correlation between patient characteristics, including the PNI, and overall survival. A joint model combining a longitudinal sub-model with a time-to-event sub-model was used to further evaluate the prognostic value of longitudinal PNI. Results: A total of 2332 patient were enrolled for the analysis. Separate survival analyses showed that longitudinal PNI was an independent indicator of a reduced mortality risk (adjusted HR 0.813; 95% CI, 0.805 to 0.821). Joint modeling confirmed longitudinal PNI as a consistent predictor of survival (HR 0.864; 95% CI, 0.850 to 0.879). An ROC analysis revealed that a PNI below 38.1 significantly increased the risk of 90-day mortality, with 90.0% sensitivity and 89.6% specificity. Conclusions: Longitudinal PNI data independently predicted the overall survival in patients with NPC, significantly forecasting 90-day survival outcomes. We recommend routine PNI assessments during each clinic visit for these patients.
背景：鼻咽癌患者预后营养指数（PNI）偏低与不良生存结局相关，但既往研究多基于单时间点测量。本研究旨在运用联合模型分析每次常规随访中的纵向PNI数据，探讨其与总生存期的关联。方法：本研究利用长庚研究数据库（2007-2019年）的回顾性数据，纳入接受根治性治疗的鼻咽癌患者。分析包括PNI在内的患者特征与总生存期的相关性，并采用纵向子模型与时间-事件子模型相结合的联合模型，进一步评估纵向PNI的预后价值。结果：共纳入2332例患者进行分析。独立生存分析显示，纵向PNI是降低死亡风险的独立指标（校正后HR 0.813；95% CI 0.805-0.821）。联合模型证实纵向PNI是生存期的稳定预测因子（HR 0.864；95% CI 0.850-0.879）。ROC分析显示PNI低于38.1时90天死亡风险显著升高，敏感度为90.0%，特异度为89.6%。结论：纵向PNI数据可独立预测鼻咽癌患者总生存期，对90天生存结局具有显著预测价值。建议对此类患者每次门诊随访时常规进行PNI评估。
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