Predictive Role of the Prognostic Nutritional Index for the Prognosis of Pediatric High-grade Glioma Patients

Aim: Pediatric high-grade glioma (pHGG) is a highly aggressive malignancy with poor prognosis.The role of nutritional status in pHGG prognosis is understudied.This study examined the prognostic value of the prognostic nutritional index (PNI) in pHGG patients. Materials and Methods:This retrospective study analyzed data from 67 pediatric pHGG patients admitted to the Department of Neurosurgery at The 904 th Hospital of the PLA between October 1 st , 2016, and December 1 st , 2022.The PNI was calculated at three time points: at admission, post-radiotherapy, and at 12 months.Clinical data including age, gender, Lansky performance status score, World Health Organization glioma grade, treatment, overall survival (OS), and time to progression were collected.Multivariate Cox regression analysis and Kaplan-Meier survival analysis were used to assess the correlation between PNI and the clinical outcomes. Results:The median survival time was 15.3 months.PNI was highest post-radiotherapy and lowest at 12 months.Higher PNI scores at admission and at 12 months were associated with longer progression-free and OS.Multivariate analysis showed that Grade 3 glioma, isocitrate dehydrogenase mutation, and high PNI at admission were associated with delayed tumor progression and longer OS, while Grade 4 glioma and H3K27M mutation were associated with poorer outcomes. Conclusion:The PNI is a valuable predictor of prognosis in pHGG patients.Higher PNI scores at admission and at 12 months are associated with better clinical outcomes.Nutritional support during the disease course may improve prognosis in pHGG patients.