Correlation Between Prognostic Nutritional Index and Oral Mucositis in Patients with Lung Adenocarcinoma Treated with Almonertinib: A Multicenter Prospective Study

Why It Matters

Identifying patients at higher risk for OM enables proactive nutritional and oral‑care interventions, preserving treatment adherence and outcomes in EGFR‑mutated lung cancer.

Key Takeaways

• Higher baseline PNI correlates with reduced oral mucositis risk
• Each 1‑unit PNI increase cuts OM odds by ~1.4%
• Top PNI quartile patients have ~65% lower OM incidence
• PNI remained significant after propensity‑score matching and adjustments
• Stage‑specific analysis shows stronger predictive value in advanced disease

Pulse Analysis

Oral mucositis remains a common, dose‑limiting side effect of epidermal growth factor receptor tyrosine‑kinase inhibitors (EGFR‑TKIs), compromising quality of life and therapy continuity. Almonertinib, a third‑generation EGFR‑TKI developed in China, offers improved selectivity and a favorable safety profile, yet OM rates of 13‑72% have been reported across studies. Clinicians lack reliable, bedside tools to anticipate which patients will develop this toxicity, prompting research into biomarkers that reflect patients' nutritional and immune reserves.

The prognostic nutritional index (PNI), calculated from serum albumin and peripheral lymphocyte count, integrates protein‑energy status and immune competence. In the present multicenter cohort, baseline PNI emerged as the strongest predictor of OM, outperforming traditional inflammatory markers. Logistic regression showed a linear inverse relationship, with the highest PNI quartile experiencing a 0.35 odds ratio compared with the lowest. Restricted cubic spline analysis confirmed the dose‑response trend, and propensity‑score matching eliminated confounding, reinforcing the robustness of the finding.

Clinically, PNI’s simplicity—requiring only routine lab values—makes it ideal for routine risk stratification before initiating almonertinib. Patients identified with low PNI could benefit from targeted nutritional support, intensified oral hygiene protocols, and closer monitoring, potentially reducing OM incidence and avoiding treatment interruptions. While the study’s Chinese cohort limits immediate generalizability, the results lay groundwork for broader validation and integration of PNI into personalized supportive‑care pathways for EGFR‑mutated lung cancer worldwide.