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Background The prognostic interplay between skeletal muscle mass and nutritional/immune status in non-metastatic nasopharyngeal carcinoma (NPC) is unclear. This study investigates the independent and joint association of estimated skeletal muscle mass index (eSMI) and Prognostic Nutritional Index (PNI) with all-cause mortality. Methods We analyzed 942 non-metastatic NPC patients. Low muscle mass was defined by sex-specific 20th percentiles of eSMI. PNI was categorized using a clinical cutoff of 45. Patients were stratified into four groups: normal eSMI high PNI (reference), normal eSMI Low PNI, low eSMI high PNI, and low eSMI low PNI. Multivariate Cox models and a win ratio analysis were used to evaluate joint prognostic value. Results During a median follow-up of 54 months, 204 deaths (21.7%) occurred. In multivariate Cox analysis, low PNI was independently associated with higher risk (HR = 1.68, p = 0.006), while low eSMI alone was not (HR = 1.05, 95% CI: 0.66–1.66). However, the low eSMI low PNI group exhibited the highest mortality risk (HR = 2.39, 95% CI: 1.32–4.30, p = 0.004). The win ratio analysis confirmed a significant clinical benefit for the normal SMI high PNI over the low SMI low PNI group, with a win ratio of 1.547 (95% CI: 1.54–1.56, p 0.001). Conclusion Joint assessment of eSMI and PNI provides superior risk stratification. Pre-treatment assessment of these simple markers may facilitate targeted nutritional and supportive interventions.
Huang et al. (Thu,) studied this question.