Pre-radiotherapy modified prognostic nutritional index predicts acute radiation enteritis in patients with cervical cancer undergoing radiotherapy: A retrospective study.

Acute radiation enteritis (ARE) is a common complication of pelvic radiotherapy in patients with cervical cancer and may adversely affect treatment tolerance and nutritional status. The present retrospective study investigated whether the pre-radiotherapy modified prognostic nutritional index (mPNI), a cholesterol-modified nutritional and immune-related score, is associated with ARE in patients with cervical cancer receiving radiotherapy. A total of 92 patients with pathologically confirmed cervical cancer who completed radiotherapy at Fuyang People's Hospital Affiliated to Anhui Medical University (Fuyang, China) between January 2023 and December 2025 were included. ARE was graded according to the Radiation Therapy Oncology Group acute lower gastrointestinal toxicity criteria, with grade ≥1 ARE defined as the primary endpoint. Sensitivity analyses were conducted using grade ≥2 and grade ≥3 ARE as more clinically relevant endpoints. mPNI was calculated from pre-radiotherapy total cholesterol level, albumin level and total lymphocyte count. During radiotherapy, 67 patients developed grade ≥1 ARE. Pre-radiotherapy mPNI was higher in the ARE group than in the non-ARE group [median, 88.27 (interquartile range, 81.26-97.02) vs. 76.41 (interquartile range, 70.22-80.38); P<0.001]. In the clinically adjusted logistic regression model, a higher mPNI remained significantly associated with grade ≥1 ARE [odds ratio (OR), 1.163; 95% confidence interval (CI), 1.072-1.261; P<0.001]. Sensitivity analyses likewise demonstrated significant associations between mPNI and grade ≥2 ARE (OR, 1.069; 95% CI, 1.023-1.117; P=0.003) and grade ≥3 ARE (OR, 1.071; 95% CI, 1.013-1.133; P=0.016). Receiver operating characteristic curve analysis showed good discriminatory performance for grade ≥1 ARE, with an area under the curve of 0.835 (95% CI, 0.732-0.917), an optimal cut-off value of 80.406, a sensitivity of 79.1% and a specificity of 76.0%. These findings suggest that pre-radiotherapy mPNI may serve as a practical laboratory-based indicator for identifying patients with cervical cancer at increased risk of developing ARE during radiotherapy.