Salati M, Filippi R, Vivaldi C, et al. - In order to evaluate the influence of the prognostic nutritional index (PNI) on survival and treatment response in advanced biliary cancer (ABC) taking first-line chemotherapy, researchers retrospectively analyzed medical records of ABC managed with standard chemotherapy at the Modena Cancer Centre. The training cohort comprised of 114 ABC that satisfied the inclusion criteria. They used the ROC analysis to ascertain a PNI cut-off value of 36.7. The link of low PNI value (< 36.7) with shorter OS, together with increased NLR and ECOG > 1, was revealed in both the univariate and the multivariate analysis. The low- vs high PNI-group experienced a median OS of 5.4 vs 12.1 months. Higher disease control was achieved as a result of a PNI value > 36.7 in patients managed with gemcitabine/platinum combination. These findings were confirmed in an independent cohort of 253 ABC. Overall, a prognostic role for the PNI in ABC managed with first-line chemotherapy was shown as well as externally validated. In the subset of patients taking platinum/gemcitabine combination, a predictive role of the PNI was noted but there is a requirement for future prospective validation.