Hofbauer Sebastian L, Pantuck Allan J, de Martino Michela, Lucca Ilaria, Haitel Andrea, Shariat Shahrokh F, Belldegrun Arie S, Klatte Tobias
Department of Urology, Comprehensive Cancer Center, Medical University of Vienna and General Hospital, Vienna, Austria.
Institute of Urologic Oncology, Department of Urology, University of California-Los Angeles, Los Angeles, CA.
Urol Oncol. 2015 Feb;33(2):68.e1-7. doi: 10.1016/j.urolonc.2014.08.005. Epub 2014 Sep 16.
Accurate postoperative stratification of patients with renal cell carcinoma (RCC) in distinct prognostic groups is essential for tailoring follow-up, medical therapy, and inclusion in clinical trials. Increasing evidence suggests that Onodera׳s prognostic nutritional index (PNI) is a stage- and grade-independent predictor of poor outcomes in patients with cancer, but there are no data in RCC.
We reviewed medical records of 1,344 patients with RCC who underwent radical or partial nephrectomy at the Medical University of Vienna and the University of California-Los Angeles between 1991 and 2012. Associations with cancer-specific survival were assessed with univariable and multivariable Cox proportional hazards models. Discrimination was measured with the C-index.
The median postoperative follow-up was 40 months. An increase of PNI by 1 unit was associated with a decrease in the risk of death from RCC by 7% (hazard ratio = 0.93, P<0.001). In multivariable analyses, the PNI was an independent prognostic factor (P<0.001). Adding the PNI improved the discrimination of a base model by 0.4%.
The PNI is an independent prognostic factor in patients with RCC. Its use increases the accuracy of established prognostic factors. PNI may be a meaningful adjunct for tailoring surveillance, medical therapy, and clinical trial design.
对肾细胞癌（RCC）患者进行准确的术后分层，分为不同的预后组，对于制定随访计划、药物治疗以及纳入临床试验至关重要。越来越多的证据表明，小野寺预后营养指数（PNI）是癌症患者不良预后的一个与分期和分级无关的预测指标，但在肾细胞癌方面尚无相关数据。
我们回顾了1991年至2012年间在维也纳医科大学和加利福尼亚大学洛杉矶分校接受根治性或部分肾切除术的1344例肾细胞癌患者的病历。采用单变量和多变量Cox比例风险模型评估与癌症特异性生存的相关性。用C指数衡量辨别力。
术后中位随访时间为40个月。PNI每增加1个单位，肾细胞癌死亡风险降低7%（风险比=0.93，P<0.001）。在多变量分析中，PNI是一个独立的预后因素（P<0.001）。加入PNI可使基础模型的辨别力提高0.4%。
PNI是肾细胞癌患者的一个独立预后因素。它的应用提高了既定预后因素的准确性。PNI可能是制定监测、药物治疗和临床试验设计的一个有意义的辅助指标。
