Huang Jiwei, Yuan Yichu, Wang Yanqing, Chen YongHui, Kong Wen, Xue Wei, Chen Haige, Zhang Jin, Huang Yiran
Department of Urology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Department of Urology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Urol Oncol. 2017 Dec;35(12):671.e1-671.e9. doi: 10.1016/j.urolonc.2017.07.028. Epub 2017 Aug 18.
Patient's nutritional and immunological status have a potentially significant role in survival outcome in patients with malignant tumors. We investigated the prognostic value of preoperative prognostic nutritional index (PNI) in patients with localized upper tract urothelial carcinoma (UTUC) undergoing radical nephrouretectomy (RNU).
A total of 425 patients with nonmetastatic UTUC (Ta-4N0/+M0) who underwent RNU were evaluated. PNI was calculated as 10 × serum albumin concentration (g/dl) + 0.005 × lymphocyte counts (number/mm). The associations of preoperative PNI level with clinical and pathologic variables were analyzed.
The optimal cutoff value of PNI for cancer-specific survival (CSS) stratification was determined to be 46.78. Multivariate analysis identified low PNI as an independent prognostic factor for CSS (HR = 1.98, 95% CI: 1.31-2.99, P = 0.001) and overall survival (HR = 1.74, 95% CI: 1.20-2.53, P = 0.004). The estimated c-index of the multivariate model for CSS and overall survival increased from 0.777 and 0.767 to 0.791 and 0.774, respectively, when PNI added, which was higher than hypoalbuminemia (albumin<37.75g/l) or neutrophil-to-lymphocyte ratio >2.955 added.
Preoperative PNI was an independent prognostic factor for predicting survival in patients with UTUC undergoing RNU. Preoperative PNI may become a useful biomarker, particularly because of its low associated cost and easy accessibility.
患者的营养和免疫状态在恶性肿瘤患者的生存结局中可能发挥重要作用。我们研究了术前预后营养指数（PNI）对接受根治性肾输尿管切除术（RNU）的局限性上尿路尿路上皮癌（UTUC）患者的预后价值。
共评估了425例接受RNU的非转移性UTUC（Ta-4N0/+M0）患者。PNI计算公式为10×血清白蛋白浓度（g/dl）+0.005×淋巴细胞计数（个/mm）。分析术前PNI水平与临床和病理变量的相关性。
确定PNI用于癌症特异性生存（CSS）分层的最佳临界值为46.78。多因素分析确定低PNI是CSS（HR=1.98，95%CI：1.31-2.99，P=0.001）和总生存（HR=1.74，95%CI：1.20-2.53，P=0.004）的独立预后因素。加入PNI后，CSS和总生存多因素模型的估计c指数分别从0.777和0.767增加到0.791和0.774，高于加入低白蛋白血症（白蛋白<37.75g/l）或中性粒细胞与淋巴细胞比值>2.955时的情况。
术前PNI是预测接受RNU的UTUC患者生存的独立预后因素。术前PNI可能成为一种有用的生物标志物，特别是因其相关成本低且易于获取。
