Department of Urology, Ajou University School of Medicine, Suwon.
Department of Urology, Bundang Jesaeng General Hospital, Seongnam, Korea.
Am J Clin Oncol. 2020 Jun;43(6):388-392. doi: 10.1097/COC.0000000000000680.
The objective of this study was to assess the value of a preoperative Prognostic Nutritional Index (PNI) for predicting the survival of patients with nonmetastatic renal cell carcinoma (RCC) treated with partial or radical nephrectomy.
The medical records of 480 patients with RCC who underwent partial or radical nephrectomy at 2 institutions between June 1994 and July 2017 were retrospectively reviewed. After the exclusion of 21 patients with lymph node or distant metastasis, the data of 459 patients with nonmetastatic RCC were included. The PNI was calculated using a combination of serum albumin level and lymphocyte count in the peripheral blood, as described previously. The prognostic significance of various clinicopathologic variables, including the PNI, was assessed in univariate and multivariate analyses.
The univariate analysis identified anemia, PNI, tumor size, T stage, Fuhrman nuclear grade, sarcomatoid differentiation, and lymphovascular invasion as significant prognostic factors of recurrence-free survival (RFS) and cancer-specific survival (CSS). In the multivariate analysis, anemia (P=0.010), PNI (P<0.001), tumor size (P<0.001), T stage (P<0.001), Fuhrman nuclear grade (P=0.023), sarcomatoid differentiation (P=0.003), and lymphovascular invasion (P=0.005) were independent prognostic factors for RFS, versus anemia (P=0.020), PNI (P=0.002), tumor size (P<0.001), T stage (P<0.001), sarcomatoid differentiation (P<0.001), and lymphovascular invasion (P=0.018) for CSS.
The PNI is an independent prognostic factor for RFS and CSS in patients with nonmetastatic RCC treated with partial or radical nephrectomy. It may, therefore, be a useful tool for predicting recurrence and survival in these patients.
本研究旨在评估术前预后营养指数（PNI）对于接受部分或根治性肾切除术治疗的非转移性肾细胞癌（RCC）患者生存的预测价值。
回顾性分析了 1994 年 6 月至 2017 年 7 月在 2 家机构接受部分或根治性肾切除术的 480 例 RCC 患者的病历资料。排除 21 例淋巴结或远处转移患者后，纳入 459 例非转移性 RCC 患者的数据。PNI 是根据血清白蛋白水平和外周血淋巴细胞计数的组合计算得出的，如前所述。在单因素和多因素分析中评估了各种临床病理变量（包括 PNI）的预后意义。
单因素分析确定贫血、PNI、肿瘤大小、T 分期、Fuhrman 核分级、肉瘤样分化和血管淋巴管侵犯是无复发生存（RFS）和癌症特异性生存（CSS）的显著预后因素。在多因素分析中，贫血（P=0.010）、PNI（P<0.001）、肿瘤大小（P<0.001）、T 分期（P<0.001）、Fuhrman 核分级（P=0.023）、肉瘤样分化（P=0.003）和血管淋巴管侵犯（P=0.005）是 RFS 的独立预后因素，而贫血（P=0.020）、PNI（P=0.002）、肿瘤大小（P<0.001）、T 分期（P<0.001）、肉瘤样分化（P<0.001）和血管淋巴管侵犯（P=0.018）是 CSS 的独立预后因素。
PNI 是接受部分或根治性肾切除术治疗的非转移性 RCC 患者 RFS 和 CSS 的独立预后因素。因此，它可能是预测这些患者复发和生存的有用工具。
