预后营养指数在肾细胞癌中的临床意义。
Clinical significance of prognostic nutritional index in renal cell carcinomas.
机构信息
Department of Pediatric Surgery.
Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan.
出版信息
Medicine (Baltimore). 2021 Mar 12;100(10):e25127. doi: 10.1097/MD.0000000000025127.
Prognostic nutritional index (PNI) could reflect the nutrition and inflammation status in cancer patients. This study aims to identify the prognostic significance of PNI in patients with renal cell carcinoma (RCC).A total of 694 RCC patients from our institution were included in this study. The prognostic correlation between PNI and overall survival (OS) and recurrence-free survival (RFS) was analyzed respectively using Kaplan-Meier method and univariate and multivariate Cox model. Studies about the association between pretreatment or preoperative PNI and prognosis of RCC were systemically reviewed and a meta-analysis method was performed to further evaluate the pooled prognostic value of PNI in RCC.267 (38.47%) RCC patients had low PNI according to the cut off value (49.08). Low PNI was associated with poor OS (P < .001) and RFS (P < .001), respectively. In the multivariate Cox analysis, PNI was identified to be an independent prognostic factor for OS (hazard ratio [HR] = 2.13, 95%CI: 1.25-3.62, P = .005). Compared to other nutritional indexes, this risk correlation of PNI is better than that of geriatric nutritional risk index (GNRI; HR = 1.19; P = .531), while is no better than that of neutrophil-lymphocyte ratio (NLR; 1/HR = 2.56; P < .001) and platelet-lymphocyte ratio (PLR; 1/HR = 2.85; P < .001) respectively. Meanwhile, additional 4785 patients from 6 studies were included into pooled analysis. For RCC patients who underwent surgery, low preoperative PNI was significantly associated with worse OS (pooled HR = 1.57, 95%CI: 1.37-1.80, P < .001) and worse RFS (pooled HR = 1.69, 95%CI: 1.45-1.96, P < .001). Furthermore, low PNI (<41-51) was also significantly associated with poor OS (HR = 1.78, 95%CI: 1.26-2.53 P < .05) and poor RFS (HR = 2.03, 95%CI: 1.40-2.95, P < .05) in advanced cases treated with targeted therapies.The present evidences show that PNI is an independent prognostic factor in RCC. Low PNI is significant associated with poor prognosis of RCC patients.
预后营养指数（PNI）可以反映癌症患者的营养和炎症状态。本研究旨在确定 PNI 对肾细胞癌（RCC）患者的预后意义。
本研究共纳入了 694 例来自我院的 RCC 患者。采用 Kaplan-Meier 法和单因素及多因素 Cox 模型分别分析了 PNI 与总生存（OS）和无复发生存（RFS）之间的预后相关性。系统回顾了关于术前或术前 PNI 与 RCC 预后关系的研究，并采用荟萃分析方法进一步评估了 PNI 在 RCC 中的总体预后价值。根据截断值（49.08），267（38.47%）例 RCC 患者 PNI 较低。低 PNI 与较差的 OS（P<0.001）和 RFS（P<0.001）相关。在多因素 Cox 分析中，PNI 被确定为 OS 的独立预后因素（危险比[HR]=2.13，95%CI：1.25-3.62，P=0.005）。与其他营养指标相比，PNI 的这种风险相关性优于老年营养风险指数（GNRI；HR=1.19；P=0.531），但不如中性粒细胞-淋巴细胞比值（NLR；1/HR=2.56；P<0.001）和血小板-淋巴细胞比值（PLR；1/HR=2.85；P<0.001）好。同时，来自 6 项研究的另外 4785 名患者纳入了汇总分析。对于接受手术的 RCC 患者，术前低 PNI 与较差的 OS（汇总 HR=1.57，95%CI：1.37-1.80，P<0.001）和较差的 RFS（汇总 HR=1.69，95%CI：1.45-1.96，P<0.001）显著相关。此外，低 PNI（<41-51）在接受靶向治疗的晚期患者中也与较差的 OS（HR=1.78，95%CI：1.26-2.53，P<0.05）和较差的 RFS（HR=2.03，95%CI：1.40-2.95，P<0.05）显著相关。现有证据表明，PNI 是 RCC 的一个独立预后因素。低 PNI 与 RCC 患者的不良预后显著相关。
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