Watari Shogo, Katayama Satoshi, Shiraishi Hiromasa, Tokunaga Moto, Kubota Risa, Kusumi Norihiro, Ichikawa Takaharu, Tsushima Tomoyasu, Kobayashi Yasuyuki, Bekku Kensuke, Araki Motoo
Department of Urology, National Hospital Organization Okayama Medical Center, 1711-1 Tamasu, Kita-Ku, Okayama, 701-1192, Japan.
Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-Cho, Kita-Ku, Okayama, 700-8558, Japan.
Discov Oncol. 2023 Nov 16;14(1):204. doi: 10.1007/s12672-023-00816-x.
This study aimed to investigate the effectiveness of the Geriatric Nutritional Risk Index (GNRI) in predicting the efficacy of first-line immune checkpoint inhibitor (ICI) combination therapy for metastatic or unresectable renal cell carcinoma (RCC) and associated patient prognosis.
A retrospective study was conducted using data from 19 institutions. The GNRI was calculated using body mass index and serum albumin level, and patients were classified into two groups using the GNRI values, with 98 set as the cutoff point.
In all, 119 patients with clear cell RCC who received first-line drug therapy with ICIs were analyzed. Patients with GNRI ≥ 98 had significantly better overall survival (OS) (p = 0.008) and cancer-specific survival (CSS) (p = 0.001) rates than those with GNRI < 98; however, progression-free survival (PFS) did not differ significantly. Inverse probability of treatment weighting analysis showed that low GNRI scores were significantly associated with poor OS (p = 0.004) and CSS (p = 0.015). Multivariate analysis showed that the Karnofsky performance status (KPS) score was a better predictor of prognosis (OS; HR 5.17, p < 0.001, CSS; HR 4.82, p = 0.003) than GNRI (OS; HR 0.36, p = 0.066, CSS; HR 0.35, p = 0.072). In a subgroup analysis of patients with a good KPS and GNRI ≥ 98 vs < 98, the 2-year OS rates were 91.4% vs 66.9% (p = 0.068), 2-year CSS rates were 91.4% vs 70.1% (p = 0.073), and PFS rates were 39.7% vs 21.4 (p = 0.27), respectively.
The prognostic efficiency of GNRI was inferior to that of the KPS score at the initiation of the first-line ICI combination therapy for clear cell RCC.
本研究旨在探讨老年营养风险指数（GNRI）在预测一线免疫检查点抑制剂（ICI）联合治疗转移性或不可切除肾细胞癌（RCC）疗效及相关患者预后方面的有效性。
利用来自19家机构的数据进行回顾性研究。通过体重指数和血清白蛋白水平计算GNRI，并根据GNRI值将患者分为两组，以98作为分界点。
总共分析了119例接受一线ICI药物治疗的透明细胞RCC患者。GNRI≥98的患者总生存期（OS）（p = 0.008）和癌症特异性生存期（CSS）（p = 0.001）率显著高于GNRI<98的患者；然而，无进展生存期（PFS）无显著差异。逆概率加权分析表明，低GNRI评分与较差的OS（p = 0.004）和CSS（p = 0.015）显著相关。多因素分析表明，卡诺夫斯基功能状态（KPS）评分比GNRI（OS；风险比0.36，p = 0.066，CSS；风险比0.35，p = 0.072）是更好的预后预测指标（OS；风险比5.17，p<0.001，CSS；风险比4.82，p = 0.003）。在KPS良好且GNRI≥98与<98的患者亚组分析中，2年OS率分别为91.4%和66.9%（p = 0.068），2年CSS率分别为91.4%和70.1%（p = 0.073），PFS率分别为39.7%和21.4（p = 0.27）。
在一线ICI联合治疗透明细胞RCC开始时，GNRI的预后预测效率低于KPS评分。
