Zheng Lei, Ye Jianjun, Wu Qiyou, Chen Jinhong, Wang Qihao, Chen Kai, Wei Qiang, Bao Yige
Department of Urology and Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, China.
West China School of Medicine, Sichuan University, Chengdu, China.
Sci Rep. 2025 Mar 14;15(1):8836. doi: 10.1038/s41598-025-93557-6.
The purpose of this study was to determine the prognostic value of the Geriatric Nutritional Risk Index (GNRI) in patients with upper tract urothelial carcinoma (UTUC) after radical nephrectomy (RNU). A retrospective study of UTUC patients was conducted at West China Hospital between May 2016 and June 2019. The optimal cut-off point for GNRI was determined using the X-Tile procedure. Univariate and multivariate analyses were performed to identify predictors, and two- and four-year cancer-specific survival (CSS) prediction nomograms were created based on the results of the multivariate analyses. Furthermore, time-dependent ROC curve, calibration curve and decision curve analyses were conducted. A total of 219 patients with UTUC following RNU were identified and subsequently divided into three groups based on the critical values of GNRI (91.2, 98.8). GNRI was identified as a significant risk factor for CSS, with patients exhibiting higher GNRI demonstrating elevated CSS (hazard ratio = 0.58; 95% confidence interval, 0.32-0.92; P = 0.037). Furthermore, the GNRI-based nomogram demonstrated high predictive capacity for CSS, with areas under the curve of 0.810 and 0.842 for 2- and 4-year CSS, respectively. Preoperative GNRI is an independent predictor for CSS in UTUC patients who underwent RNU and should be considered as a promising personalized tool for clinical decision-making.
本研究的目的是确定老年营养风险指数（GNRI）在根治性肾切除术（RNU）后上尿路尿路上皮癌（UTUC）患者中的预后价值。2016年5月至2019年6月期间，在四川大学华西医院对UTUC患者进行了一项回顾性研究。使用X-Tile程序确定GNRI的最佳截断点。进行单因素和多因素分析以确定预测因素，并根据多因素分析结果创建两年和四年癌症特异性生存（CSS）预测列线图。此外，还进行了时间依赖性ROC曲线、校准曲线和决策曲线分析。共确定了219例RNU术后UTUC患者，随后根据GNRI的临界值（91.2、98.8）将其分为三组。GNRI被确定为CSS的一个重要危险因素，GNRI较高的患者CSS升高（风险比=0.58；95%置信区间，0.32-0.92；P=0.037）。此外，基于GNRI的列线图对CSS具有较高的预测能力，2年和4年CSS的曲线下面积分别为0.810和0.842。术前GNRI是接受RNU的UTUC患者CSS的独立预测因素，应被视为一种有前景的临床决策个性化工具。
