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Kang Z, Wang C, Xu W, Zhang B, Wan J, Li H, Shang P. Development and validation of a predictive model for postoperative metastasis of upper tract urothelial carcinoma after radical nephroureterectomy and analysis of risk factors for different metastatic sites: a multicenter study. Int Urol Nephrol 2025:10.1007/s11255-025-04455-9. [PMID: 40117076 DOI: 10.1007/s11255-025-04455-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2024] [Accepted: 03/08/2025] [Indexed: 03/23/2025]
Abstract
PURPOSE To develop a prediction model for assessing the risk of postoperative metastasis in upper tract urothelial carcinoma (UTUC) patients after radical nephroureterectomy (RNU) and to analyze independent risk factors for metastasis at different sites. METHODS We retrospectively analyzed data from 555 UTUC patients who underwent RNU at 3 medical centers between January 2012 and August 2023. Patients were randomly divided into a training cohort (n = 388) and a validation cohort (n = 167) at a 7:3 ratio. Univariate and multivariate Cox regression analyses were performed in the training cohort to identify postoperative metastasis risk factors. A nomogram was developed based on these factors and validated. In addition, independent risk factors for metastasis at different sites were analyzed. RESULTS Among the 555 patients, 122 (22.0%) developed postoperative metastasis. Middle and lower ureteral tumors, T stage ≥ T3, high-grade tumors, lymphovascular invasion (LVI), and a prognostic nutritional index (PNI) < 48.75 were associated with poorer metastasis-free survival (MFS). The nomogram achieved C-indexes of 0.816 and 0.812 in the training and validation cohorts. Age < 65 years was a risk factor for lymph node metastasis, tumor size and necrosis predicted liver metastasis, and a higher preoperative platelet-to-lymphocyte ratio (PLR) was associated with bone metastasis. Median overall survival (OS) for lymph node, lung, liver, multiple sites, bone, and brain metastasis were 14, 10, 6, 5.5, 5, and 4.5 months, respectively. CONCLUSION The prediction model developed effectively assesses postoperative metastasis risk in UTUC patients' aids in guiding individualized treatment. The risk factors for different metastasis sites are generally similar, with slight variations, which may offer new directions for future research on site-specific therapeutic strategies.
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Affiliation(s)
- ZiMing Kang
- Department of Urology, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, Gansu Province, China
| | - Cheng Wang
- Department of Urology, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, Gansu Province, China
| | - WanRong Xu
- Department of Urology, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, Gansu Province, China
| | - Biao Zhang
- Department of Urology, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, Gansu Province, China
| | - JiangHou Wan
- Department of Urology, Lanzhou University First Hospital, Lanzhou University, Lanzhou, Gansu Province, China
| | - HengPing Li
- Department of Urology, Gansu Provincial Hospital, Lanzhou, Gansu Province, China
| | - PanFeng Shang
- Department of Urology, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, Gansu Province, China.
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Hatayama T, Goto K, Kohada Y, Nishida K, Ueno T, Furutani T, Hashimoto K, Takemoto K, Naito M, Miyamoto S, Kobatake K, Sekino Y, Kitano H, Goriki A, Hieda K, Hinata N. The advanced lung cancer inflammation index as a useful prognostic indicator for patients who underwent radical nephroureterectomy for upper tract urothelial carcinoma. World J Urol 2025; 43:132. [PMID: 39976660 PMCID: PMC11842494 DOI: 10.1007/s00345-025-05505-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2024] [Accepted: 02/06/2025] [Indexed: 02/23/2025] Open
Abstract
PURPOSE We aimed to evaluate the ability of the advanced lung cancer inflammation index (ALI) to predict the prognosis of patients who underwent radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC). We also aimed to compare the ALI with other inflammatory or nutritional indices as prognostic indicators. METHODS We retrospectively evaluated patients who underwent RNU for UTUC at multiple centers between January 2010 and April 2024. We calculated the ALI before RNU and divided the patients into the low ALI and high ALI groups. We used 1:1 propensity score matching (PSM) to adjust the clinicopathological differences between two groups. We compared the overall survival (OS) and recurrence-free survival (RFS) of the low and high ALI groups using the Kaplan-Meier method. Furthermore, we assessed the ALI as a predictor of OS and RFS using a multivariate Cox proportional hazards regression analysis. RESULTS Of 488 patients (48.3% low ALI group), 160 patients from each group were matched. The Kaplan-Meier analysis revealed that the OS (p = 0.009) and RFS (p = 0.006) of the low ALI group were significantly shorter than those of the high ALI group. According to a multivariate analysis that included clinicopathological prognostic indicators, a low ALI was an independent predictor of poor OS (p = 0.014) and RFS (p = 0.038). Furthermore, according to the multivariate analysis including other inflammatory or nutritional indices, the ALI was an independent predictor of poor OS (p = 0.024) and RFS (p = 0.044). CONCLUSIONS The ALI was a significantly useful prognostic predictors of patients with UTUC who underwent RNU.
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Affiliation(s)
- Tomoya Hatayama
- Department of Urology, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan
| | - Keisuke Goto
- Department of Urology, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan.
| | - Yuki Kohada
- Department of Urology, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan
| | - Kensuke Nishida
- Department of Urology, NHO Higashihiroshima Medical Center, Hiroshima, Japan
| | - Takeshi Ueno
- Department of Urology, JA Hiroshima General Hospital, Hiroshima, Japan
| | - Tomoki Furutani
- Department of Urology, NHO Kure Medical Center Chugoku Cancer Center, Hiroshima, Japan
| | | | - Kenshiro Takemoto
- Department of Urology, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan
| | - Miki Naito
- Department of Urology, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan
| | - Shunsuke Miyamoto
- Department of Urology, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan
| | - Kohei Kobatake
- Department of Urology, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan
| | - Yohei Sekino
- Department of Urology, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan
| | - Hiroyuki Kitano
- Department of Urology, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan
| | - Akihiro Goriki
- Department of Urology, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan
| | - Keisuke Hieda
- Department of Urology, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan
| | - Nobuyuki Hinata
- Department of Urology, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan
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Ou Y, Zheng Y, Wang D, Ren S, Liu Y. Analysis of preoperative nutrition, immunity and inflammation correlation index on the prognosis of upper tract urothelial carcinoma surgical patients: a retrospective single center study. BMC Surg 2024; 24:208. [PMID: 39010005 PMCID: PMC11251250 DOI: 10.1186/s12893-024-02496-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 07/01/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND SII, PNI, SIRI, AAPR, and LIPI are prognostic scores based on inflammation, nutrition, and immunity. The purpose of this study was to examine the prognostic value of the SII, PNI, SIRI, AAPR, and LIPI in patients with UTUC who underwent radical nephroureterectomy with bladder cuff excision. MATERIALS AND METHODS Data of UTUC patients in Sichuan Provincial People's Hospital from January 2017 to December 2021 were collected. The optimal critical values of SII, PNI, SIRI, and AAPR were determined by ROC curve, and LIPI was stratified according to the dNLR and LDH. The Kaplan-Meier method was used to draw the survival curve, and Cox proportional hazard model was used to analyze the factors affecting the prognosis of UTUC patients. RESULTS A total of 81 patients with UTUC were included in this study. The optimal truncation value of PNI, SII, SIRI and AAPR were determined to be 48.15, 596.4, 1.45 and 0.50, respectively. Univariate Cox proportional hazard regression showed that low PNI, high SII, high SIRI, low AAPR and poor LIPI group were effective predictors of postoperative prognosis of UTUC patients. Multivariate Cox proportional hazard regression showed that high SII was an independent risk factor for postoperative prognosis of UTUC patients. According to ROC curve, the prediction efficiency of fitting indexes of PNI, SII, SIRI, AAPR and LIPI is better than that of using them alone. CONCLUSIONS The SII, PNI, SIRI, AAPR, and LIPI was a potential prognostic predictor in UTUC patients who underwent radical nephroureterectomy with bladder cuff excision.
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Affiliation(s)
- Yong Ou
- Department of Urology, Xichang People's Hospital, Xichang, Sichuan, China
| | - Yang Zheng
- Department of Robotic Minimally Invasive Surgery Center, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital and Affiliated Hospital of the University of Electronic Science and Technology of China, Chengdu, 610072, China
| | - Dong Wang
- Department of Robotic Minimally Invasive Surgery Center, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital and Affiliated Hospital of the University of Electronic Science and Technology of China, Chengdu, 610072, China
| | - Shangqing Ren
- Department of Robotic Minimally Invasive Surgery Center, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital and Affiliated Hospital of the University of Electronic Science and Technology of China, Chengdu, 610072, China.
| | - Yisha Liu
- Department of Pathology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, China.
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Bitaraf M, Ghafoori Yazdi M, Amini E. Upper Tract Urothelial Carcinoma (UTUC) Diagnosis and Risk Stratification: A Comprehensive Review. Cancers (Basel) 2023; 15:4987. [PMID: 37894354 PMCID: PMC10605461 DOI: 10.3390/cancers15204987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 09/22/2023] [Accepted: 10/11/2023] [Indexed: 10/29/2023] Open
Abstract
Diagnosis and risk stratification are cornerstones of therapeutic decisions in the management of patients with upper tract urothelial carcinoma (UTUC). Diagnostic modalities provide data that can be integrated, to provide nomograms and stratification tools to predict survival and adverse outcomes. This study reviews cytology, ureterorenoscopy and the novel tools and techniques used with it (including photodynamic diagnosis, narrow-band imaging, optical coherence tomography, and confocal laser endomicroscopy), and biopsy. Imaging modalities and novel biomarkers are discussed in another article. Patient- and tumor-related prognostic factors, their association with survival indices, and their roles in different scores and predictive tools are discussed. Patient-related factors include age, sex, ethnicity, tobacco consumption, surgical delay, sarcopenia, nutritional status, and several blood-based markers. Tumor-related prognosticators comprise stage, grade, presentation, location, multifocality, size, lymphovascular invasion, surgical margins, lymph node status, mutational landscape, architecture, histologic variants, and tumor-stroma ratio. The accuracy and validation of pre-operative predictive tools, which incorporate various prognosticators to predict the risk of muscle-invasive or non-organ confined disease, and help to decide on the surgery type (radical nephroureterectomy, or kidney-sparing procedures) are also investigated. Post-operative nomograms, which help decide on adjuvant chemotherapy and plan follow-up are explored. Finally, a revision of the current stratification of UTUC patients is endorsed.
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Affiliation(s)
| | | | - Erfan Amini
- Uro-Oncology Research Center, Tehran University of Medical Sciences, Tehran 1419733141, Iran; (M.B.); (M.G.Y.)
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[Pre-operative prognostic nutritional index as a predictive factor for prognosis in non-metastatic renal cell carcinoma treated with surgery]. BEIJING DA XUE XUE BAO. YI XUE BAN = JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2023; 55:149-155. [PMID: 36718704 PMCID: PMC9894816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To evaluate the implications of the prognostic nutrition index (PNI) in non-metastatic renal cell carcinoma (RCC) patients treated with surgery and to compare it with other hematological biomarkers, including neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and systemic immune inflammation index (SII). METHODS A cohort of 328 non-metastatic RCC patients who received surgical treatment between 2010 and 2012 at Peking University First Hospital was analyzed retrospectively. Receiver operating characteristic (ROC) curve analysis was used to determine the optimal cutoff values of the hematological biomarkers. The Youden index was maximum for PNI was value of 47.3. So we divided the patients into two groups (PNI≤ 47. 3 and >47. 3) for further analysis. Categorical variables [age, gender, body mass index (BMI), surgery type, histological subtype, necrosis, pathological T stage and tumor grade] were compared using the Chi-square test and Student' s t test. The association of the biomarkers with overall survival (OS) and disease-free survival (DFS) was analyzed using Kaplan-Meier methods with log-rank test, followed by multivariate Cox proportional hazards model. RESULTS According to the maximum Youden index of ROC curve, the best cut-off value of PNI is 47. 3. Low level of PNI was significantly associated with older age, lower BMI and higher tumor pathological T stage (P < 0.05). Kaplan-Meier univariate analysis showed that lower PNI was significantly correlated with poor OS and DFS (P < 0.05). In addition, older age, lower BMI, tumor necrosis, higher tumor pathological T stage and Fuhrman grade were significantly correlated with poor OS (P < 0.05). Cox multivariate analysis showed that among the four hematological indexes, only PNI was an independent factor significantly associated with OS, whether as a continuous variable (HR=0.9, 95%CI=0.828-0.978, P=0.013) or a classified variable (HR=2.397, 95%CI=1.061-5.418, P=0.036). CONCLUSION Low PNI was a significant predictor for advanced pathological T stage, decreased OS, or DFS in non-metastatic RCC patients treated with surgery. In addition, PNI was superior to the other hematological biomar-kers as a useful tool for predicting prognosis of RCC in our study. It should be externally validated in future research before the PNI can be used widely as a predictor of RCC patients undergoing nephrectomy.
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Meng C, Gan L, Li K, Yi F, Peng L, Li J, Li Y. Prognostic nutritional index before surgical treatment may serve as a prognostic biomarker for patients with upper tract urothelial carcinoma: A systematic review and meta-analysis. Front Nutr 2022; 9:972034. [PMID: 36211527 PMCID: PMC9538959 DOI: 10.3389/fnut.2022.972034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 08/26/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveThis meta-analysis aims to assess whether the prognostic nutritional index (PNI) score before treatment can be an independent biomarker of the prognosis of patients with upper tract urothelial carcinoma (UTUC).Materials and methodsWe systematically search PubMed, Embase, Scopus database, and Cochrane Library, and the search time is up to April 2021. Use STATA 16.0 software for data processing and statistical analysis.ResultsSix studies, including seven cohorts, were eventually included in our meta-analysis. The meta-analysis results showed that low PNI scores are associated with worse OS (HR: 1.92; 95% CI 1.60 to 2.30; P < 0.01), DFS/RFS/PFS (HR: 1.57; 95% CI 1.33 to 1.85; P < 0.01), and CSS/DSS (HR: 1.79; 95% CI 1.49 to 2.16; P < 0.01), which supported the PNI score as an independent prognostic biomarker for survival outcomes. The subgroup analysis and Begg’s test showed that the results were stable.ConclusionBased on current evidence, this meta-analysis proves that the PNI score of UTUC patients before treatment is an independent prognostic biomarker. It performs well on OS, DFS/RFS/PFS, and CSS/DSS. This conclusion needs to be verified by a prospective cohort study with larger sample size and a more rigorous design.Systematic review registration[https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022338503], identifier [CRD42022338503].
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Affiliation(s)
- Chunyang Meng
- Department of Urology, The Affiliated Nanchong Central Hospital of North Sichuan Medical College (University), Nanchong, China
| | - Lijian Gan
- Department of Urology, The Affiliated Nanchong Central Hospital of North Sichuan Medical College (University), Nanchong, China
| | - Kangsen Li
- Department of Urology, The Affiliated Nanchong Central Hospital of North Sichuan Medical College (University), Nanchong, China
| | - Fulin Yi
- Department of Anesthesiology, North Sichuan Medical College (University), Nanchong, China
| | - Lei Peng
- Department of Urology, The Affiliated Nanchong Central Hospital of North Sichuan Medical College (University), Nanchong, China
| | - Jinze Li
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Yunxiang Li
- Department of Urology, The Affiliated Nanchong Central Hospital of North Sichuan Medical College (University), Nanchong, China
- *Correspondence: Yunxiang Li,
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Yang F, Pan M, Nie J, Xiao F, Zhang Y. Evaluation of the prognostic nutritional index for the prognosis of Chinese patients with high/extremely high-risk prostate cancer after radical prostatectomy. World J Clin Cases 2022; 10:8863-8871. [PMID: 36157668 PMCID: PMC9477051 DOI: 10.12998/wjcc.v10.i25.8863] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 05/22/2022] [Accepted: 07/29/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The incidence of prostate cancer (PCa) is on the rise in China. The risk level of patients with PCa is associated with disease-free survival rate at 10 years after radical prostatectomy. Predicting prognosis in advance according to the degree of risk can provide a reference for patients, especially treatment options and postoperative adjuvant treatment measures for high-risk/extremely high-risk patients.
AIM To explore the predictive value of the prognostic nutritional index (PNI) for biological recurrence in Chinese patients with high/extremely high-risk PCa after radical prostatectomy.
METHODS The biochemical test results and clinical data of 193 patients who underwent radical prostatectomy for the first time from January 2015 to December 2020 were retrospectively collected. The PNI value of peripheral blood within 1 wk before surgery was calculated, and during the follow-up period, prostate-specific antigen ≥ 0.2 ng/mL was considered to have biological recurrence. The receiver operating characteristic (ROC) curve was used to calculate the optimal critical value and area under the curve (AUC) of the patients. According to the critical value, the progression-free survival of the high PNI group and low PNI group was compared. The independent influencing factors of the patients' prognosis were obtained by the Cox proportional hazards regression model.
RESULTS The non-biological recurrence rates at 1, 3, and 5 years were 92.02%, 84.05%, and 74.85%, respectively. The optimal critical value for PNI to predict biological recurrence was 46.23, and the AUC was 0.789 (95% confidence interval: 0.651-0.860; P < 0.001). The sensitivity and specificity were 82.93% and 62.30%, respectively. In accordance with the optimal critical value of the ROC curve (46.23), 193 patients were further divided into a high PNI group (PNI ≤ 46.23, n = 108) and low PNI group (PNI > 46.23, n = 85). The incidence of postoperative complications in the high PNI group was lower than that in the low PNI group (21.18% vs 38.96%). Kaplan-Meier survival analysis showed that the overall survival rate at 5 years in the low PNI group was 87.96% (13/108), which was lower than that in the high PNI group (61.18%, 33/85; P < 0.05). Low PNI [hazard ratio (HR) = 1.74; P = 0.003] and positive incisal margin status (HR = 2.14; P = 0.001) were independent predictors of biological recurrence in patients with high/extremely high-risk PCa.
CONCLUSION The PNI has predictive value for the prognosis of patients with high/extremely high-risk PCa, and is an independent prognostic factor. Patients with low PNI value have a shorter time of non-biological recurrence after prostatectomy. It is expected that the combined prediction of other clinicopathological data will further improve the accuracy and guide postoperative adjuvant therapy to improve the quality of prognosis.
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Affiliation(s)
- Fan Yang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Min Pan
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Jin Nie
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Fan Xiao
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Yuan Zhang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
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Liu J, Wu P, Lai S, Song X, Wang M, Wang X, Liu S, Hou H, Zhang Y, Wang J. Clinicopathological and Prognostic Significance of Preoperative Prognostic Nutritional Index in Patients with Upper Urinary Tract Urothelial Carcinoma. Nutr Cancer 2022; 74:2964-2974. [PMID: 35297733 DOI: 10.1080/01635581.2022.2049829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 02/07/2022] [Accepted: 02/16/2022] [Indexed: 10/18/2022]
Abstract
To investigate the prognostic value of preoperative prognostic nutritional index (PNI) to predict oncological outcome and intravesical recurrence (IVR) in upper tract urothelial carcinoma (UTUC) after radical nephroureterectomy (RNU). This study involved the clinical data of 255 patients with UTUC who had undergone RNU from 2004 to 2019 at our institution. Patients were grouped according to an optimal value of preoperative PNI. Kaplan-Meier analyses and Cox proportional hazards models were used to analyze the associations of preoperative PNI with progression-free survival (PFS), cancer-specific survival (CSS), overall survival (OS), and IVR. Patients with low PNI were more likely to be older, have higher tumor stage, higher eGFR, and multifocal lesions. No significant association was found between PNI and CSS, IVR. In subgroup analysis according to the risk stratification, low PNI was associated with worse PFS, CSS, and OS for patients with higher risk. Multivariate analyses showed that elevated PNI was an independent prognostic indicator for PFS (P = 0.014) and OS (P = 0.048). A low PNI is an independent predictor of PFS and OS in patients with UTUC after RNU. By subgroup analysis, the prognostic value of PNI was limited to patients with higher risk. PNI may become a useful biomarker to predict oncological outcomes in patients with UTUC after RNU.
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Affiliation(s)
- Jianyong Liu
- Department of Urology, Beijing Hospital, Beijing, People's Republic of China
- National Center of Gerontology, Beijing, People's Republic of China
- Institute of the Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
- Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China
- Beijing Hospital Continence Center, Beijing, People's Republic of China
| | - Pengjie Wu
- Department of Urology, Beijing Hospital, Beijing, People's Republic of China
- National Center of Gerontology, Beijing, People's Republic of China
- Institute of the Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
- Beijing Hospital Continence Center, Beijing, People's Republic of China
| | - Shicong Lai
- Department of Urology, Beijing Hospital, Beijing, People's Republic of China
- National Center of Gerontology, Beijing, People's Republic of China
- Institute of the Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
- Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Xinda Song
- Department of Urology, Beijing Hospital, Beijing, People's Republic of China
- National Center of Gerontology, Beijing, People's Republic of China
- Institute of the Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
- Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Miao Wang
- Department of Urology, Beijing Hospital, Beijing, People's Republic of China
- National Center of Gerontology, Beijing, People's Republic of China
- Institute of the Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
- Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China
- Beijing Hospital Continence Center, Beijing, People's Republic of China
| | - Xuan Wang
- Department of Urology, Beijing Hospital, Beijing, People's Republic of China
- National Center of Gerontology, Beijing, People's Republic of China
- Institute of the Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
- Beijing Hospital Continence Center, Beijing, People's Republic of China
| | - Shengjie Liu
- Department of Urology, Beijing Hospital, Beijing, People's Republic of China
- National Center of Gerontology, Beijing, People's Republic of China
- Institute of the Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
- Beijing Hospital Continence Center, Beijing, People's Republic of China
| | - Huimin Hou
- Department of Urology, Beijing Hospital, Beijing, People's Republic of China
- National Center of Gerontology, Beijing, People's Republic of China
- Institute of the Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
- Beijing Hospital Continence Center, Beijing, People's Republic of China
| | - Yaoguang Zhang
- Department of Urology, Beijing Hospital, Beijing, People's Republic of China
- National Center of Gerontology, Beijing, People's Republic of China
- Institute of the Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
- Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China
- Beijing Hospital Continence Center, Beijing, People's Republic of China
| | - Jianye Wang
- Department of Urology, Beijing Hospital, Beijing, People's Republic of China
- National Center of Gerontology, Beijing, People's Republic of China
- Institute of the Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
- Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China
- Beijing Hospital Continence Center, Beijing, People's Republic of China
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Fujiwara D, Tsubaki M, Takeda T, Miura M, Nishida S, Sakaguchi K. Objective evaluation of nutritional status using the prognostic nutritional index during and after chemoradiotherapy in Japanese patients with head and neck cancer: a retrospective study. Eur J Hosp Pharm 2021; 28:266-270. [PMID: 34426479 DOI: 10.1136/ejhpharm-2019-001979] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 06/18/2019] [Accepted: 08/06/2019] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES The incidence of severe mucosal damage due to low nutritional status is high in patients receiving concurrent chemoradiotherapy (CCRT) for head and neck cancer. Objective assessments do not exist for discharge criteria after completion of CCRT. Although the prognostic nutritional index (PNI) is an objective indicator of postoperative outcomes in patients undergoing cancer surgery, the prognostic impact of the PNI in patients with head and neck cancer receiving CCRT is unexplored. We investigated whether the PNI could be an objective criterion for nutritional status and a discharge criterion after completion of CCRT. METHODS We assessed the medical records of 23 patients with head and neck cancer who received triweekly cisplatin +radiotherapy (2 Gy ×35 fractions). We evaluated whether the PNI could be a useful evaluation indicator in patients with head and neck cancer receiving CCRT and determined the cut-off PNI value by receiver operating characteristic (ROC) curve analysis as a criterion for hospital discharge. RESULTS The PNI pre-treatment and post-treatment values were 51.0 and 38.0, respectively (p<0.05). The median length of hospitalisation after therapy was 5 days in patients with grades 1 and 2 and 10 days in patients with grade 3 oral and pharyngeal mucositis (p<0.05). The optimal cut-off PNI value as a criterion for hospital discharge was found to be 40.4 (grades 1 and 2 mucositis) and 38.6 (grade 3 mucositis) by the ROC analysis. CONCLUSIONS The PNI is a simple, objective and temporal indicator which is useful in assessing the nutritional status of patients with head and neck cancer. The PNI could be used as an objective indicator to determine the time of discharge after CCRT completion.
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Affiliation(s)
- Daichiro Fujiwara
- Department of Pharmacy, Japanese Red Cross Society Wakayama Medical Center, Wakayama, Japan .,Division of Pharmacotherapy, School of Pharmacy, Kindai University, Higashi-Osaka, Japan
| | - Masanobu Tsubaki
- Division of Pharmacotherapy, School of Pharmacy, Kindai University, Higashi-Osaka, Japan
| | - Tomoya Takeda
- Division of Pharmacotherapy, School of Pharmacy, Kindai University, Higashi-Osaka, Japan
| | - Makoto Miura
- Department of Otolaryngology, Japanese Red Cross Society Wakayama Medical Center, Wakayama, Japan
| | - Shozo Nishida
- Division of Pharmacotherapy, School of Pharmacy, Kindai University, Higashi-Osaka, Japan
| | - Katsuhiko Sakaguchi
- Department of Pharmacy, Japanese Red Cross Society Wakayama Medical Center, Wakayama, Japan
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10
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Zahran AM, Riad KF, Elsayh KI, Elmasry HM, Rayan A. Role of pretreatment inflammatory indicators in pediatric acute leukemias; where do we stand? A prospective cohort study. Cancer Biomark 2021; 29:553-564. [PMID: 32986662 DOI: 10.3233/cbm-201790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIM There is a limited data at the moment regarding the clinical value of inflammatory indices and malnutrition markers in children with acute leukemias. We have examined the usefulness of prognostic nutritional index (PNI), Glasgow prognostic score (GPS), Prognostic Index (PI), monocyte to lymphocyte (MLR), neutrophil to lymphocyte (NLR), and platelet to lymphocyte (PLR) ratios to stratify patients as regards the response to induction therapy correlating them to different prognostic factors. PATIENTS AND METHODS Children with acute leukemia and without microbial-induced inflammation at the time of diagnosis were prospectively recruited. Preliminary total and differential CBC, c-reactive protein (CRP), serum albumin (ALB) were used to calculate different inflammatory indicators including NLR, MLR, PLR, PNI, GPS, and PI. RESULTS Higher PNI was significantly more associated to children who achieved remission as compared to those without remission (p< 0.0001). Patients without remission had GPS 1 or 2 compared to GPS 0 or 1 in those who entered remission (p= 0.001). NLR was significantly lower in patients in remission than in those without remission (p= 0.005). Similarly, complete remission was significantly associated to MLR ⩽ 0.45 as compared to MLR > 0.45 (p< 0.0001). CONCLUSION Pretreatment PNI, GPS, CRP, serum albumin, NLR, MLR, and PLR are remission promising prognostic markers in pediatric acute leukemias, which deserve to be further investigated in large-scale studies.
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Affiliation(s)
- Asmaa M Zahran
- Clinical Pathology Department, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
| | - Khalid F Riad
- Pediatric Oncology Department, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
| | - Khalid I Elsayh
- Pediatric Department, Assiut University Hospital, Assiut University, Assiut, Egypt
| | - Heba M Elmasry
- Clinical Pathology Department, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
| | - Amal Rayan
- Clinical Oncology Department, Assiut University Hospital, Assiut University, Assiut, Egypt
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11
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Wang C, Jin S, Xu S, Cao S. The combination of pretreatment prognostic nutritional index and neuron-specific enolase enhances prognosis predicting value of small cell lung cancer. CLINICAL RESPIRATORY JOURNAL 2020; 15:264-271. [PMID: 33058444 DOI: 10.1111/crj.13291] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 09/17/2020] [Accepted: 10/08/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Tumor and immune-inflammatory biomarkers have been demonstrated to be closely associated with cancer prognosis. OBJECTIVE The present study aims to assess the prognostic value of pretreatment prognostic nutritional index (PNI), carcinoembryonic antigen (CEA), and neuron-specific enolase (NSE) in small cell lung cancer (SCLC). METHODS A retrospective analysis of 301 SCLC patients treated with platinum-based chemotherapy was performed. Overall survival (OS) was assessed by Kaplan-Meier and multivariate Cox hazard analyses. RESULTS The median OS for total cases was 15.0 months. On univariate analysis, tumor stage (P < 0.001), pretreatment PNI (P < 0.001), CEA (P = 0.039), NSE (P = 0.010), distant metastasis numbers (P < 0.001), and thoracic radiotherapy (P < 0.001) were found to be the predictors of OS. Multivariate analysis showed limited stage, high PNI, NSE < 15 μg/L, and chemoradiotherapy were positive independent prognostic factors (P < 0.05). Low PNI and NSE ≥ 15 μg/L were closely correlated with a high tumor burden status. Three cohorts of SCLC with significant different survival outcomes were divided based on variable PNI and NSE levels. Patients with high PNI and NSE < 15 μg/L showed the best OS of 24.5 months, while patients with low PNI and NSE ≥ 15 μg/L had the worst survival outcome of 10.0 months. Patients with low PNI and NSE < 15 μg/L or high PNI and NSE ≥ 15 μg/L had the similar outcome of 16.5 and 17.0 months, respectively. CONCLUSIONS Pretreatment PNI and NSE were independent prognostic factors of SCLC. The combination of PNI and NSE enhanced the OS predicting ability, and patients with high PNI and NSE < 15 μg/L had the best survival outcome.
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Affiliation(s)
- Chunyan Wang
- Department of Medical and Radiation Oncology, Linyi People's Hospital, Linyi, China
| | - Shi Jin
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | - Shanqi Xu
- Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, China
| | - Shoubo Cao
- Department of Medical and Radiation Oncology, Linyi People's Hospital, Linyi, China
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12
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Zhao H, Zhang L, Wu B, Zha Z, Yuan J, Jiang Y, Feng Y. The prognostic value of tumor architecture in patients with upper tract urothelial carcinoma treated with radical nephroureterectomy: A systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e22176. [PMID: 32925787 PMCID: PMC7489711 DOI: 10.1097/md.0000000000022176] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND AND PURPOSE There is a lack of consensus regarding the prognostic value of tumor architecture (sessile vs. papillary) in upper tract urothelial carcinoma (UTUC) treated with radical nephroureterectomy (RNU). The aim of the present study was to analyze the current evidence regarding the prognostic role of tumor architecture in patients undergoing RNU for UTUC through a systematic review and meta-analysis. METHODS According to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, a literature search in PubMed, Web of Science, Wanfang, and China National Knowledge Infrastructure (CNKI) databases was performed for citations published prior to February 2020. Cumulative analyses of hazard ratios (HRs) and their corresponding 95% confidence intervals (95% CIs) were conducted for the survival outcomes by Stata 12.0 software. RESULTS We retrieved 17 studies (including 8,146 patients) evaluating the effect of tumor architecture on oncologic outcomes in patients treated with RNU. According to our final results, sessile tumor architecture had a significant correlation with worse cancer-specific survival (CSS) (HR = 1.43, 95% CI: 1.31-1.55, P < .001), overall survival (OS) (HR = 1.40, 95% CI: 1.24-1.58, P < .001), recurrence-free survival (RFS) (HR = 1.43, 95% CI: 1.35-1.53, P < .001), and progression-free survival (PFS) (HR = 1.27, 95% CI: 1.11-1.45, P = 0.001). The funnel plot test indicated that there was no significant publication bias in the meta-analysis. Besides, the findings of this study were found to be reliable by our sensitivity and subgroup analysis. CONCLUSIONS Sessile tumor architecture correlates with a significantly worse survival outcome compared with papillary tumor architecture, and it can be used as a valuable biomarker for monitoring prognoses of UTUC patients.
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Bao Z, Li Y, Guan B, Xiong G, Zhang L, Tang Q, Wang T, Li X, Fang D, Zhou L. High Preoperative Controlling Nutritional Status Score Predicts a Poor Prognosis in Patients with Localized Upper Tract Urothelial Cancer: A Propensity Score Matching Study in a Large Chinese Center. Cancer Manag Res 2020; 12:323-335. [PMID: 32021446 PMCID: PMC6970241 DOI: 10.2147/cmar.s225711] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 11/28/2019] [Indexed: 12/17/2022] Open
Abstract
Purpose The aim of this study was to elucidate the prognostic value of the preoperative controlling nutritional status (CONUT) score, a new index based on the total lymphocyte count, serum albumin concentration and total cholesterol concentration, in patients with localized upper tract urothelial cancer (UTUC) after radical nephroureterectomy (RNU) using propensity score matching (PSM) analysis. Methods We retrospectively reviewed 908 consecutive patients with localized UTUC who underwent RNU between 1999 and 2015. Patients were divided into two groups according to the optimal cutoff value of the preoperative CONUT score. Relationships between the CONUT score with clinicopathological characteristics, overall survival (OS), cancer-specific survival (CSS), and disease-free survival (DFS) were analyzed before and after 1:1 PSM. Results A high preoperative CONUT score was significantly correlated with older age, low body mass index (BMI), poor American Statistical Association (ASA) score, advanced pathological T stage, and tumor squamous or glandular differentiation (all p<0.05). Kaplan-Meier curves showed poor OS, CSS, and DFS for patients with a high CONUT score before and after PSM (all p<0.001). Furthermore, multivariate analyses revealed that a high preoperative CONUT score was an independent risk factor for poor DFS (hazard ratio [HR] 1.418, 95% confidence interval [CI] 1.132–1.776, p=0.002) before PSM and an independent risk factor for poor DFS (HR 1.333, 95% CI 1.010–1.760, p=0.042) and OS (HR 1.459, 95% CI 1.010–2.107, p=0.044) after PSM. Conclusion A high preoperative CONUT score is an independent prognostic factor for poor outcomes in patients with localized UTUC after RNU.
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Affiliation(s)
- Zhengqing Bao
- Department of Urology, Peking University First Hospital, Beijing 100034, People's Republic of China.,Institute of Urology, Peking University, Beijing 100034, People's Republic of China.,National Urological Cancer Center, Beijing 100034, People's Republic of China
| | - Yifan Li
- Department of Urology, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu 225000, People's Republic of China
| | - Bao Guan
- Department of Urology, Peking University First Hospital, Beijing 100034, People's Republic of China.,Institute of Urology, Peking University, Beijing 100034, People's Republic of China.,National Urological Cancer Center, Beijing 100034, People's Republic of China
| | - Gengyan Xiong
- Department of Urology, Peking University First Hospital, Beijing 100034, People's Republic of China.,Institute of Urology, Peking University, Beijing 100034, People's Republic of China.,National Urological Cancer Center, Beijing 100034, People's Republic of China
| | - Lei Zhang
- Department of Urology, Peking University First Hospital, Beijing 100034, People's Republic of China.,Institute of Urology, Peking University, Beijing 100034, People's Republic of China.,National Urological Cancer Center, Beijing 100034, People's Republic of China
| | - Qi Tang
- Department of Urology, Peking University First Hospital, Beijing 100034, People's Republic of China.,Institute of Urology, Peking University, Beijing 100034, People's Republic of China.,National Urological Cancer Center, Beijing 100034, People's Republic of China
| | - Tianyu Wang
- Department of Urology, Peking University First Hospital, Beijing 100034, People's Republic of China.,Institute of Urology, Peking University, Beijing 100034, People's Republic of China.,National Urological Cancer Center, Beijing 100034, People's Republic of China
| | - Xuesong Li
- Department of Urology, Peking University First Hospital, Beijing 100034, People's Republic of China.,Institute of Urology, Peking University, Beijing 100034, People's Republic of China.,National Urological Cancer Center, Beijing 100034, People's Republic of China
| | - Dong Fang
- Department of Urology, Peking University First Hospital, Beijing 100034, People's Republic of China.,Institute of Urology, Peking University, Beijing 100034, People's Republic of China.,National Urological Cancer Center, Beijing 100034, People's Republic of China.,Andrology Center, Peking University First Hospital, Beijing 100034, People's Republic of China
| | - Liqun Zhou
- Department of Urology, Peking University First Hospital, Beijing 100034, People's Republic of China.,Institute of Urology, Peking University, Beijing 100034, People's Republic of China.,National Urological Cancer Center, Beijing 100034, People's Republic of China
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14
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Lv Y, Ji ML, Feng QY, Zhu DX, Lin SB, Mao YH, Xu YQ, Zheng P, He GD, Xu JM. Combined test of third lumbar skeletal muscle index and prognostic nutrition index improve prognosis prediction power in resected colorectal cancer liver metastasis. Aging (Albany NY) 2019; 11:10301-10315. [PMID: 31760384 PMCID: PMC6914437 DOI: 10.18632/aging.102457] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 11/07/2019] [Indexed: 12/11/2022]
Abstract
Background: In this paper, we aim to explore clinical value of skeletal muscle index (SMI) and prognostic nutrition index (PNI) on resected colorectal cancer liver metastasis (CRLM). Results: Among the 539 patients, 355 were males. Baseline lower SMI was associated with smaller BMI, smaller PNI, smaller pre-albumin and longer hospitalization days (P<0.05). Patients with lower SMI and PNI had significantly shorter duration of PFS and OS (P<0.05). SMI can reflect the postoperative treatment response. Postoperative 6-month’s and 12-month’s SMI and PNI can indicate overall prognosis. When combined SMI and PNI, prognostic AUC of ROC curves improved significantly. Conclusion: Combined monitor of SMI and PNI can improve the power at predicting prognosis. Postoperative 6-month’s record of SMI and PNI was more accurate and predictive for CRLM prognosis. Method: A total of 539 resected CRLM patients between January 2013 to December 2016 with complete clinical data were included. Computed tomography image was collected from each patient. Receiver-operating characteristic (ROC) curves were constructed; area under curves (AUC) were also determined. All clinical variables were analyzed in proper way.
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Affiliation(s)
- Yang Lv
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Mei-Ling Ji
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Qing-Yang Feng
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - De-Xiang Zhu
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Song-Bin Lin
- Department of General Surgery, Zhongshan Hospital Xiamen Branch, Fudan University, Xiamen 361000, China
| | - Yi-Hao Mao
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Yu-Qiu Xu
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Peng Zheng
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Guo-Dong He
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Jian-Min Xu
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
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Xue W, Tan P, Xu H, Yang L, Wei Q. Impact of the preoperative prognostic nutritional index on survival outcomes in upper tract urothelial carcinomas. Cancer Med 2019; 8:2971-2978. [PMID: 31070304 PMCID: PMC6558464 DOI: 10.1002/cam4.2161] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 03/28/2019] [Indexed: 02/05/2023] Open
Abstract
PURPOSES To investigate the value of prognostic nutritional index (PNI) in patients with upper tract urothelial carcinoma (UTUC) who underwent radical nephroureterectomy (RNU). PATIENTS AND METHODS A total of 717 patients were included in our study from 2003 to 2016. PNI was calculated as 10 × serum albumin level (g/dL) + 0.005 × total lymphocyte count (per mm3 ). Kaplan-Meier analysis and Cox regression models were adapted to analyze the value of PNI on survival outcomes. RESULTS The cutoff value of PNI was set as 46.91 and 298 patients (47.6%) had PNI <46.91. The median follow-up was 50 months. The results suggested that low PNI was significantly associated with worse pathologic features (all P < 0.001). Multivariable Cox regression analysis revealed that PNI < 46.91 was an independent predictor of poor overall survival (Hazard ratios [HR] = 1.777, 95% CI = 1.383-2.284, P < 0.001), cancer-specific survival (HR = 1.850, 95% CI = 1.399-2.445, P < 0.001), and recurrence-free survival (HR = 1.554, 95% CI = 1.229-1.964, P < 0.001). CONCLUSIONS Low preoperative PNI was associated with worse survival outcomes in patients with UTUC. PNI could be an easily assessed blood-based biomarker to predict the prognosis in patients with UTUC treated with RNU.
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Affiliation(s)
- Wenbin Xue
- Department of Urology & Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Ping Tan
- Department of Urology & Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Hang Xu
- Department of Urology & Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Lu Yang
- Department of Urology & Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Qiang Wei
- Department of Urology & Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
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