Impact of the preoperative prognostic nutritional index on survival outcomes in upper tract urothelial carcinomas.

Wenbin Xue,Hang Xu,Ping Tan,Lu Yang,Qiang Wei

doi:10.1002/cam4.2161

Wenbin Xue, Hang Xu + Show 3 more

Open Access

https://doi.org/10.1002/cam4.2161

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Journal: Cancer medicine	Publication Date: May 9, 2019
Citations: 12	License type: CC BY 4.0

Affiliation: West China Hospital of Sichuan University

Abstract

PurposesTo investigate the value of prognostic nutritional index (PNI) in patients with upper tract urothelial carcinoma (UTUC) who underwent radical nephroureterectomy (RNU).Patients and methodsA 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.ResultsThe 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).ConclusionsLow 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.

Highlights

Upper tract urothelial carcinoma (UTUC) is a relatively rare but potentially fatal disease, which occurs in the pyelocaliceal cavities or ureter
The radical nephroureterectomy (RNU) with bladder cuff excision has been considered as the standard treatment for the patients with UTUCs, the prognosis remains poor with a potential of intravesical recurrence and distant metastasis.[2]
The prognostic nutritional index (PNI), which was calculated based on serum albumin levels and total lymphocyte count, was first reported by Buzby and colleagues in 1980.12 To date, many studies have proved that PNI is a significant indicator for prognosis in patients with several malignancies, but the prognostic value of PNI has been poorly investigated in UTUC

Summary

| INTRODUCTION

Upper tract urothelial carcinoma (UTUC) is a relatively rare but potentially fatal disease, which occurs in the pyelocaliceal cavities or ureter. Many preoperative and postoperative prognostic factors of UTUC have been indicated,[5,6] such as lymphovascular invasion (LVI), tumor stage, tumor grade, tumor size, and lymph node invasion,[7,8] which can be used to predict prognosis and adapt the treatment for the patients of UTUC. The prognostic nutritional index (PNI), which was calculated based on serum albumin levels and total lymphocyte count, was first reported by Buzby and colleagues in 1980.12 To date, many studies have proved that PNI is a significant indicator for prognosis in patients with several malignancies, but the prognostic value of PNI has been poorly investigated in UTUC. The multivariable Cox regression analysis was adjusted for tumor stage, tumor grade, tumor size, tumor architecture, surgical margin status, concomitant variant histology (CVH), lymph node status, LVI status, and PNI. All the analyses were conducted using SPSS 22.0 (IBM SPSS, Chicago, IL)

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