Abstract
BackgroundTo explore the prognostic significance of preoperative prognostic nutritional index (PNI) in bladder cancer after radical cystectomy and compare the prognostic ability of inflammation-based indices.MethodsWe retrospectively analyzed data for 516 patients with bladder cancer who underwent radical cystectomy in our institution between 2006 to 2012. Clinicopathologic characteristics and inflammation-based indices (PNI, neutrophil/lymphocyte ratio [NLR], platelet/lymphocyte ratio [PLR], lymphocyte/monocyte ratio [LMR]) were evaluated by pre-treatment measurements. Overall survival (OS) and progression-free survival (PFS) were estimated by the Kaplan–Meier method and compared by log-rank test. Multivariate analysis with a Cox proportional hazards model was used to confirm predictors identified on univariate analysis. The association between clinicopathological characteristics and PNI or NLR was tested.ResultsAmong the 516 patients, the median follow-up was 37 months (interquartile range 20 to 56). On multivariate analysis, PNI and NLR independently predicted OS (PNI: hazard ratio [HR] = 1.668, 95% CI: 1.147–2.425, P = 0.007; NLR: HR = 1.416, 95% CI:1.094–2.016, P = 0.0149) and PFS (PNI: HR = 1.680, 95% CI:1.092–2.005, P = 0.015; NLR: HR = 1.550, 95% CI:1.140–2.388, P = 0.008). Low PNI predicted worse OS for all pathological stages and PFS for T1 and T2 stages. Low PNI was associated with older age (>65 years), muscle-invasive bladder cancer, high American Society of Anesthesiologists grade and anemia.ConclusionPNI and NLR were independent predictors of OS and PFS for patients with bladder cancer after radical cystectomy and PNI might be a novel reliable biomarker for bladder cancer.
Highlights
To explore the prognostic significance of preoperative prognostic nutritional index (PNI) in bladder cancer after radical cystectomy and compare the prognostic ability of inflammation-based indices
Radical cystectomy is the standard treatment for localized muscle-invasive bladder cancer (MIBC) and non-muscle invasive bladder cancer (NMIBC) unresponsive to intravesical therapy [1, 2]
Prognostic indicators suggested have been based on albumin and C-reactive protein levels and platelet and blood count, such as neutrophil/lymphocyte ratio [NLR], platelet/lymphocyte ratio (PLR) and lymphocyte/monocyte ratio (LMR) [4,5,6,7,8]
Summary
To explore the prognostic significance of preoperative prognostic nutritional index (PNI) in bladder cancer after radical cystectomy and compare the prognostic ability of inflammation-based indices. Despite the advances in surgical skills and chemotherapy, the 5-year survival with all bladder cancer is 77.9% and only 33.0% and 5.4% for regional and distant disease [3]. Prognostic factors for Several preoperative hematological parameters have been reported as prognostic biomarkers for bladder cancer. Prognostic nutritional index (PNI), which combines nutrition and inflammation status, has been found to predict outcomes in various cancers [9,10,11,12,13,14]. No study has evaluated the prognostic value of PNI in bladder cancer
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