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Prognostic Significance of Pre- to Postoperative Dynamics of the Prognostic Nutritional Index for Patients with Renal Cell Carcinoma Who Underwent Radical Nephrectomy

  • Urologic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

This study aimed to examine the prognostic role of Prognostic Nutritional Index (PNI) dynamics in the pre- and postoperative periods for patients with renal cell carcinoma (RCC) who undergo radical nephrectomy (RN).

Methods

The study analyzed 324 patients with RCC who underwent RN. The overall population was classified into four groups according to four types of pre- to postoperative PNI dynamics as follows: group 1 (low → low PNI), group 2 (low → high PNI), group 3 (high → low PNI), and group 4 (high → high PNI). The level of PNI was calculated using the following formula: 10 × serum albumin level (g/dL) + 0.005 × absolute lymphocyte counts in blood (/mm3). The primary end point was cancer-specific survival (CSS), and the secondary end point was overall survival (OS).

Results

The patients with higher pre- and postoperative PNI (>45) had better survival outcomes than those with lower pre- and postoperative PNI (≤45). Notably, the patients in group 4 showed the best CSS and OS rates, whereas the patients in group 1 had the worst survival outcomes. Furthermore, PNI dynamics were identified as an independent predictor of CSS and OS outcomes, in addition to pre- and postoperative PNI, tumor size, and pathologic T (pT) stage. The patients with localized RCC (≤pT2) showed significant differences in both CSS and OS estimates, whereas the patients with advanced pT stage (≥pT3) demonstrated a difference only in OS outcomes, according to PNI dynamics.

Conclusions

This study is the first to provide the independent prognostic importance of dynamics of nutritional status for patients with RCC.

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References

  1. Stone PC, Lund S. Predicting prognosis in patients with advanced cancer. Ann Oncol. 2007;18:971–6.

    Article  CAS  PubMed  Google Scholar 

  2. Volpe A, Patard JJ. Prognostic factors in renal cell carcinoma. World J Urol. 2010;28:319–27.

    Article  PubMed  Google Scholar 

  3. Morgan TM, Tang D, Stratton KL, et al. Preoperative nutritional status is an important predictor of survival in patients undergoing surgery for renal cell carcinoma. Eur Urol. 2011;59:923–8.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Ko K, Park YH, Lee JW, et al. Influence of nutritional deficiency on prognosis of renal cell carcinoma (RCC). BJU Int. 2013;112:775–80.

    Article  CAS  PubMed  Google Scholar 

  5. Cancer Genome Atlas Research Network. Comprehensive molecular characterization of clear cell renal cell carcinoma. Nature 2013;499:43–9.

    Article  Google Scholar 

  6. Brugarolas J. Molecular genetics of clear-cell renal cell carcinoma. J Clin Oncol. 2014;32:1968–76.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Ball MW, Singer EA, Srinivasan R. Renal cell carcinoma: molecular characterization and evolving treatment paradigms. Curr Opin Oncol. 2017. doi:10.1097/CCO.0000000000000364.

    Google Scholar 

  8. Onodera T, Goseki N, Kosaki G. Prognostic nutritional index in gastrointestinal surgery of malnourished cancer patients. Nihon Geka Gakkai Zasshi 1984;85:1001–5.

    CAS  PubMed  Google Scholar 

  9. Sun K, Chen S, Xu J, et al. The prognostic significance of the prognostic nutritional index in cancer: a systematic review and meta-analysis. J Cancer Res Clin Oncol. 2014;140:1537–49.

    Article  PubMed  Google Scholar 

  10. Yang Y, Gao P, Chen X, et al. Prognostic significance of preoperative prognostic nutritional index in colorectal cancer: results from a retrospective cohort study and a meta-analysis. Oncotarget 2016;7:58543–52.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Wang SH, Zhai ST, Lin H. Role of Prognostic Nutritional Index in patients with gastric cancer: a meta-analysis. Minerva Med. 2016;107:322–7.

    PubMed  Google Scholar 

  12. Jeon HG, Choi DK, Sung HH, et al. Preoperative Prognostic Nutritional Index is a significant predictor of survival in renal cell carcinoma patients undergoing nephrectomy. Ann Surg Oncol. 2016;23:321–7.

    Article  PubMed  Google Scholar 

  13. Schisterman EF, Perkins NJ, Liu A, et al. Optimal cut-point and its corresponding Youden Index to discriminate individuals using pooled blood samples. Epidemiology 2005;16:73–81.

    Article  PubMed  Google Scholar 

  14. Mohri Y, Inoue Y, Tanaka K, et al. Prognostic Nutritional Index predicts postoperative outcome in colorectal cancer. World J Surg. 2013;37:2688–92.

    Article  PubMed  Google Scholar 

  15. Chan AW, Chan SL, Wong GL, et al. Prognostic Nutritional Index (PNI) predicts tumor recurrence of very early/early stage hepatocellular carcinoma after surgical resection. Ann Surg Oncol. 2015;22:4138–48.

    Article  PubMed  Google Scholar 

  16. Yang Y, Gao P, Song Y, et al. The prognostic nutritional index is a predictive indicator of prognosis and postoperative complications in gastric cancer: a meta-analysis. Eur J Surg Oncol. 2016;42:1176–82.

    Article  CAS  PubMed  Google Scholar 

  17. Hofbauer SL, Pantuck AJ, de Martino M, et al. The preoperative prognostic nutritional index is an independent predictor of survival in patients with renal cell carcinoma. Urol Oncol. 2015;33:68.e61–7.

    Article  Google Scholar 

  18. Broggi MS, Patil D, Baum Y, et al. Onodera’s Prognostic Nutritional Index as an independent prognostic factor in clear cell renal cell carcinoma. Urology 2016;96:99–105.

    Article  PubMed  Google Scholar 

  19. Kwon WA, Kim S, Kim SH, et al. Pretreatment Prognostic Nutritional Index is an independent predictor of survival in patients with metastatic renal cell carcinoma treated with targeted therapy. Clin Genitourin Cancer 2017;15:100–11.

    Article  PubMed  Google Scholar 

  20. Shibutani M, Maeda K, Nagahara H, et al. The prognostic significance of the postoperative Prognostic Nutritional Index in patients with colorectal cancer. BMC Cancer 2015;15:521–30.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Miyake M, Morizawa Y, Hori S, et al. Clinical impact of postoperative loss in psoas major muscle and nutrition index after radical cystectomy for patients with urothelial carcinoma of the bladder. BMC Cancer 2017;17:237–47.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Lee HH, Park JM, Song KY, et al. Survival impact of postoperative body mass index in gastric cancer patients undergoing gastrectomy. Eur J Cancer 2016;52:129–37.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This research was also supported by a Grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health and Welfare, Republic of Korea (Grant No. HI17C0025). This funding organization had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Authors and Affiliations

  1. Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

    Minyong Kang MD, PhD, Chun Tae Chang MD, Hyun Hwan Sung MD, PhD, Hwang Gyun Jeon MD, PhD, Byong Chang Jeong MD, PhD, Seong Il Seo MD, PhD, Seong Soo Jeon MD, PhD, Han Yong Choi MD, PhD & Hyun Moo Lee MD, PhD

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  1. Minyong Kang MD, PhD
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  2. Chun Tae Chang MD
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  3. Hyun Hwan Sung MD, PhD
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  4. Hwang Gyun Jeon MD, PhD
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  5. Byong Chang Jeong MD, PhD
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  6. Seong Il Seo MD, PhD
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  7. Seong Soo Jeon MD, PhD
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  9. Hyun Moo Lee MD, PhD
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Corresponding author

Correspondence to Hyun Moo Lee MD, PhD.

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Electronic supplementary material

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10434_2017_6065_MOESM1_ESM.jpeg

Supplementary material 1 (JPEG 88 kb) Fig. S1. Cancer-specific survival according to a preoperative PNI and b 6 months postoperative PNI in patients with localized renal cell carcinoma (pT1 and 2) who underwent radical nephrectomy. c Cancer-specific survival according to the dynamics of PNI following radical nephrectomy (1 low → low, 2 low → high, 3 high → low, 4 high → high) in patients with localized renal cell carcinoma (pT1 and 2) who underwent radical nephrectomy

10434_2017_6065_MOESM2_ESM.jpeg

Supplementary material 2 (JPEG 89 kb) Fig. S2. Overall survival according to a preoperative PNI and b 6 months postoperative PNI in patients with localized renal cell carcinoma (pT1 and 2) who underwent radical nephrectomy. c Overall survival according to the dynamics of PNI following radical nephrectomy (1 low → low, 2 low → high, 3 high → low, 4 high → high) in patients with localized renal cell carcinoma (pT1 and 2) who underwent radical nephrectomy

10434_2017_6065_MOESM3_ESM.jpeg

Supplementary material 3 (JPEG 55 kb) Fig. S3. Cancer-specific survival according to a preoperative PNI and b 6 months postoperative PNI in patients with localized renal cell carcinoma (pT3 and 4) who underwent radical nephrectomy

10434_2017_6065_MOESM4_ESM.jpeg

Supplementary material 4 (JPEG 56 kb) Fig. S4. Overall survival according to a preoperative PNI and b 6 months postoperative PNI in patients with localized renal cell carcinoma (pT3 and 4) who underwent radical nephrectomy

10434_2017_6065_MOESM5_ESM.jpeg

Supplementary material 5 (JPEG 79 kb) Fig. S5. a Cancer-specific survival and b overall survival according to the dynamics of PNI following radical nephrectomy (1 low → low, 2 low → high, 3 high → low, 4 high → high) in patients with localized renal cell carcinoma (pT3 and 4) who underwent radical nephrectomy

Supplementary material 6 (DOCX 21 kb)

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Kang, M., Chang, C.T., Sung, H.H. et al. Prognostic Significance of Pre- to Postoperative Dynamics of the Prognostic Nutritional Index for Patients with Renal Cell Carcinoma Who Underwent Radical Nephrectomy. Ann Surg Oncol 24, 4067–4075 (2017). https://doi.org/10.1245/s10434-017-6065-2

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  • DOI: https://doi.org/10.1245/s10434-017-6065-2

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