Advertisement

International Urology and Nephrology

, Volume 49, Issue 11, pp 1955–1963 | Cite as

Significance of preoperative prognostic nutrition index as prognostic predictors in patients with metastatic renal cell carcinoma with tyrosine kinase inhibitors as first-line target therapy

  • Wen Cai
  • Hai Zhong
  • Wen Kong
  • Baijun Dong
  • Yonghui Chen
  • Lixin Zhou
  • Wei Xue
  • Yiran Huang
  • Jin Zhang
  • Jiwei Huang
Urology – Original Paper

Abstract

Objective

Prognostic nutritional index (PNI) is a recognized indicator of both immune and nutritional status. It was firstly used as a preoperative prognostic indicator, and its role in the prognosis of patients with metastatic renal cell carcinoma (mRCC) has not yet been investigated in large-scale study. The purpose of this work was to investigate the prognostic role of pretreatment PNI in patients with mRCC with sorafenib or sunitinib as first-line targeted therapy.

Method

In this retrospective single-center research, the Kaplan–Meier method was used to estimate the progression-free survival (PFS) and overall survival (OS) of 178 mRCC patients who received first-line therapy of sorafenib or sunitinib. Log-rank test was used to compare the survival outcomes of patients with low pretreatment PNI (PNI < 51.62) and high pretreatment PNI (PNI ≥ 51.62), and Cox proportional hazard regression model was used to compare PFS and OS between these two groups. Prognostic accuracy was determined using Harrell concordance index.

Results

The overall median PFS and OS time for all 178 patients were 11 months (95% CI 9–12 months) and 24 months (95% CI 19–33 months), respectively. Patients with low pretreatment PNI both had significantly shorter median PFS (7 vs 19 months, P < 0.001) and OS (14 vs 50 months, P < 0.001) than those with high PNI. Multivariate analysis showed that pretreatment PNI was an independent predictor of OS (HR 1.658, 95% CI 1.040–2.614, P = 0.033) and an independent predictor of PFS as well (HR 1.842, 95% CI 1.226–2.766, P = 0.003). The model built by the addition of pretreatment PNI improved predictive accuracy of PFS and OS compared with the International Metastatic Renal Cell Carcinoma Database Consortium Model (Heng model) (c-index: 0.68 and 0.70). Comparing to NLR (neutrophil-to-lymphocyte ratio) (0.69 and 0.72), PNI might be a preciser factor to predict PFS and OS (0.71 and 0.73).

Conclusions

Low pretreatment PNI could be a significant risk factor for mRCC patients who received tyrosine kinase inhibitors as first-line target therapy and increase the accuracy of established prognostic model.

Keywords

Metastatic renal cell carcinoma Prognosis Sorafenib Sunitinib PNI 

Notes

Acknowledgements

This study was funded by National Natural Science Foundation of China (Grant Numbers 81402084, 81472378 and 81672513) and the Shanghai Municipal Commission of Health and Family Planning (Grant Number 2013SY027) and the Incubating Program for Clinical Research and Innovation of Renji Hospital (Grant Number PYXJS16-008).

Compliance with ethical standards

Conflict of interest

All author declares no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Renji Hospital and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

References

  1. 1.
    Cohen HT, McGovern FJ (2005) Renal-cell carcinoma. New Engl J Med 353(23):2477–2490. doi: 10.1056/NEJMra043172 CrossRefPubMedGoogle Scholar
  2. 2.
    Capitanio U, Montorsi F (2016) Renal cancer. Lancet 387(10021):894–906. doi: 10.1016/s0140-6736(15)00046-x CrossRefPubMedGoogle Scholar
  3. 3.
    Gore ME, Szczylik C, Porta C, Bracarda S, Bjarnason GA, Oudard S, Hariharan S, Lee S-H, Haanen J, Castellano D, Vrdoljak E, Schöffski P, Mainwaring P, Nieto A, Yuan J, Bukowski R (2009) Safety and efficacy of sunitinib for metastatic renal-cell carcinoma: an expanded-access trial. Lancet Oncol 10(8):757–763. doi: 10.1016/s1470-2045(09)70162-7 CrossRefPubMedGoogle Scholar
  4. 4.
    Patard JJ, Pignot G, Escudier B, Eisen T, Bex A, Sternberg C, Rini B, Roigas J, Choueiri T, Bukowski R, Motzer R, Kirkali Z, Mulders P, Bellmunt J (2011) ICUD-EAU international consultation on kidney cancer 2010: treatment of metastatic disease. Eur Urol 60(4):684–690. doi: 10.1016/j.eururo.2011.06.017 CrossRefPubMedGoogle Scholar
  5. 5.
    Harshman LC, Xie W, Bjarnason GA, Knox JJ, MacKenzie M, Wood L, Srinivas S, Vaishampayan UN, Tan M-H, Rha S-Y, Donskov F, Agarwal N, Kollmannsberger C, North S, Rini BI, Heng DYC, Choueiri TK (2012) Conditional survival of patients with metastatic renal-cell carcinoma treated with VEGF-targeted therapy: a population-based study. Lancet Oncol 13(9):927–935. doi: 10.1016/s1470-2045(12)70285-1 CrossRefPubMedGoogle Scholar
  6. 6.
    Heng DY, Xie W, Regan MM, Warren MA, Golshayan AR, Sahi C, Eigl BJ, Ruether JD, Cheng T, North S, Venner P, Knox JJ, Chi KN, Kollmannsberger C, McDermott DF, Oh WK, Atkins MB, Bukowski RM, Rini BI, Choueiri TK (2009) Prognostic factors for overall survival in patients with metastatic renal cell carcinoma treated with vascular endothelial growth factor-targeted agents: results from a large, multicenter study. J Clin Oncol 27(34):5794–5799. doi: 10.1200/JCO.2008.21.4809 CrossRefPubMedGoogle Scholar
  7. 7.
    Choueiri TK, Duh MS, Clement J, Brick AJ, Rogers MJ, Kwabi C, Shah K, Percy AG, Antras L, Jayawant SS, Chen K, Wang ST, Luka A, Neary MP, McDermott D, Oh WK (2010) Angiogenesis inhibitor therapies for metastatic renal cell carcinoma: effectiveness, safety and treatment patterns in clinical practice-based on medical chart review. BJU Int 105(9):1247–1254. doi: 10.1111/j.1464-410X.2009.08972.x CrossRefPubMedGoogle Scholar
  8. 8.
    Mir MH, Changal KH, Aziz SA, Bhat GM, Lone AR (2016) Sunitinib in metastatic renal cell carcinoma (mRCC): a developing country experience. Do our patients behave differently than the Western patients? Int Urol Nephrol 48(11):1811–1816. doi: 10.1007/s11255-016-1380-2 CrossRefPubMedGoogle Scholar
  9. 9.
    Ye DW, Zhang HL (2014) Critical appraisal of sorafenib in the treatment of Chinese patients with renal cell carcinoma. OncoTargets Ther 7:925–935. doi: 10.2147/OTT.S41828 CrossRefGoogle Scholar
  10. 10.
    Ko JJ, Xie W, Kroeger N, J-l Lee, Rini BI, Knox JJ, Bjarnason GA, Srinivas S, Pal SK, Yuasa T, Smoragiewicz M, Donskov F, Kanesvaran R, Wood L, Ernst DS, Agarwal N, Vaishampayan UN, S-y Rha, Choueiri TK, Heng DYC (2015) The international metastatic renal cell carcinoma database consortium model as a prognostic tool in patients with metastatic renal cell carcinoma previously treated with first-line targeted therapy: a population-based study. Lancet Oncol 16(3):293–300. doi: 10.1016/s1470-2045(14)71222-7 CrossRefPubMedGoogle Scholar
  11. 11.
    Du XJ, Tang LL, Mao YP, Guo R, Sun Y, Lin AH, Ma J (2015) Value of the prognostic nutritional index and weight loss in predicting metastasis and long-term mortality in nasopharyngeal carcinoma. J Transl Med 13:364. doi: 10.1186/s12967-015-0729-0 CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Hong S, Zhou T, Fang W, Xue C, Hu Z, Qin T, Tang Y, Chen Y, Ma Y, Yang Y, Hou X, Huang Y, Zhao H, Zhao Y, Zhang L (2015) The prognostic nutritional index (PNI) predicts overall survival of small-cell lung cancer patients. Tumour Biol J Int Soc Oncodevelopmental Biol Med 36(5):3389–3397. doi: 10.1007/s13277-014-2973-y CrossRefGoogle Scholar
  13. 13.
    Tokunaga R, Sakamoto Y, Nakagawa S, Miyamoto Y, Yoshida N, Oki E, Watanabe M, Baba H (2015) Prognostic nutritional index predicts severe complications, recurrence, and poor prognosis in patients with colorectal cancer undergoing primary tumor resection. Dis Colon Rectum 58(11):1048–1057. doi: 10.1097/DCR.0000000000000458 CrossRefPubMedGoogle Scholar
  14. 14.
    Goh BK, Kam JH, Lee SY, Chan CY, Allen JC, Jeyaraj P, Cheow PC, Chow PK, Ooi LL, Chung AY (2016) Significance of neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio and prognostic nutrition index as preoperative predictors of early mortality after liver resection for huge (>/=10 cm) hepatocellular carcinoma. J Surg Oncol 113(6):621–627. doi: 10.1002/jso.24197 CrossRefPubMedGoogle Scholar
  15. 15.
    Jeon HG, Choi DK, Sung HH, Jeong BC, Seo SI, Jeon SS, Choi HY, Lee HM (2016) Preoperative prognostic nutritional index is a significant predictor of survival in renal cell carcinoma patients undergoing nephrectomy. Ann Surg Oncol 23(1):321–327. doi: 10.1245/s10434-015-4614-0 CrossRefPubMedGoogle Scholar
  16. 16.
    Hofbauer SL, Pantuck AJ, de Martino M, Lucca I, Haitel A, Shariat SF, Belldegrun AS, Klatte T (2015) The preoperative prognostic nutritional index is an independent predictor of survival in patients with renal cell carcinoma. Urol Oncol 33(2):68 e61-67. doi: 10.1016/j.urolonc.2014.08.005 CrossRefGoogle Scholar
  17. 17.
    Kwon WA, Kim S, Kim SH, Joung JY, Seo HK, Lee KH, Chung J (2016) Pretreatment prognostic nutritional index is an independent predictor of survival in patients with metastatic renal cell carcinoma treated with targeted therapy. Clin Genitourin Cancer. doi: 10.1016/j.clgc.2016.07.025 Google Scholar
  18. 18.
    Budczies J, Klauschen F, Sinn BV, Gyorffy B, Schmitt WD, Darb-Esfahani S, Denkert C (2012) Cutoff finder: a comprehensive and straightforward Web application enabling rapid biomarker cutoff optimization. PLoS ONE 7(12):e51862. doi: 10.1371/journal.pone.0051862 CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Onodera T, Goseki N, Kosaki G (1984) Prognostic nutritional index in gastrointestinal surgery of malnourished cancer patients. Nihon Geka Gakkai Zasshi 85(9):1001–1005PubMedGoogle Scholar
  20. 20.
    Stenman M, Laurell A, Lindskog M (2014) Prognostic significance of serum albumin in patients with metastatic renal cell carcinoma. Med Oncol 31(3):841. doi: 10.1007/s12032-014-0841-7 CrossRefPubMedGoogle Scholar
  21. 21.
    Ray-Coquard I, Cropet C, Van Glabbeke M, Sebban C, Le Cesne A, Judson I, Tredan O, Verweij J, Biron P, Labidi I, Guastalla JP, Bachelot T, Perol D, Chabaud S, Hogendoorn PC, Cassier P, Dufresne A, Blay JY, Europeanfor Organization R, Treatment of Cancer Soft T, Bone Sarcoma G (2009) Lymphopenia as a prognostic factor for overall survival in advanced carcinomas, sarcomas, and lymphomas. Cancer Res 69(13):5383–5391. doi: 10.1158/0008-5472.CAN-08-3845 CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Berghoff AS, Ricken G, Wilhelm D, Rajky O, Widhalm G, Dieckmann K, Birner P, Bartsch R, Preusser M (2016) Tumor infiltrating lymphocytes and PD-L1 expression in brain metastases of small cell lung cancer (SCLC). J Neurooncol 130(1):19–29. doi: 10.1007/s11060-016-2216-8 CrossRefPubMedGoogle Scholar
  23. 23.
    Coussens LM, Werb Z (2002) Inflammation and cancer. Nature 420(6917):860–867. doi: 10.1038/nature01322 CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Gu W, Zhang G, Sun L, Ma Q, Cheng Y, Zhang H, Shi G, Zhu Y, Ye D (2015) Nutritional screening is strongly associated with overall survival in patients treated with targeted agents for metastatic renal cell carcinoma. J Cachexia Sarcopenia Muscle 6(3):222–230. doi: 10.1002/jcsm.12025 CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Templeton AJ, Knox JJ, Lin X, Simantov R, Xie W, Lawrence N, Broom R, Fay AP, Rini B, Donskov F, Bjarnason GA, Smoragiewicz M, Kollmannsberger C, Kanesvaran R, Alimohamed N, Hermanns T, Wells JC, Amir E, Choueiri TK, Heng DY (2016) Change in neutrophil-to-lymphocyte ratio in response to targeted therapy for metastatic renal cell carcinoma as a prognosticator and biomarker of efficacy. Eur Urol 70(2):358–364. doi: 10.1016/j.eururo.2016.02.033 CrossRefPubMedGoogle Scholar
  26. 26.
    Koo KC, Lee KS, Cho KS, Rha KH, Hong SJ, Chung BH (2016) Comprehensive analysis and validation of contemporary survival prognosticators in Korean patients with metastatic renal cell carcinoma treated with targeted therapy: prognostic impact of pretreatment neutrophil-to-lymphocyte ratio. Int Urol Nephrol 48(6):985–992. doi: 10.1007/s11255-016-1252-9 CrossRefPubMedGoogle Scholar
  27. 27.
    Zhang GM, Zhu Y, Gu WJ, Zhang HL, Shi GH, Ye DW (2016) Pretreatment neutrophil-to-lymphocyte ratio predicts prognosis in patients with metastatic renal cell carcinoma receiving targeted therapy. Int J Clin Oncol 21(2):373–378. doi: 10.1007/s10147-015-0894-4 CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2017

Authors and Affiliations

  • Wen Cai
    • 1
  • Hai Zhong
    • 1
  • Wen Kong
    • 1
  • Baijun Dong
    • 1
  • Yonghui Chen
    • 1
  • Lixin Zhou
    • 1
  • Wei Xue
    • 1
  • Yiran Huang
    • 1
  • Jin Zhang
    • 1
  • Jiwei Huang
    • 1
  1. 1.Department of Urology, Renji Hospital, School of MedicineShanghai Jiao Tong UniversityPudong District, ShanghaiPeople’s Republic of China

Personalised recommendations