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
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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.
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.
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).
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.
KeywordsMetastatic renal cell carcinoma Prognosis Sorafenib Sunitinib PNI
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.
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.
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