Impact of nutritional status on the prognosis of patients with metastatic hormone-naïve prostate cancer: a multicenter retrospective cohort study in Japan



To investigate the association between the Geriatric Nutritional Risk Index (GNRI) and prognosis of patients with metastatic hormone-naïve prostate cancer (mHNPC) and to design the optimal risk score predicting for prognosis.


We retrospectively reviewed data from the Michinoku Japan Urological Cancer Study Group database, containing information about 656 patients with mHNPC who initially received androgen-deprivation therapy between 2005 and 2017. The baseline GNRI was calculated using serum albumin level and body mass index. Poor nutrition was defined as GNRI < 92.0. The impact of GNRI, CHAARTED criteria, and laboratory parameters on oncological outcomes was investigated using the multivariable Cox regression models. We developed the risk comprising GNRI and laboratory parameters and compared its prognostic performance with the CHAARTED criteria using the receiver operating characteristic curve with the DeLong method.


Of 339 patients with sufficient data, 66 (19%) were diagnosed with poor nutrition. Multivariate analyses showed that GNRI < 92.0 was an independent prognostic factor of cancer-specific survival [hazard ratio (HR) 1.76; 95% confidence interval (CI) 1.04–2.98, P = 0.035] and overall survival (HR 1.80; 95% CI 1.13–2.89, P = 0.013), in addition to hemoglobin (Hb) and lactic dehydrogenase (LDH) levels. We designed the risk score comprising GNRI < 92.0, Hb < 13.0 g/dL, and LDH > 222 IU/L. The predictive value of the risk score was significantly superior to that of the CHAARTED criteria.


Poor nutrition may predict mortality in patients with mHNPC. Risk factors, such as nutritional status and laboratory parameters, may be useful in decision-making regarding aggressive treatments for patients with mHNPC.

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  1. 1.

    Siegel RL, Miller KD, Jemal A (2015) Cancer statistics, 2015. CA Cancer J Clin 65:5–29

    Article  PubMed  Google Scholar 

  2. 2.

    Fujimoto H, Nakanishi H, Miki T, Kubota Y, Takahashi S, Suzuki K et al (2011) Oncological outcomes of the prostate cancer patients registered in 2004: report from the Cancer Registration Committee of the JUA. Int J Urol 18:876–881

    Article  PubMed  Google Scholar 

  3. 3.

    Gravis G, Fizazi K, Joly F, Oudard S, Priou F, Esterni B et al (2013) Androgen-deprivation therapy alone or with docetaxel in non-castrate metastatic prostate cancer (GETUG-AFU 15): a randomised, open-label, phase 3 trial. Lancet Oncol 14:149–158

    Article  CAS  PubMed  Google Scholar 

  4. 4.

    Komura K, Sweeney CJ, Inamoto T, Ibuki N, Azuma H, Kantoff PW (2018) Current treatment strategies for advanced prostate cancer. Int J Urol 25:220–231

    Article  PubMed  Google Scholar 

  5. 5.

    Sweeney CJ, Chen Y-H, Carducci M, Liu G, Jarrard DF, Eisenberger M et al (2015) Chemohormonal therapy in metastatic hormone-sensitive prostate cancer. N Engl J Med 373:737–746

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. 6.

    Fizazi K, Tran N, Fein L, Matsubara N, Rodriguez-Antolin A, Alekseev BY et al (2017) Abiraterone plus prednisone in metastatic, castration-sensitive prostate cancer. N Engl J Med 377:352–360

    Article  CAS  PubMed  Google Scholar 

  7. 7.

    Beer TM, Tangen CM, Bland LB, Thompson IM, Crawford ED (2004) Prognostic value of anemia in newly diagnosed metastatic prostate cancer: a multivariate analysis of southwest oncology group study 8894. J Urol 172:2213–2217

    Article  PubMed  Google Scholar 

  8. 8.

    Yamada Y, Nakamura K, Aoki S, Tobiume M, Zennami K, Kato Y et al (2011) Lactate dehydrogenase, Gleason score and HER-2 overexpression are significant prognostic factors for M1b prostate cancer. Oncol Rep 25:937–944

    Article  PubMed  Google Scholar 

  9. 9.

    Gu W, Zhang G, Sun L, Ma Q, Cheng Y, Zhang H et al (2015) Nutritional screening is strongly associated with overall survival in patients treated with targeted agents for metastatic renal cell carcinoma. J Cachexia Sarcopenia Muscle 6:222–230

    Article  PubMed  PubMed Central  Google Scholar 

  10. 10.

    Bouillanne O, Morineau G, Dupont C, Coulombel I, Vincent J-P, Nicolis I et al (2005) Geriatric Nutritional Risk Index: a new index for evaluating at-risk elderly medical patients. Am J Clin Nutr 82:777–783

    Article  CAS  PubMed  Google Scholar 

  11. 11.

    Bo Y, Wang K, Liu Y, You J, Cui H, Zhu Y et al (2016) The Geriatric Nutritional Risk Index predicts survival in elderly esophageal squamous cell carcinoma patients with radiotherapy. PLoS One 11:e0155903

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. 12.

    Sobin LH, Gospodarowicz MK, Wittekind C, IU against Cancer (2009) International Union against Cancer. TNM classification of malignant tumours. Wiley-Blackwell, Chichester

    Google Scholar 

  13. 13.

    WHO (2011) Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. Vitamin and Mineral Nutrition Information System. Geneva, World Health Organization, 2011 (WHO/NMH/NHD/MNM/11.1).

  14. 14.

    Yamamoto Y, Hosogaya S, Osawa S, Ichihara K, Onuma T, Saito A et al (2013) Nationwide multicenter study aimed at the establishment of common reference intervals for standardized clinical laboratory tests in Japan. Clin Chem Lab Med 51:1663–1672

    CAS  PubMed  Google Scholar 

  15. 15.

    Soloway MS, Hardeman SW, Hickey D, Raymond J, Todd B, Soloway S et al (1988) Stratification of patients with metastatic prostate cancer based on extent of disease on initial bone scan. Cancer 61:195–202

    Article  CAS  PubMed  Google Scholar 

  16. 16.

    Scher HI, Halabi S, Tannock I, Morris M, Sternberg CN, Carducci MA et al (2008) Design and end points of clinical trials for patients with progressive prostate cancer and castrate levels of testosterone: recommendations of the Prostate Cancer Clinical Trials Working Group. J Clin Oncol 26:1148–1159

    Article  PubMed  PubMed Central  Google Scholar 

  17. 17.

    Kanda Y (2013) Investigation of the freely available easy-to-use software “EZR” for medical statistics. Bone Marrow Transplant 48:452–458

    Article  CAS  PubMed  Google Scholar 

  18. 18.

    DeLong ER, DeLong DM, Clarke-Pearson DL (1988) Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics 44:837–845

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. 19.

    Wang N, Liu J-Y, Li X, Deng M-H, Long Z, Tang J et al (2018) Pretreatment serum albumin/globulin ratio as a prognostic biomarker in metastatic prostate cancer patients treated with maximal androgen blockade. Asian J Androl.

    Article  PubMed  PubMed Central  Google Scholar 

  20. 20.

    Montgomery RB, Goldman B, Tangen CM, Hussain M, Petrylak DP, Page S et al (2007) Association of body mass index with response and survival in men with metastatic prostate cancer: Southwest Oncology Group trials 8894 and 9916. J Urol 178:1946–1951 (discussion 1951)

    Article  PubMed  Google Scholar 

  21. 21.

    Hebuterne X, Lemarie E, Michallet M, de Montreuil CB, Schneider SM, Goldwasser F (2014) Prevalence of malnutrition and current use of nutrition support in patients with cancer. JPEN J Parenter Enter Nutr 38:196–204

    Article  Google Scholar 

  22. 22.

    Argiles JM, Olivan M, Busquets S, Lopez-Soriano FJ (2010) Optimal management of cancer anorexia–cachexia syndrome. Cancer Manag Res 2:27–38

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. 23.

    Gupta D, Lis CG (2010) Pretreatment serum albumin as a predictor of cancer survival: a systematic review of the epidemiological literature. Nutr J 9:69

    Article  PubMed  PubMed Central  Google Scholar 

  24. 24.

    Macciò A, Madeddu C, Gramignano G, Mulas C, Tanca L, Cherchi MC et al (2015) The role of inflammation, iron, and nutritional status in cancer-related anemia: results of a large, prospective, observational study. Haematologica 100:124–132

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. 25.

    Andreyev HJ, Norman AR, Oates J, Cunningham D (1998) Why do patients with weight loss have a worse outcome when undergoing chemotherapy for gastrointestinal malignancies? Eur J Cancer 34:503–509

    Article  CAS  PubMed  Google Scholar 

  26. 26.

    Fearon K, Arends J, Baracos V (2013) Understanding the mechanisms and treatment options in cancer cachexia. Nat Rev Clin Oncol 10:90–99

    Article  CAS  PubMed  Google Scholar 

  27. 27.

    Vidal AC, Howard LE, de Hoedt A, Kane CJ, Terris MK, Aronson WJ et al (2018) Obese patients with castration-resistant prostate cancer may be at a lower risk of all-cause mortality: results from the Shared Equal Access Regional Cancer Hospital (SEARCH) database. BJU Int 122:76–82

    Article  PubMed  PubMed Central  Google Scholar 

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We would like to thank Itsuto Hamano, Takuma Narita, Naoki Fujita, Hiromichi Iwamura, Yuki Fujita, Yukie Nishizawa, and the entire staff of the Department of Urology in Hirosaki University for their invaluable help with the data collection. The authors would also like to thank Enago ( for the English language review.


This work was supported by a Grant-in-Aid for Scientific Research (Grant nos. 15H02563, 15K15579, 17K11118, 17K11119, 17K16768, 17K16770, 17K16771, 18K16681, 18K16682, 18K16717, 18K16718, 18K16719, and 18K09157) from the Japan Society for the Promotion of Science.

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TO: data analysis, manuscript writing/editing. SH: data collection or management, data analysis, manuscript writing/editing. SN: protocol/project development, data collection or management. MT, TS, SK, SH, MI, TK, SI, JS, HS, KM, and TT: data collection or management. NT, YA, TH, and CO: protocol/project development, supervision.

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Correspondence to Shingo Hatakeyama.

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Okamoto, T., Hatakeyama, S., Narita, S. et al. Impact of nutritional status on the prognosis of patients with metastatic hormone-naïve prostate cancer: a multicenter retrospective cohort study in Japan. World J Urol 37, 1827–1835 (2019).

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  • Metastatic hormone-naïve prostate cancer
  • Malnutrition
  • Geriatric Nutritional Risk Index
  • Survival