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Impact of a novel immune and nutritional score on prognosis in patients with upper urinary tract urothelial carcinoma following radical nephroureterectomy

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Abstract

Background

This study aimed to evaluate the clinical significance of a novel immune and nutritional score combining prognostic values of the controlling nutritional status (CONUT) score and prognostic immune and nutritional index (PINI) on long-term outcomes in patients with upper tract urothelial carcinoma (UTUC) after radical nephroureterectomy (RNU).

Methods

This study analyzed 437 consecutive patients with UTUC treated by RNU. Restricted cubic splines were used to visualize the relation of PINI with Survival in patients with UTUC. The PINI was stratified into low- (1) and high-PINI (0) categories. The CONUT score was divided into three groups: Normal (1), Light (2), and Moderate/severe (3). Subsequently, patients were grouped according to CONUT-PINI score (CPS) (CPS group 1; CPS group 2; CPS group 3; and CPS group 4). Survival curves were plotted using the Kaplan–Meier method and log-rank test. The Cox proportional hazards regression model was used to determine the risk factors associated with overall Survival (OS) and cancer-specific Survival (CSS). By comprising independent prognostic factors, a predictive nomogram was constructed.

Results

PINI and CONUT score were identified as independent prognostic factors for OS and CSS. Kaplan–Meier survival analysis showed that the high CPS group was associated with worse OS and CSS than the low CPS group. Multivariate Cox regression and competing risk analyses showed that CPS, LVI, T stage, margin, and pN were independent factors associated with OS and CSS. Based on these five significant factors, we constructed a prognostic model for predicting clinical outcomes. The receiver operating characteristic curve indicated that the model had excellent predictive abilities for survival. The C-index of this model for OS and CSS were 0.773, and 0.789, respectively. The nomogram for OS and CSS showed good discrimination and calibration. Decision curve analysis (DCA) showed that this nomogram has a higher net benefit.

Conclusion

The CPS combined the prognostic capacity of PINI and CONUT score and was able to predict patient outcomes in our cohort of UTUC patients. We have developed a nomogram to facilitate the clinical use of the CPS and provide accurate estimates of survival for individuals.

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Data availability

All data generated or analyzed during this study are included in this published article. The data are not publicly available due to data protection reasons.

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Funding

The study was funded by National Key R&D Program of China (Grant Numbers: 2018YFC2002202) and the Chinese Academy of Medical Sciences (Grant Numbers: BJ-2022-237).

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Author notes

  1. Jianyong Liu and Shicong Lai have contributed equally to this work and share the first authorship.

  2. Jianye Wang, Jianlong Wang and Yaoguang Zhang have contributed equally to this work and share the last authorship.

Authors and Affiliations

  1. Department of Urology, Institute of the Geriatric Medicine, Beijing Hospital, National Center of Gerontology, Chinese Academy of Medical Sciences, No. 1 DaHua Road, Dong Dan, Beijing, 100730, People’s Republic of China

    Jianyong Liu, Pengjie Wu, Jiawen Wang, Jianye Wang, Jianlong Wang & Yaoguang Zhang

  2. Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People’s Republic of China

    Jianyong Liu, Pengjie Wu, Jiawen Wang, Jianye Wang, Jianlong Wang & Yaoguang Zhang

  3. Beijing Hospital Continence Center, Beijing, People’s Republic of China

    Jianyong Liu, Pengjie Wu, Jiawen Wang, Jianye Wang, Jianlong Wang & Yaoguang Zhang

  4. Department of Urology, Peking University People’s Hospital, Beijing, 100044, People’s Republic of China

    Shicong Lai

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  1. Jianyong Liu
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Contributions

JL: Project development, data collection, data analysis, manuscript writing. SL: Project development, data collection, data analysis, manuscript writing. PW: Data collection, data analysis, manuscript editing. JW: Data collection, data analysis. JW: Project development, data analysis, manuscript editing. JW: Project development, data analysis, manuscript editing. YZ: Project development, data analysis, manuscript editing.

Corresponding authors

Correspondence to Jianye Wang, Jianlong Wang or Yaoguang Zhang.

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This was a retrospective study, and clinical data were de-identified before analysis; therefore, ethical approval was not required.

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Liu, J., Lai, S., Wu, P. et al. Impact of a novel immune and nutritional score on prognosis in patients with upper urinary tract urothelial carcinoma following radical nephroureterectomy. J Cancer Res Clin Oncol 149, 10893–10909 (2023). https://doi.org/10.1007/s00432-023-04977-8

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