title: The preoperative prognostic nutritional index is an independent predictor of survival in patients with renal cell carcinoma.
abstract: OBJECTIVE
  Accurate postoperative stratification of patients with renal cell carcinoma (RCC) in distinct prognostic groups is essential for tailoring follow-up, medical therapy, and inclusion in clinical trials. Increasing evidence suggests that Onodera׳s prognostic nutritional index (PNI) is a stage- and grade-independent predictor of poor outcomes in patients with cancer, but there are no data in RCC.
  
  
  METHODS
  We reviewed medical records of 1,344 patients with RCC who underwent radical or partial nephrectomy at the Medical University of Vienna and the University of California-Los Angeles between 1991 and 2012. Associations with cancer-specific survival were assessed with univariable and multivariable Cox proportional hazards models. Discrimination was measured with the C-index.
  
  
  RESULTS
  The median postoperative follow-up was 40 months. An increase of PNI by 1 unit was associated with a decrease in the risk of death from RCC by 7% (hazard ratio = 0.93, P<0.001). In multivariable analyses, the PNI was an independent prognostic factor (P<0.001). Adding the PNI improved the discrimination of a base model by 0.4%.
  
  
  CONCLUSIONS
  The PNI is an independent prognostic factor in patients with RCC. Its use increases the accuracy of established prognostic factors. PNI may be a meaningful adjunct for tailoring surveillance, medical therapy, and clinical trial design.
authors.affiliation: Department of Urology, Comprehensive Cancer Center, Medical University of Vienna and General Hospital, Vienna, Austria.
authors.forename: Sebastian L
authors.initials: SL
authors.lastname: Hofbauer
authors.affiliation: Institute of Urologic Oncology, Department of Urology, University of California-Los Angeles, Los Angeles, CA.
authors.forename: Allan J
authors.initials: AJ
authors.lastname: Pantuck
authors.affiliation: Department of Urology, Comprehensive Cancer Center, Medical University of Vienna and General Hospital, Vienna, Austria.
authors.forename: Michela
authors.initials: M
authors.lastname: de Martino
authors.affiliation: Department of Urology, Comprehensive Cancer Center, Medical University of Vienna and General Hospital, Vienna, Austria; Department of Urology, Centre hospitalier universitaire vaudois, Lausanne, Switzerland.
authors.forename: Ilaria
authors.initials: I
authors.lastname: Lucca
authors.affiliation: Clinical Institute of Pathology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria.
authors.forename: Andrea
authors.initials: A
authors.lastname: Haitel
authors.affiliation: Department of Urology, Comprehensive Cancer Center, Medical University of Vienna and General Hospital, Vienna, Austria.
authors.forename: Shahrokh F
authors.initials: SF
authors.lastname: Shariat
authors.affiliation: Institute of Urologic Oncology, Department of Urology, University of California-Los Angeles, Los Angeles, CA.
authors.forename: Arie S
authors.initials: AS
authors.lastname: Belldegrun
authors.affiliation: Department of Urology, Comprehensive Cancer Center, Medical University of Vienna and General Hospital, Vienna, Austria. Electronic address: tobias.klatte@gmx.de.
authors.forename: Tobias
authors.initials: T
authors.lastname: Klatte
mesh_terms: D002292:Carcinoma, Renal Cell / Q000378:metabolism / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D015596:Nutrition Assessment; D057234:Preoperative Period; D011379:Prognosis; D016016:Proportional Hazards Models; D016019:Survival Analysis
keywords: Inflammation; Prognosis; Prognostic nutritional index; Recurrence; Renal cell carcinoma