Pretreatment Prognostic Nutritional Index Is an Independent Predictor of Survival in Patients With Metastatic Renal Cell Carcinoma Treated With Targeted Therapy.
In the present study we examined the effect of the Prognostic Nutritional Index (PNI) on the overall survival (OS) and progression-free survival (PFS) of patients with metastatic renal cell carcinoma (RCC) treated with targeted therapy.



The study included 125 patients with metastatic RCC. Pretreatment PNI was calculated as 10 × serum albumin (g/dL) + 0.005 × total lymphocyte count (per mm3). Univariable and multivariable Cox proportional hazards models were used to assess the correlation between pretreatment PNI and OS and PFS. Harrell concordance index was used to measure discrimination.



The median follow-up time was 45.3 months (interquartile range, 23.7-77.3 months). Decreased PNI was significantly associated with older female patients, poor Eastern Cooperative Oncology Group performance status, types of initial drug, and increased Memorial Sloan Kettering Cancer Center (MSKCC) and Heng risk score (P < .05). An increase in the PNI of 1 unit was associated with a 10% decrease in the risk of death from RCC (hazard ratio, 0.90; P < .001). In the multivariable analysis, the PNI was an independent prognostic factor for OS (P < .001). In intermediate-risk patients according to MSKCC and Heng risk criteria, OS was better in the high PNI group than in the low PNI group (P = .0136 and P = .0009, respectively).



PNI is an independent prognostic factor in patients with metastatic RCC treated with targeted therapy. When used as an adjunct, it increases the prognostic accuracy of established factors and could be a valuable tool for tailoring surveillance, patient counseling, and clinical trial design.
Department of Urology, School of Medicine, Institute of Wonkwang Medical Science, Wonkwang University Sanbon Hospital, Gunpo, Gyeonggi-do, Korea.
Whi-An
WA
Kwon
Biometric Research Branch, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea.
Sohee
S
Kim
Department of Urology, Center for Prostate Cancer, National Cancer Center, Goyang, Republic of Korea.
Sung Han
SH
Kim
Department of Urology, Center for Prostate Cancer, National Cancer Center, Goyang, Republic of Korea.
Jae Young
JY
Joung
Department of Urology, Center for Prostate Cancer, National Cancer Center, Goyang, Republic of Korea.
Ho Kyung
HK
Seo
Department of Urology, Center for Prostate Cancer, National Cancer Center, Goyang, Republic of Korea.
Kang Hyun
KH
Lee
Department of Urology, Center for Prostate Cancer, National Cancer Center, Goyang, Republic of Korea. Electronic address: cjs5225@ncc.re.kr.
Jinsoo
J
Chung
D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002292:Carcinoma, Renal Cell / Q000188:drug therapy*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D058990:Molecular Targeted Therapy / Q000379:methods*; D009362:Neoplasm Metastasis; D015596:Nutrition Assessment; D011379:Prognosis; D016019:Survival Analysis; D016896:Treatment Outcome
D000970:Antineoplastic Agents
Kidney; Prognostic nutritional index; Renal cell carcinoma; Survival; Targeted therapy