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Bayoğlu İV, Hüseynov J, Topal A, Sever N, Majidova N, Çelebi A, Yaşar A, Arıkan R, Işık S, Hacıoğlu MB, Ercelep Ö, Sarı M, Erdoğan B, Hacıbekiroğlu İ, Topaloğlu S, Köstek O, Çiçin İ. PNI as a Potential Add-On Biomarker to Improve the IMDC Intermediate Prognostic Score. J Clin Med 2023; 12:6420. [PMID: 37835062 PMCID: PMC10573811 DOI: 10.3390/jcm12196420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 08/30/2023] [Accepted: 08/31/2023] [Indexed: 10/15/2023] Open
Abstract
INTRODUCTION This study aimed to assess the role of the adjusted PNI-IMDC risk scoring system in stratifying the intermediate group of metastatic RCC patients who received TKIS in the first-line setting. METHODS A total of 185 patients were included. The adjusted PNI and IMDC model was used to divide the intermediate group into two groups: intermediate PNI-high and intermediate PNI-low groups. The statistical data were analyzed using Kaplan-Meier and Cox regression analysis. RESULTS The results showed that the adjusted PNI-IMDC risk score, classic IMDC, and PNI had similar prognostic values. Adjusted PNI-IMDC risk score might be used for a more homogeneous differentiation of the classic intermediate group. On the other hand, multivariate analysis revealed that the presence of nephrectomy, adjusted favorable/intermediate (PNI-high) group, ECOG performance score, and presence of bone metastasis were independent predictors of OS. CONCLUSIONS Pre-treatment PNI, as a valuable and potential add-on biomarker to the adjusted PNI-IMDC classification model, can be helpful for establishing an improved prognostic model for intermediate group mRCC patients treated with first-line TKISs. Further validation studies are needed to clarify these findings.
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Affiliation(s)
- İbrahim Vedat Bayoğlu
- Department of Medical Oncology, School of Medicine, Marmara University, 34899 Istanbul, Turkey; (J.H.)
| | - Javid Hüseynov
- Department of Medical Oncology, School of Medicine, Marmara University, 34899 Istanbul, Turkey; (J.H.)
| | - Alper Topal
- Department of Medical Oncology, School of Medicine, Trakya University, 22000 Edirne, Turkey; (A.T.)
| | - Nadiye Sever
- Department of Medical Oncology, School of Medicine, Marmara University, 34899 Istanbul, Turkey; (J.H.)
| | - Nargiz Majidova
- Department of Medical Oncology, School of Medicine, Marmara University, 34899 Istanbul, Turkey; (J.H.)
| | - Abdussamet Çelebi
- Department of Medical Oncology, School of Medicine, Marmara University, 34899 Istanbul, Turkey; (J.H.)
| | - Alper Yaşar
- Department of Medical Oncology, School of Medicine, Marmara University, 34899 Istanbul, Turkey; (J.H.)
| | - Rukiye Arıkan
- Department of Medical Oncology, School of Medicine, Marmara University, 34899 Istanbul, Turkey; (J.H.)
| | - Selver Işık
- Department of Medical Oncology, School of Medicine, Marmara University, 34899 Istanbul, Turkey; (J.H.)
| | - Muhammet Bekir Hacıoğlu
- Department of Medical Oncology, School of Medicine, Trakya University, 22000 Edirne, Turkey; (A.T.)
| | - Özlem Ercelep
- Department of Medical Oncology, School of Medicine, Marmara University, 34899 Istanbul, Turkey; (J.H.)
| | - Murat Sarı
- Department of Medical Oncology, School of Medicine, Marmara University, 34899 Istanbul, Turkey; (J.H.)
| | - Bülent Erdoğan
- Department of Medical Oncology, School of Medicine, Trakya University, 22000 Edirne, Turkey; (A.T.)
| | - İlhan Hacıbekiroğlu
- Department of Medical Oncology, School of Medicine, Sakarya University, 54290 Sakarya, Turkey
| | - Sernaz Topaloğlu
- Department of Medical Oncology, School of Medicine, Trakya University, 22000 Edirne, Turkey; (A.T.)
| | - Osman Köstek
- Department of Medical Oncology, School of Medicine, Marmara University, 34899 Istanbul, Turkey; (J.H.)
| | - İrfan Çiçin
- Department of Medical Oncology, School of Medicine, Trakya University, 22000 Edirne, Turkey; (A.T.)
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Shim SR, Kim SI, Kim SJ, Cho DS. Prognostic nutritional index as a prognostic factor for renal cell carcinoma: A systematic review and meta-analysis. PLoS One 2022; 17:e0271821. [PMID: 35930538 PMCID: PMC9355260 DOI: 10.1371/journal.pone.0271821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 07/07/2022] [Indexed: 11/29/2022] Open
Abstract
Background Prognostic nutritional index (PNI) is a simple parameter which reflects patient’s nutritional and inflammatory status and reported as a prognostic factor for renal cell carcinoma (RCC). Studies were included from database inception until February 2, 2022. The aim of this study is to evaluate prognostic value of PNI by meta-analysis of the diagnostic test accuracy in RCC. Methods and findings Studies were retrieved from PubMed, Cochrane, and EMBASE databases and assessed sensitivity, specificity, summary receiver operating characteristic curve (SROC) and area under curve (AUC). Totally, we identified 11 studies with a total of 7,296 patients were included to evaluate the prognostic value of PNI in RCC finally. They indicated a pooled sensitivity of 0.733 (95% CI, 0.651–0.802), specificity of 0.615 (95% CI, 0.528–0.695), diagnostic odds ratio (DOR) of 4.382 (95% CI, 3.148–6.101) and AUC of 0.72 (95% CI, 0.68–0.76). Heterogeneity was significant and univariate meta-regression revealed that metastasis and cut-off value of PNI might be the potential source of heterogeneity. Multivariate meta-regression analysis also demonstrated that metastasis might be the source of heterogeneity. Conclusions PNI demonstrated a good diagnostic accuracy as a prognostic factor for RCC and especially in case of metastatic RCC.
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Affiliation(s)
- Sung Ryul Shim
- Department of Health and Medical Informatics, Kyungnam University College of Health Sciences, Changwon, Republic of Korea
| | - Sun Il Kim
- Department of Urology, Ajou University School of Medicine, Suwon, Korea
| | - Se Joong Kim
- Department of Urology, Ajou University School of Medicine, Suwon, Korea
| | - Dae Sung Cho
- Department of Urology, Ajou University School of Medicine, Suwon, Korea
- * E-mail:
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Prognostic impact of prognostic nutritional index on renal cell carcinoma: A meta-analysis of 7,629 patients. PLoS One 2022; 17:e0265119. [PMID: 35312690 PMCID: PMC8936492 DOI: 10.1371/journal.pone.0265119] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 02/23/2022] [Indexed: 12/03/2022] Open
Abstract
Background Prognostic nutritional index (PNI) is a parameter which reflects nutritional and inflammatory status. The prognostic value of PNI in renal cell carcinoma (RCC) remains in debate. The aim of this study is to evaluate the prognostic value and clinicopathological features of PNI in RCC. Methods A literature search was performed in the databases of PubMed, Embase, Web of Science, and Cochrane Library. Hazard ratios (HRs), odds ratios (ORs), and 95% confidence intervals (CIs) were extracted for meta-analysis. The association between PNI and overall survival (OS), cancer-specific survival (CSS), disease-free survival (DFS), progression-free survival (PFS), recurrence-free survival (RFS), and clinicopathological factors were evaluated. Results Eleven studies involving 7,629 patients were included for meta-analysis. A decreased PNI was shown to be a significant predictor of worse OS (HR = 2.00, 95%CI = 1.64–2.42, p<0.001), CSS (HR = 2.54, 95%CI = 1.61–4.00, p<0.001), and DFS/PFS/RFS (HR = 2.12, 95%CI = 1.82–2.46, p<0.001) in RCC. Furthermore, a low PNI was correlated with Fuhrman grade III-IV (OR = 1.96, 95%CI = 1.27–3.02, p = 0.002), T stage T3-T4 (OR = 2.21, 95%CI = 1.27–3.87, p = 0.005), presence of sarcomatoid differentiation (OR = 5.00, 95%CI = 2.52–9.92, p<0.001), and presence of tumor necrosis (OR = 3.63, 95%CI = 2.54–5.19, p<0.001). Conclusion PNI is an independent prognostic indicator of survival and associated with Fuhrman grade, T stage, sarcomatoid differentiation, and tumor necrosis in patients with RCC.
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Xue S, Zhao H, Zhang K, Zhang H, Wang W. Prognostic and Clinicopathological Correlations of Pretreatment Prognostic Nutritional Index in Renal Cell Carcinoma: A Meta-Analysis. Urol Int 2022; 106:567-580. [PMID: 35073548 DOI: 10.1159/000521353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 12/06/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Prognostic nutritional index (PNI) was indicted as a potential prognostic biomarker for cancer. However, the conclusion remains uncertain for renal cell carcinoma (RCC). This study was to confirm the association of PNI with prognosis and clinicopathological features in RCCs. METHODS The PubMed, EMBASE, Cochrane Library, CNKI, and Wan Fang databases were searched to retrieve eligible studies. Hazard ratios (HRs) and 95% confidence intervals (CIs) were pooled to assess the strength of the association. RESULTS Fifteen studies were included. The results showed a low pretreatment PNI level was significantly associated with poor overall survival (HR = 1.67, 95% CI: 1.45-1.92), progression-free survival (HR = 1.72, 95% CI: 1.23-2.42), cancer-specific survival (HR = 1.17, 95% CI: 1.09-1.26), disease-free survival (HR = 1.28, 95% CI: 1.09-1.26), and recurrence-free survival (HR = 2.14, 95% CI: 1.38-3.31). This prognostic role of PNI was almost not changed by subgroup analysis based on study design, HR source, RCC type, sample size, cutoff, follow-up, treatment, and country. Furthermore, low PNI was correlated with old age, large tumor size and high T stage, Fuhrman grade, lymph node, and distant metastases. CONCLUSION Pretreatment PNI might be a promising indicator to beforehand predict the progression and prognosis for RCC patients.
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Affiliation(s)
- Senyao Xue
- Department of Urology, Yidu Central Hospital of Weifang, Qingzhou, China
| | - Hui Zhao
- Department of Nephrology, Yidu Central Hospital of Weifang, Qingzhou, China
| | - Kaikai Zhang
- Department of Interventional Therapy, Yidu Central Hospital of Weifang, Qingzhou, China
| | - Huapeng Zhang
- Department of Anesthesiology, Yidu Central Hospital of Weifang, Qingzhou, China
| | - Wei Wang
- Department of Anesthesiology, Yidu Central Hospital of Weifang, Qingzhou, China
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Mao C, Xu W, Ma W, Wang C, Guo Z, Yan J. Prognostic Value of Pretreatment Prognostic Nutritional Index in Patients With Renal Cell Carcinoma: A Meta-Analysis. Front Oncol 2021; 11:719941. [PMID: 34676162 PMCID: PMC8523954 DOI: 10.3389/fonc.2021.719941] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 09/10/2021] [Indexed: 01/11/2023] Open
Abstract
Background The pretreatment prognostic nutritional index (PNI) is correlated with poor prognosis in several malignancies. However, the prognostic role of PNI in patients with renal cell carcinoma (RCC) remains unclear. Therefore, we performed a meta-analysis to investigate the prognostic significance of PNI in patients with RCC. Methods We searched the PubMed, Web of Science, Embase, Scopus, and Cochrane Library databases up to February 2021. Pooled hazard ratios (HRs) and 95% confidence intervals (CIs) were used to estimate correlation between PNI and survival endpoints in RCC. Results Ten studies with 4,908 patients were included in the meta-analysis. The pooled results indicated that a low PNI associated with poor overall survival (HR = 2.10, 95% CI = 1.67–2.64, p<0.001), shorter progression-free survival, disease-free survival, recurrence-free survival (HR = 1.99, 95% CI = 1.67–2.36, p<0.001), and poor cancer-specific survival (HR = 2.95, 95% CI = 1.61–5.39, p<0.001). Additionally, the prognostic ability of PNI was not affected by subgroup analysis factors. Conclusion The meta-analysis indicated that low PNI associated with shorter survival outcomes in patients with RCC. Therefore, PNI could be used as an effective prognostic indicator in RCC.
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Affiliation(s)
- Changqing Mao
- Department of Nephrology, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Weixin Xu
- Department of Laboratory Medicine, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Weina Ma
- Department of Pharmacy, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Chun Wang
- Department of Oncology, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Zhaojiao Guo
- Department of Oncology, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Jun Yan
- Department of Oncology, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences, Shanghai, China
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Prognostic nutritional index and prognosis in renal cell carcinoma: A systematic review and meta-analysis. Urol Oncol 2021; 39:623-630. [PMID: 34253447 DOI: 10.1016/j.urolonc.2021.05.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 03/11/2021] [Accepted: 05/21/2021] [Indexed: 01/11/2023]
Abstract
PURPOSE To perform a systematic review and meta-analysis of the Prognostic Nutritional Index (PNI) as a prognostic factor for renal cell carcinoma (RCC). MATERIALS AND METHODS Eligible studies that evaluated the prognostic impact of pretreatment PNI in RCC patients were identified by comprehensive searching the electronic databases PubMed, Cochrane Central Search library, and EMBASE. The end points were overall/cancer-specific survival (OS/CSS) and recurrence-free/disease-free survival (RFS/DFS). Meta-analysis using random-effects models was performed to calculate hazard ratios (HRs) with 95 % confidence intervals (CIs). RESULTS In total, 9 retrospective, observational, case-control studies involving 5,976 patients were included for final analysis. Eight studies evaluated OS/CSS, and 5 evaluated RFS/DFS. Our results showed that lower PNI was significantly associated with unfavorable OS/CSS (HR = 1.68, 95% CI 1.44-1.96, P < 0.001, I2 = 9.2%, P = 0.359) and RFS/DFS (HR = 1.98, 95% CI 1.57-2.50, P < 0.001, I2 = 18.2%, P = 0.299) in patients with RCC. Subgroup and meta-regression analysis based on ethnicity, study sample size, presence of metastasis, PNI cut-off value, Newcastle-Ottawa quality assessment scale (NOS) score, and gender ratio all showed that lower PNI was associated with poorer OS/CSS and RFS/DFS. Funnel plots and Egger's tests indicated significant publication bias in OS/CSS (P = 0.001), but not in RFS/DFS (P = 0.757). CONCLUSION This meta-analysis indicated that lower PNI was a negative prognostic factor and associated with tumor progression and poorer survival of patients with RCC. Therefore, PNI could be a potential prognostic predictor of treatment outcomes for patients with RCC.
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Significance of preoperative hematologic scoring in predicting death among patients with non-metastatic renal cell carcinoma undergoing nephrectomy. Asian J Surg 2021; 44:952-956. [PMID: 33622600 DOI: 10.1016/j.asjsur.2021.01.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 01/06/2021] [Accepted: 01/19/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) are hematologic scoring and indicators of the systemic inflammatory response. The increasing use of NLR and PLR have been associated with poor outcome in various types of malignancy. We evaluated the effect of NLR and PLR on survival outcomes of nonmetastatic renal cell carcinoma (RCC). MATERIALS AND METHODS We retrospectively review 150 patients who had undergone nephrectomy for nonmetastatic RCC between 2006 and 2016. Cancer specific survival (CSS) was assessed using Kaplan-Meier method and compared using log-rank test. We applied univariate and multivariate Cox regression model to analyze the association of NLP and PLR with clinical outcome. RESULTS At median follow up of 33 months, 45 patients had died. High PLR (>100) was an independent prognostic hematologic marker for CSS (hazard ratio [HR] 2.61, 95% confidence interval [CI],1.08-6.31; P = 0.034). Univariate analysis identified elevated NLR (p = 0.005), and anemia (p = 0.023) were significantly associated with CSS. CONCLUSION Elevated PLR is a strong hematologic prognosis factor in term of survival for patients with nonmetastatic RCC undergoing nephrectomy with curative intent. The PLR is an easily obtained biomarker which is useful for preoperative risk stratification.
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