A Low Geriatric Nutritional Risk Index is Associated with Aggressive Pathologic Characteristics and Poor Survival after Nephrectomy in Clear Renal Cell Carcinoma: A Multicenter Retrospective Study
A Low Geriatric Nutritional Risk Index is Associated with Aggressive Pathologic Characteristics and Poor Survival after Nephrectomy in Clear Renal Cell Carcinoma: A Multicenter Retrospective Study
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DOI：
10.1080/01635581.2019.1621357
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发表时间：
2019-05-30
影响因子：
2.9
通讯作者：
Kim, Yong-June
中科院分区：
文献类型：
--
作者：
Kang, Ho Won;Seo, Sung Pil;Kim, Yong-June
目的：探讨老年营养风险指数 (GNRI) 对手术治疗的透明细胞肾细胞癌 (ccRCC) 患者的预后意义。患者和方法：我们回顾性地选择了 1988 年至 2015 年间韩国多机构合作的 4,591 名连续接受手术治疗的 ccRCC 患者。确定了 GNRI 作为连续和分类变量的临床意义。结果：术前低 GNRI 与年龄较大、低体重指数、糖尿病、体力状态差、诊断时出现症状以及病理特征（如侵袭性肿瘤特征，包括肿瘤尺寸大、晚期、高核级别、淋巴管侵犯、肉瘤分化和肿瘤坏死）显着相关。低 GNRI 与局部 (pT1-2N0M0) ccRCC 的短无复发生存期 (RFS) 和整个队列中的癌症特异性生存期 (CSS) 显着相关，并且与根据年龄类别 (65 岁) 的亚组分析中的短 RFS 和 CSS 显着相关。多变量 Cox 回归分析显示，术前 GNRI 作为连续变量或校准变量，是 RFS 和 CSS 的独立预测因子。结论：根据术前 GNRI 评估，营养不良与接受手术治疗的 ccRCC 患者的侵袭性肿瘤特征和较差的生存率相关。
Purpose: To investigated the prognostic significance of the geriatric nutritional risk index (GNRI) in patients with surgically treated clear cell renal cell carcinoma (ccRCC). Patients and methods: We retrospectively selected 4,591 consecutive patients with surgically treated ccRCC from a multi-institutional Korean collaboration between 1988 and 2015. The clinical significance of the GNRI as a continuous and categorical variable was determined. Results: Preoperative low GNRI was significantly associated with older age, low body mass index, presence of diabetes, poor performance status, and presence of symptoms at diagnosis, as well as pathologic features such as aggressive tumor characteristics including large tumor size, advanced stage, high nuclear grade, lymphovascular invasion, sarcomatous differentiation, and tumor necrosis. A low GNRI was significantly associated with a short recurrence-free survival (RFS) in localized (pT1-2N0M0) ccRCC and cancer-specific survival (CSS) in the entire cohort, and with short RFS and CSS in the subgroup analysis according to age categories (65 years). Multivariate Cox regression analysis showed that preoperative GNRI, as a continuous or categorical variable, was an independent predictor of RFS and CSS. Conclusion: Malnutrition as assessed by the preoperative GNRI is associated with aggressive tumor characteristics and poor survival in patients with surgically treated ccRCC.