Preoperative prognostic nutritional index is a significant predictor of survival in patients with localized upper tract urothelial carcinoma after radical nephroureterectomy.

BACKGROUND: Patient's nutritional and immunological status have a potentially significant role in survival outcome in patients with malignant tumors. We investigated the prognostic value of preoperative prognostic nutritional index (PNI) in patients with localized upper tract urothelial carcinoma (UTUC) undergoing radical nephrouretectomy (RNU).

PATIENTS AND METHODS: A total of 425 patients with nonmetastatic UTUC (Ta-4N0/+M0) who underwent RNU were evaluated. PNI was calculated as 10 × serum albumin concentration (g/dl) + 0.005 × lymphocyte counts (number/mm3 ). The associations of preoperative PNI level with clinical and pathologic variables were analyzed.

RESULTS: The optimal cutoff value of PNI for cancer-specific survival (CSS) stratification was determined to be 46.78. Multivariate analysis identified low PNI as an independent prognostic factor for CSS (HR = 1.98, 95% CI: 1.31-2.99, P = 0.001) and overall survival (HR = 1.74, 95% CI: 1.20-2.53, P = 0.004). The estimated c-index of the multivariate model for CSS and overall survival increased from 0.777 and 0.767 to 0.791 and 0.774, respectively, when PNI added, which was higher than hypoalbuminemia (albumin<37.75g/l) or neutrophil-to-lymphocyte ratio >2.955 added.

CONCLUSIONS: Preoperative PNI was an independent prognostic factor for predicting survival in patients with UTUC undergoing RNU. Preoperative PNI may become a useful biomarker, particularly because of its low associated cost and easy accessibility.