Prognostic value of the geriatric nutritional risk index in patients with non-metastatic clear cell renal cell carcinoma: a propensity score matching analysis.

IF 4.4 2区 医学 Q1 NUTRITION & DIETETICS
Huiyu Zhou, Dingyang Lv, Fan Cui, Qian Gong, Jinshuai Li, Jie Wen, Mohan Jia, Yinbo Kang, Yi Rong, Wenlong Zhang, Weibing Shuang
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引用次数: 0

Abstract

Background: This study aimed to investigate the prognostic value of the geriatric nutritional risk index (GNRI) in patients with non-metastatic clear cell renal cell carcinoma (ccRCC) who underwent nephrectomy.

Methods: Patients with non-metastatic ccRCC who underwent nephrectomy between 2013 and 2021 were analyzed retrospectively. The GNRI was calculated within one week before surgery. The optimal cut-off value of GNRI was determined using X-tile software, and the patients were divided into a low GNRI group and a high GNRI group. The Kaplan-Meier method was used to compare the overall survival (OS), cancer-specific survival (CSS) and recurrence-free survival (RFS) between the two groups. Univariate and multivariate Cox proportional hazard models were used to determine prognostic factors. In addition, propensity score matching (PSM) was performed with a matching ratio of 1:3 to minimize the influence of confounding factors. Variables entered into the PSM model were as follows: sex, age, history of hypertension, history of diabetes, smoking history, BMI, tumor sidedness, pT stage, Fuhrman grade, surgical method, surgical approach, and tumor size.

Results: A total of 645 patients were included in the final analysis, with a median follow-up period of 37 months (range: 1-112 months). The optimal cut-off value of GNRI was 98, based on which patients were divided into two groups: a low GNRI group (≤ 98) and a high GNRI group (> 98). Kaplan-Meier analysis showed that OS (P < 0.001), CSS (P < 0.001) and RFS (P < 0.001) in the low GNRI group were significantly worse than those in the high GNRI group. Univariate and multivariate Cox analysis showed that GNRI was an independent prognostic factor of OS, CSS and RFS. Even after PSM, OS (P < 0.05), CSS (P < 0.05) and RFS (P < 0.05) in the low GNRI group were still worse than those in the high GNRI group. In addition, we observed that a low GNRI was associated with poor clinical outcomes in elderly subgroup (> 65) and young subgroup (≤ 65), as well as in patients with early (pT1-T2) and low-grade (Fuhrman I-II) ccRCC.

Conclusion: As a simple and practical tool for nutrition screening, the preoperative GNRI can be used as an independent prognostic indicator for postoperative patients with non-metastatic ccRCC. However, larger prospective studies are necessary to validate these findings.

非转移性透明细胞肾细胞癌患者老年营养风险指数的预后价值:倾向得分匹配分析。
背景:本研究旨在探讨老年营养风险指数(GNRI)在接受肾切除术的非转移性透明细胞肾癌(ccRCC)患者中的预后价值:对2013年至2021年间接受肾切除术的非转移性ccRCC患者进行回顾性分析。在手术前一周内计算 GNRI。使用X-tile软件确定GNRI的最佳临界值,并将患者分为低GNRI组和高GNRI组。采用 Kaplan-Meier 法比较两组患者的总生存期(OS)、癌症特异性生存期(CSS)和无复发生存期(RFS)。采用单变量和多变量考克斯比例危险模型确定预后因素。此外,还进行了倾向评分匹配(PSM),匹配比例为 1:3,以尽量减少混杂因素的影响。输入 PSM 模型的变量如下:性别、年龄、高血压病史、糖尿病病史、吸烟史、体重指数、肿瘤侧位、pT 分期、Fuhrman 分级、手术方法、手术方式和肿瘤大小:共有 645 名患者纳入最终分析,中位随访时间为 37 个月(范围:1-112 个月)。GNRI的最佳临界值为98,根据该临界值,患者被分为两组:低GNRI组(≤98)和高GNRI组(>98)。Kaplan-Meier 分析显示,低 GNRI 组的 OS(P < 0.001)、CSS(P < 0.001)和 RFS(P < 0.001)明显差于高 GNRI 组。单变量和多变量Cox分析显示,GNRI是OS、CSS和RFS的独立预后因素。即使在 PSM 后,低 GNRI 组的 OS(P < 0.05)、CSS(P < 0.05)和 RFS(P < 0.05)仍比高 GNRI 组差。此外,我们还观察到,在老年亚组(大于 65 岁)和年轻亚组(小于 65 岁)以及早期(pT1-T2)和低级别(Fuhrman I-II)ccRCC 患者中,低 GNRI 与较差的临床预后相关:结论:作为一种简单实用的营养筛查工具,术前 GNRI 可作为非转移性 ccRCC 患者术后的独立预后指标。不过,还需要更大规模的前瞻性研究来验证这些发现。
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来源期刊
Nutrition Journal
Nutrition Journal NUTRITION & DIETETICS-
CiteScore
9.80
自引率
0.00%
发文量
68
审稿时长
4-8 weeks
期刊介绍: Nutrition Journal publishes surveillance, epidemiologic, and intervention research that sheds light on i) influences (e.g., familial, environmental) on eating patterns; ii) associations between eating patterns and health, and iii) strategies to improve eating patterns among populations. The journal also welcomes manuscripts reporting on the psychometric properties (e.g., validity, reliability) and feasibility of methods (e.g., for assessing dietary intake) for human nutrition research. In addition, study protocols for controlled trials and cohort studies, with an emphasis on methods for assessing dietary exposures and outcomes as well as intervention components, will be considered. Manuscripts that consider eating patterns holistically, as opposed to solely reductionist approaches that focus on specific dietary components in isolation, are encouraged. Also encouraged are papers that take a holistic or systems perspective in attempting to understand possible compensatory and differential effects of nutrition interventions. The journal does not consider animal studies. In addition to the influence of eating patterns for human health, we also invite research providing insights into the environmental sustainability of dietary practices. Again, a holistic perspective is encouraged, for example, through the consideration of how eating patterns might maximize both human and planetary health.
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