nutrition_urologie

ONCOSCREEN - Evaluation of a psychosocial and supportive care screening in cancer patients

Sat, 09 Mar 2024 08:25:16 +0000

Author Names: Ratjen I.,Stolzel F.,Agius M.,Clemens R.,Cordesmeyer L.,Dittmann F.,Gesewsky L.,Knispel E.,Von Lehmden M.,Medlin J.,Schmid L.,Sohl M.F.,Hamm A.F.,Schwitlick C.,Khandanpour C.,Letsch A.

Database Source: Embase Weekly Updates

Journal Title: Oncology Research and Treatment

Article Title: ONCOSCREEN - Evaluation of a psychosocial and supportive care screening in cancer patients

Year: 2024

Issue: Supplement 1

Volume: 47

Abstract: Background: Many cancer patients do not report their supportive care needs of their own volition. To identify cancer patients' demand for psychosocial and/or further supportive care, screening instruments are routinely applied in certified cancer centers. ONCOSCREEN evaluates a widened supportive cancer care screening (SCCS). <br/>Method(s): Starting in June 2023, participating in- and outpatient cancer patients treated at the University Hospital Schleswig-Holstein are asked to fill in SCS questionnaires, consisting of the NCCN Distress Thermometer and Problem List, the Minimal Documentation System, a nutrition self-report questionnaire leaned on the Nutritional Risk Score and the Minimal Nutritional Assessment, questions on physical activity from the Bewegungs- und Sportaktivitat questionnaire (BSA) and overall scores on quality of life based on the EORTC QLQ-C30. As recruitment is ongoing, preliminary data on study sample characteristics and psychosocial distress are presented. <br/>Result(s): Up to August 15th 2023, more than 326 patients participated in ONCOSCREEN, comprising 145 patients with hematological, 41 urological, 41 nasopharynx/oropharynx/mouth, 39 gynecological, 38 gastrointestinal, 13 musculoskeletal, 8 lung and 1 neuroendocrine cancers. Mean age was 63+/-13.5 years (range, 19-89 y), 45% of the participants were female. Mean value on the distress thermometer was 4,9+/-2,6, with 185 patients (57%) having a score of >= 5 which is defined as indication for psychosocial care need. <br/>Discussion(s): The ONCOSCREEN cohort consists of a broad range of oncological patients representing the whole adult age range. Preliminary results on psychosocial distress in ONCOSCREEN are in line with findings of other studies. A substantial proportion of patients show high distress scores exemplifying the need for psychosocial supportive care. <br/>Conclusion(s): First results of the ongoing ONCOSCREEN-study show a high need of psychosocial supportive care measures and reinforce the goal of evaluating a comprehensive SCCS.

Rolle der Ernährung in der urologischen Prähabilitation.

Sun, 01 Oct 2023 04:00:00 +0000

Die Urologie; 10/01/2023
(AN 172916553); ISSN: 27317064
CINAHL Complete

Clinical utility of the prognostic nutritional index in patients with metastatic hormone-sensitive prostate cancer: A retrospective, multicenter, cohort study

Sun, 10 Sep 2023 00:00:00 +0000

Prostate. 2023 Dec;83(16):1610-1618. doi: 10.1002/pros.24619. Epub 2023 Sep 10.

ABSTRACT

BACKGROUND: The prognostic nutritional index (PNI) based on the serum albumin level and the lymphocyte count has been investigated as a prognostic factor in patients with malignant tumors. However, it has been poorly studied in prostate cancer (PCa), and little is known about its clinical utility.

METHODS: Clinical data of 353 patients with de novo, metastatic, hormone-sensitive PCa (mHSPC) who received androgen deprivation therapy (ADT) were obtained from multiple institutions between 2000 and 2019. The impacts of the pretreatment PNI level on treatment response and survival, together with clinical parameters, were examined. The Mann-Whitney U test, Cox proportional hazards models, and Kaplan-Meier methods were used to evaluate significance.

RESULTS: The median age and initial prostate-specific antigen level were 73 and 266.18 ng/mL, respectively. Patients with a low PNI had shorter progression-free survival (PFS), cancer-specific survival (CSS), and overall survival (OS) (p < 0.0001). On multivariate analysis, low PNI was an independent prognostic factor for OS (p = 0.0027, HR = 1.65), as well as advanced age (p = 0.049, HR = 1.38), the International Society of Urological Pathology (ISUP) grade group (GG) 5 (p = 0.0027, HR = 1.69), and elevated lactate dehydrogenase (LDH) (p < 0.0001, HR = 2.08). A propensity score-matching analysis showed that the PNI level remained a significant prognostic biomarker for PFS (p = 0.0263), CSS (p = 0.0006), and OS (p = 0.0015). Furthermore, a novel risk classification using PNI, LDH, and the ISUP GG was established to stratify patients' prognosis. An increase in the number of risk factors was significantly correlated with poor outcomes.

CONCLUSIONS: A low pretreatment PNI might be an effective biomarker of poor treatment response and survival in patients with mHSPC undergoing ADT.

PMID:37690087 | DOI:10.1002/pros.24619

Relationship between Bladder Cancer, Nutritional Supply, and Treatment Strategies: A Comprehensive Review

Sat, 09 Sep 2023 00:00:00 +0000

Nutrients. 2023 Aug 31;15(17):3812. doi: 10.3390/nu15173812.

ABSTRACT

Bladder cancer (BC) is the predominant neoplasm affecting the urinary system and ranks among the most widespread malignancies globally. The causes of bladder cancer include genetic factors; age; sex; and lifestyle factors, such as imbalanced nutrition, obesity, and metabolic disorders. The lack of proper nutrient intake leads to the development of bladder cancer because insufficient nutrients are consumed to prevent this disease. The purpose of this review was to analyze the nutrients closely linked to the onset and advancement of bladder cancer and to explore the relationship between dietary nutrients and bladder cancer. Particular emphasis was placed on nutrients that are frequently ingested in daily life, including sugar, fat, protein, and others. The focus of this research was to analyze how nutritional intake before and after surgery affects the recovery process of patients who have been diagnosed with bladder cancer. This article seeks to increase awareness among both society and the medical community about the significance of implementing appropriate dietary nutrition to reduce the chances of developing bladder cancer, enhance perioperative care for patients with bladder cancer, and aid in their recuperation.

PMID:37686845 | PMC:PMC10490344 | DOI:10.3390/nu15173812

Prognostic Ability of Nutritional Indices for Outcomes of Bladder Cancer: A Systematic Review and Meta-Analysis

Tue, 29 Aug 2023 00:00:00 +0000

Urol Int. 2023;107(9):886-894. doi: 10.1159/000531884. Epub 2023 Aug 29.

ABSTRACT

BACKGROUND: Nutrition has become an important parameter influencing the prognosis of several cancers. However, its impact on outcomes for bladder cancer (BC) is still unclear. This review examines the association between three commonly used nutritional indices, namely, the prognostic nutritional index (PNI), controlling nutritional status (CONUT), and the geriatric nutritional risk index (GNRI) and outcomes of BC.

METHODS: PubMed, CENTRAL, Scopus, Web of Science, Embase, and Google Scholar were explored for studies published up to April 13, 2023. Data from studies were pooled to examine the association between PNI, CONUT, or GNRI and overall survival (OS) and recurrence-free survival (RFS).

RESULTS: Thirteen studies were included. Meta-analysis demonstrated significantly poor OS with low PNI versus high PNI in BC patients (hazard ratio [HR]: 1.71; 95% confidence interval [CI]: 1.37, 2.14; I2 = 0%). This result remained significant in various subgroup analyses. However, no association was noted between PNI and RFS (HR: 1.22; 95% CI: 0.67, 2.24; I2 = 84%). Meta-analysis showed that patients with high CONUT scores had significantly poor OS (HR: 2.43; 95% CI: 1.82, 3.25; I2 = 0%) as well as RFS (HR: 2.90; 95% CI: 2.10, 4.01; I2 = 0%). Data on GNRI were scarce and conflicting.

CONCLUSION: Limited data show that PNI and CONUT are predictive of outcomes in BC. Low PNI was associated with poor OS, while high CONUT was associated with poor OS and RFS. Data on GNRI are too scarce to obtain conclusions. Further studies are needed to supplement the results.

PMID:37643581 | DOI:10.1159/000531884

Lifestyle aspects in a contemporary middle-European cohort of patients undergoing androgen deprivation therapy for advanced prostate cancer: data from the non-interventional LEAN study.

Mon, 14 Aug 2023 04:00:00 +0000

British Journal of Nutrition; 08/14/2023
(AN 164721921); ISSN: 00071145
CINAHL Complete

Preoperative Nutritional Status and Enhanced Recovery after Surgery (ERAS) Prior to Radical Cystectomy: A Review of the Literature

Wed, 09 Aug 2023 00:00:00 +0000

Nutr Cancer. 2023;75(9):1743-1751. doi: 10.1080/01635581.2023.2244172. Epub 2023 Aug 8.

ABSTRACT

Preoperative nutritional status is an important and modifiable risk factor of a patient's recovery and outcome after radical cystectomy. There are multiple malnutrition screening tools and treatment options. In this review, we discuss the best indicators of this condition and how to optimize nutrition status prior to radical cystectomy.

PMID:37553951 | DOI:10.1080/01635581.2023.2244172

Risk Investigation and Analysis of Risk Factors for Malnutrition in Patients with Advanced Kidney Cancer: A Single-Centre Retrospective Study

Mon, 07 Aug 2023 00:00:00 +0000

Arch Esp Urol. 2023 Jul;76(5):328-334. doi: 10.56434/j.arch.esp.urol.20237605.38.

ABSTRACT

OBJECTIVE: To investigate the nutritional status of patients with advanced kidney cancer and analyse the risk factors for malnutrition in such patients.

METHODS: The study selected the clinical data of 103 patients with advanced kidney cancer who were admitted to Qingdao Jiaozhou Central Hospital from February 2020 to February 2022 for a retrospective analysis. The Subjective Global Assessment of Nutrition scale was used to evaluate the nutritional status of all research subjects. Patients' baseline data, such as gender, age and clinical classifications, and laboratory indicators, such as albumin and C-reactive protein (CRP), were collected, and multivariate logistic regression was used to screen the independent risk factors for malnutrition in patients with advanced kidney cancer.

RESULTS: A total of 78 (76.00%) individuals among the 103 patients with advanced kidney cancer had malnutrition. The results of univariate analysis showed marked differences in the age, body mass index (BMI), albumin, haemoglobin, CRP, diabetes, anorexia and family monthly income of patients of the good nutrition and malnutrition groups (p < 0.05). The results of logistic regression showed that age ≥65 years old (odds ratio (OR) = 29.187), albumin <40 g/L (OR = 0.025), haemoglobin <110 g/L (OR = 0.049), the presence of diabetes (OR = 28.138), the presence of anorexia (OR = 98.739), BMI <18.5 kg/m² (OR = 0.024) and CRP <3 mg/L (OR = 24.819) were independent influencing factors of malnutrition in the patients with advanced kidney cancer (all p < 0.05).

CONCLUSIONS: The incidence of malnutrition in patients with advanced kidney cancer is relatively high. Therefore, the understanding of malnutrition in such patients in clinical work must be fortified, and attention should be paid to screening the above risk factors and implementing active measures in nutrition therapy to reduce the risk of malnutrition in patients with advanced kidney cancer and prolong their survival time.

PMID:37545151 | DOI:10.56434/j.arch.esp.urol.20237605.38

Immunonutrition in Radical Cystectomy: State of the Art and Perspectives.

Sat, 15 Jul 2023 04:00:00 +0000

Cancers; 07/15/2023
(AN 168601840); ISSN: 20726694
CINAHL Complete

Prognostic nutritional index combined with NLR to construct a survival prediction model and decision analysis of patients with muscle-invasive bladder cancer after surgery

Thu, 18 May 2023 00:00:00 +0000

Cancer Med. 2023 Jul;12(13):14207-14224. doi: 10.1002/cam4.6088. Epub 2023 May 18.

ABSTRACT

OBJECTIVES: To build a nomogram prediction model, assess its predictive ability, and perform a survival decision analysis on patients with muscle-invasive bladder cancer (MIBC) to study risk factors affecting overall survival (OS).

METHODS: A retrospective analysis was performed on the clinical information of 262 patients with MIBC who underwent radical cystectomy (RC) at the Urology Department of the Second Affiliated Hospital of Kunming Medical University between July 2015 and August 2021. The final model variables that were included were chosen using single-factor stepwise Cox regression, optimal subset regression, and LASSO regression + cross-validation with the minimum AIC value. The next step was to do a multivariate Cox regression analysis. The establishment of a nomogram model by fitting and the screening out of independent risk factors impacting the survival of patients with MIBC having radical resection. Receiver Activity Characteristic curves, C-index, and a calibration plot evaluated the prediction accuracy, validity, and clinical benefit of the model. The 1-, 3-, and 5-year survival rates were then computed for each risk factor using a Kaplan-Meier survival analysis.

RESULTS: 262 eligible patients in total were enrolled. With a median follow-up of 32 months, the follow-up period ranged from 2 to 83 months. 171 cases (65.27%) survived while 91 cases (34.73%) perished. Age (HR = 1.06 [1.04; 1.08], p = 0.001), preoperative hydronephrosis (HR = 0.69 [0.46, 1.05], p = 0.087), T stage (HR = 2.06 [1.09, 3.93], p = 0.027), lymphovascular invasion (LVI, HR = 1.73 [1.12, 2.67], p = 0.013), prognostic nutritional index (PNI, HR = 1.70 [1.09, 2.63], p = 0.018), and neutrophil-to-lymphocyte ratio (NLR, HR = 0.52 [0.29, 0.93)], p = 0.026) were independent risk factor for the survival of bladder cancer patients. Create a nomogram based on the aforementioned findings, and then draw the 1-year, 3-year, and 5-year OS receiver operating characteristic curves by the nomogram. The AUC values were 0.811 (95% CI [0.752, 0.869]), 0.814 (95% CI [0.755, 0.873]), and 0.787 (95% CI [0.708, 0.865]), respectively, and the calibration plot matched the predicted value well. The 1-year, 3-year, and 5-year decision curve analyses were higher than the ALL line and None line at threshold values of >5%, 5%-70%, and 20%-70% indicating that the model has good clinical applicability. The calibration plot for the Bootstrap 1000-time resampled validation model was similar to the actual value. Patients with preoperative combination hydronephrosis, higher T-stage, combined LVI, low PNI, and high NLR had worse survival, according to Kaplan-Meier survival analysis for each variable.

CONCLUSIONS: This study might conclude that PNI and NLR were separate risk factors that affect a patient's OS after RC for MIBC. The prognosis of bladder cancer may be predicted by PNI and NLR, but additional confirmation in randomized controlled trials is required.

PMID:37199384 | PMC:PMC10358268 | DOI:10.1002/cam4.6088

Clinical significance of prognostic nutritional index (PNI)-monocyte-to-lymphocyte ratio (MLR)-platelet (PLT) score on postoperative outcomes in non-metastatic clear cell renal cell carcinoma

Wed, 10 May 2023 00:00:00 +0000

BMC Surg. 2023 May 10;23(1):117. doi: 10.1186/s12893-023-02001-x.

ABSTRACT

BACKGROUND: Prognositic nutritional index (PNI), monocyte-to-lymphocyte ratio (MLR) and platelet (PLT) are associated with tumor survival in many human malignancies. Whereas, no study combined PNI-MLR-PLT score and indicated its predictive significance on the prognosis of patients with non-metastatic clear cell renal cell carcinoma (ccRCC).

METHODS: In this study, we retrospectively collected the clinicopathological characteristics and prognostic data from 164 cases of non-metastatic ccRCC and aimed to determine the clinical significance of PNI-MLR-PLT score on patients' outcomes after surgery. The optimal cut-off values of PNI (PNI > 47.40 vs PNI < 47.40), MLR (MLR > 0.31 vs MLR < 0.31) and PLT (PLT > 245 vs PLT < 245) were identified with relative operating characteristic (ROC) curve analysis. The PNI-MLR-PLT score system was established by the value of three indexes, each indication was assigned a score of 0 or 1. Overall survival (OS) and metastasis-free survival (MFS) were analyzed using Kaplan-Meier estimate and Cox regression models.

RESULTS: The mean follow-up period was 85.67 months. Eight (5.0%) patients died, 4 (2.0%) relapsed, and 7 (4.0%) developed metastasis after surgery. The 3-year OS and MFS rates were 98.2% and 97.6%, and the 5-year OS and MFS rates were both 90.2%. Our results suggested that PNI-MLR-PLT score negatively correlated with pathological T stage and tumor grade. Survival outcomes revealed that lower PNI-MLR-PLT score is associated with inferior OS (P < 0.001) and MFS (P < 0.001) after surgery. Subgroup analysis regarding pathological T stage, tumor grade and surgical modalities obtained consistent results. univariable and multivariable Cox analysis showed that high PNI-MLR-PLT score was the independent protective factor of tumor survival in non-metastatic ccRCC patients.

CONCLUSIONS: Our data suggested that PNI-MLR-PLT score could serve as a promising independent prognostic factor in patients with non-metastatic ccRCC.

PMID:37165423 | PMC:PMC10170679 | DOI:10.1186/s12893-023-02001-x

The impact of nutritional status and changes of body composition on the prognosis of metastatic renal cell carcinoma patients

Wed, 10 May 2023 00:00:00 +0000

J Med Invest. 2023;70(1.2):80-87. doi: 10.2152/jmi.70.80.

ABSTRACT

PURPOSE: This study aimed to analyze the impact of patients' nutritional status and changes in body composition on the prognosis of metastatic renal cell carcinoma (mRCC) patients who received systemic therapy with tyrosine kinase inhibitors (TKIs).

METHODS: A total of 57 mRCC patients who received systemic therapy with TKIs as first-line therapy at our facility between November 2004 and October 2018 were included. The Prognostic Nutritional Index (PNI) was used to evaluate their nutritional status. The volumes of skeletal muscle mass and fat tissue were calculated using the SYNAPSE VINCENT system. The effects of nutritional status and body composition of mRCC patients on progression-free survival (PFS) and overall survival (OS) were analyzed using Cox regression methods.

RESULTS: Low PNI at the start of systemic therapy was a significant prognostic predictor for OS (HR 3.807 [95% CI 1.205-12.027], P=0.046), and it was related to loss of muscle mass three months after systemic therapy. Although the loss of muscle mass at the start of systemic therapy was not associated with OS, loss of muscle mass during treatment predicted worse OS.

CONCLUSIONS: Nutritional status of mRCC patients may predict changes in body composition and be associated with their prognosis. J. Med. Invest. 70 : 80-87, February, 2023.

PMID:37164748 | DOI:10.2152/jmi.70.80

Investigating the differences in nutritional status between successfully weaned and unsuccessfully weaned respirator patients

Tue, 02 May 2023 00:00:00 +0000

Sci Rep. 2023 May 2;13(1):7144. doi: 10.1038/s41598-023-34432-0.

ABSTRACT

Long-term respirator users admitted to intensive care units need to be transferred to a respiratory care center (RCC) for weaning. It may cause malnutrition in critical care patients, which may manifest as a reduction in respiratory muscle mass, lower ventilatory capacity, and decreased respiratory tolerance. This study aimed to assess that if the patients' nutritional status were improved, it could help RCC patients to wean from respirators. All participants were recruited from the RCC of a medical foundation in the city and Taipei Tzu Chi Hospital. The indicators include serum albumin level, respirator detachment index, maximum inspiratory pressure (PImax), rapid shallow breathing index, and body composition measurements. We recorded the length of hospital stay, mortality, and RCW (respiratory care ward) referral rate for these participants and analyzed the differences in relevant research indicators between those who were and weren't weaned off. 43 of 62 patients were weaned from respirators, while 19 failed. The resuscitation rate was 54.8%. Patients with respirator weaning had a lower number of RCC admission days (23.1 ± 11.1 days) than respirator-dependent patients (35.6 ± 7.8 days, P < 0.05). The PImax of successfully weaned patients had a greater reduction (- 27.09 ± 9.7 cmH₂O) than unsuccessful ones (- 21.4 ± 10.2 cmH₂O, P < 0.05). The Acute Physiology and Chronic Health Evaluation II (APACHE II) scores of successfully weaned patients (15.8 ± 5.0) were lower than those who were not (20.4 ± 8.4, P < 0.05). There was no significant difference in serum albumin levels between the two groups. In the successfully weaned patients, the serum albumin concentration was increased from 2.2 ± 0.3 to 2.5 ± 0.4 mg/dL, P < 0.05. Improved nutritional status can help RCC patients to wean from respirators.

PMID:37130876 | PMC:PMC10154359 | DOI:10.1038/s41598-023-34432-0

Hemoglobin, Albumin, Lymphocyte, and Platelet Count is a Significant Biomarker Surrogate for Nutritional Status to Predict Overall Survival in Patients Post-radical Cystectomy

Thu, 27 Apr 2023 00:00:00 +0000

Urol Pract. 2023 May;10(3):262-269. doi: 10.1097/UPJ.0000000000000386. Epub 2023 Jan 24.

ABSTRACT

INTRODUCTION: Nutritional status is an independent predictor of overall survival after radical cystectomy. Various biomarkers of nutritional status are proposed to predict postoperative outcome, including albumin, anemia, thrombocytopenia, and sarcopenia. Recently, a score comprising hemoglobin, albumin, lymphocyte, and platelet counts was postulated as an encompassing biomarker to predict overall survival post-radical cystectomy in a single-institution study. However, cutoffs for hemoglobin, albumin, lymphocyte, and platelet count are not well defined. In this study, we analyzed hemoglobin, albumin, lymphocyte, and platelet count thresholds predicting overall survival and examined the platelet-to-lymphocyte as an additional prognostic biomarker.

METHODS: Fifty radical cystectomy patients were retrospectively evaluated from 2010-2021. American Society of Anesthesiologists classification, pathological data, and survival were extracted from our institutional registry. Univariable and multivariable Cox regression analysis was fit to the data to predict overall survival.

RESULTS: Median follow-up was 22 (12-54) months. Hemoglobin, albumin, lymphocyte, and platelet count (continuous) was a significant predictor of overall survival on multivariable Cox regression analysis (HR 0.95, 95% CI: 0.90-0.99, P = .03), adjusting for Charlson Comorbidity Index, lymphadenopathy (pN >N0), muscle-invasive disease, and neoadjuvant chemotherapy. Optimal hemoglobin, albumin, lymphocyte, and platelet count cutoff was 25.0. Patients with hemoglobin, albumin, lymphocyte, and platelet count <25.0 had inferior overall survival (median, 33 months) vs with those with hemoglobin, albumin, lymphocyte, and platelet count ≥25.0 (median, not reached) (P = .03).

CONCLUSIONS: Low hemoglobin, albumin, lymphocyte, and platelet count <25.0 was an independent predictor of inferior overall survival.

PMID:37103496 | DOI:10.1097/UPJ.0000000000000386

Development of an immune-nutritional prognostic index in patients with muscle-infiltrating bladder cancer candidates for radical cystectomy

Thu, 20 Apr 2023 00:00:00 +0000

Actas Urol Esp (Engl Ed). 2023 Jan-Feb;47(1):34-40. doi: 10.1016/j.acuroe.2022.09.001. Epub 2022 Sep 6.

ABSTRACT

INTRODUCTION: Muscle-infiltrating bladder tumor (MIBT) has a recurrence-free survival (RFS) of 50% at 5 years. Although neoadjuvant chemotherapy (NCT) has increased it by 8%, which group of patients benefits the most from this treatment remains unclear.

OBJECTIVE: Evaluate the prognostic value of immune-nutritional status in patients with MIBT who are candidates for cystectomy, and to develop a score that allows identifying patients with a worse prognosis (pT3-4 and/or pN0-1).

MATERIAL AND METHODS: A retrospective analysis was carried out on 284 patients with MIBT treated with radical cystectomy. Preoperative laboratory tests were analyzed and immune-nutritional indices were calculated. The Kaplan-Meier method was used to calculate the PFS. Cox regression was used for multivariate analysis.

RESULTS: Univariate analysis showed a statistically significant relationship with leukocyte/lymphocyte index (p = 0.0001), neutrophil/lymphocyte index (p = 0.02), prognostic nutritional index (p = 0.002), and platelet/lymphocyte ratio (p = 0.002). In multivariate analysis, the leukocyte/lymphocyte ratio (p = 0.002) and PNI (p = 0.04) behaved as independent prognostic factors of decreased RFS. Based on these, a prognostic score was developed to classify patients into 3 prognostic groups. Eighty percent of patients with pT3-4 and/or pN0-1 tumors were in the intermediate-poor prognostic groups.

CONCLUSION: The implementation of a precystectomy immune-nutritional score in clinical practice would help in the selection of a group of patients with a more unfavorable pathologic stage and worse PFS. We believe that these patients could benefit more from a NACT.

PMID:37078843 | DOI:10.1016/j.acuroe.2022.09.001

GNRI Sustainability during One Cycle of First-Line Chemotherapy as a Prognostic Indicator in Patients with Metastatic Urothelial Carcinoma.

Sat, 01 Apr 2023 04:00:00 +0000

Oncology; 04/01/2023
(AN 162938263); ISSN: 00302414
CINAHL Complete

Predictive Value of Inflammatory and Nutritional Indexes in the Pathology of Bladder Cancer Patients Treated with Radical Cystectomy

Tue, 28 Mar 2023 00:00:00 +0000

Curr Oncol. 2023 Feb 21;30(3):2582-2597. doi: 10.3390/curroncol30030197.

ABSTRACT

In recent years, the focus of numerous studies has been the predictive value of inflammatory and nutritional parameters in oncology patients. The aim of our study was to examine the relationship between the inflammatory and nutritional parameters and the histopathological characteristics of patients with bladder cancer. A retrospective study included 491 patients who underwent radical cystectomy for bladder cancer between 2017 and 2021. We calculated the preoperative values of the neutrophil-to-lymphocyte ratio (NLR), the derived neutrophil-to-lymphocyte ratio (dNLR), the systemic immune-inflammation index (SII), the systemic inflammatory response index (SIRI), the platelet-to-lymphocyte ratio (PLR), the lymphocyte-to-monocyte ratio (LMR), the prognostic nutritional index (PNI), and the geriatric nutritional risk index (GNRI). Statistically significant positive correlations were observed between NLR, dNLR, SII, SIRI, and PLR and the pathological stage of the tumor. We observed statistically significant inverse correlations for LMR, PNI, and GNRI with the tumor stage. SIRI was identified as an independent predictor of the presence of LVI. dNLR was identified as an independent predictor of positive surgical margins. GNRI was identified as an independent predictor of the presence of metastases in the lymph nodes. We noticed the predictive value of SIRI, dNLR, and GNRI in the pathology of bladder cancer patients.

PMID:36975410 | PMC:PMC10047817 | DOI:10.3390/curroncol30030197

Immune-inflammatory-nutritional status predicts oncologic outcomes after radical cystectomy for urothelial carcinoma of bladder

Thu, 02 Feb 2023 00:00:00 +0000

Actas Urol Esp (Engl Ed). 2023 Sep;47(7):430-440. doi: 10.1016/j.acuroe.2023.01.001. Epub 2023 Jan 31.

ABSTRACT

OBJECTIVE: To perform the first investigation of the role of immune-inflammatory-nutritional status (INS) on oncological outcomes in patients undergoing open radical cystectomy (ORC) for urothelial carcinoma (UC).

MATERIALS AND METHODS: The records of consecutive patients who underwent ORC for non-metastatic bladder cancer between 2009 and 2020 were retrospectively analyzed. Neoadjuvant chemotherapy, non-urothelial tumor biology, and absence of oncological follow-up were exclusion criteria. Systemic immune-inflammatory index (SII) and Prognostic Nutritional Index (PNI) values were calculated and optimal cut-off values for these were used to designate four subgroups: "high SII-high PNI", "low SII-high PNI", "low SII-low PNI", and "high SII-low PNI". The Low SII-high PNI INS group had best overall survival (OS) rate while the remainder were included in non-favorable INS group. Survival curves were constructed, and a multivariate Cox regression model was used for OS and recurrence-free survival (RFS).

RESULTS: After exclusions, the final cohort size was 173 patients. The mean age was 64.31 ± 8.35 and median follow-up was 21 (IQR: 9-58) months. Optimal cut-off values for SII and PNI were 1216 and 47, respectively. The favorable INS group (low SII-high PNI, n = 89) had the best OS rate (62.9%). Multivariate Cox regression analysis indicated that non-favorable INS (n = 84) was a worse independent prognostic factor for OS (HR: 1.509, 95%CI: 1.104-3.145, p = 0.001) and RFS (HR: 1.285; 95%CI: 1.009-1.636, p = 0.042).

CONCLUSION: Preoperative assessment of INS may be a useful prognostic panel for OS and RFS in patients who had ORC for UC.

PMID:36731820 | DOI:10.1016/j.acuroe.2023.01.001

Pre-operative prognostic nutritional index as a predictive factor for prognosis in non-metastatic renal cell carcinoma treated with surgery

Tue, 31 Jan 2023 00:00:00 +0000

Beijing Da Xue Xue Bao Yi Xue Ban. 2023 Feb 18;55(1):149-155. doi: 10.19723/j.issn.1671-167X.2023.01.023.

ABSTRACT

OBJECTIVE: To evaluate the implications of the prognostic nutrition index (PNI) in non-metastatic renal cell carcinoma (RCC) patients treated with surgery and to compare it with other hematological biomarkers, including neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and systemic immune inflammation index (SII).

METHODS: A cohort of 328 non-metastatic RCC patients who received surgical treatment between 2010 and 2012 at Peking University First Hospital was analyzed retrospectively. Receiver operating characteristic (ROC) curve analysis was used to determine the optimal cutoff values of the hematological biomarkers. The Youden index was maximum for PNI was value of 47.3. So we divided the patients into two groups (PNI≤ 47. 3 and >47. 3) for further analysis. Categorical variables [age, gender, body mass index (BMI), surgery type, histological subtype, necrosis, pathological T stage and tumor grade] were compared using the Chi-square test and Student' s t test. The association of the biomarkers with overall survival (OS) and disease-free survival (DFS) was analyzed using Kaplan-Meier methods with log-rank test, followed by multivariate Cox proportional hazards model.

RESULTS: According to the maximum Youden index of ROC curve, the best cut-off value of PNI is 47. 3. Low level of PNI was significantly associated with older age, lower BMI and higher tumor pathological T stage (P < 0.05). Kaplan-Meier univariate analysis showed that lower PNI was significantly correlated with poor OS and DFS (P < 0.05). In addition, older age, lower BMI, tumor necrosis, higher tumor pathological T stage and Fuhrman grade were significantly correlated with poor OS (P < 0.05). Cox multivariate analysis showed that among the four hematological indexes, only PNI was an independent factor significantly associated with OS, whether as a continuous variable (HR=0.9, 95%CI=0.828-0.978, P=0.013) or a classified variable (HR=2.397, 95%CI=1.061-5.418, P=0.036).

CONCLUSION: Low PNI was a significant predictor for advanced pathological T stage, decreased OS, or DFS in non-metastatic RCC patients treated with surgery. In addition, PNI was superior to the other hematological biomar-kers as a useful tool for predicting prognosis of RCC in our study. It should be externally validated in future research before the PNI can be used widely as a predictor of RCC patients undergoing nephrectomy.

PMID:36718704 | PMC:PMC9894816 | DOI:10.19723/j.issn.1671-167X.2023.01.023

GNRI Sustainability during One Cycle of First-Line Chemotherapy as a Prognostic Indicator in Patients with Metastatic Urothelial Carcinoma

Mon, 23 Jan 2023 00:00:00 +0000

Oncology. 2023;101(4):224-233. doi: 10.1159/000529203. Epub 2023 Jan 23.

ABSTRACT

INTRODUCTION: This study evaluated the prognostic value of a sustained high Geriatric Nutritional Risk Index (GNRI) during first-line chemotherapy for patients with metastatic urothelial carcinoma (mUC).

METHODS: Between January 2018 and February 2022, 123 patients received platinum-based chemotherapy at Nagoya City University Hospital and affiliated institutions. Of these, 118 eligible patients who showed an Eastern Cooperative Oncology Group performance status (ECOG-PS) between 0 and 2 were retrospectively examined. Based on body mass index and serum albumin levels, GNRI was calculated immediately before and after the first primary chemotherapy cycle. Patients were divided into two groups based on GNRI: GNRI sustained ≥92 in sustainable (n = 63) and GNRI <92 in unsustainable (n = 55) groups, respectively. Clinical outcomes were compared.

RESULTS: No significant differences were noted between the two groups for age, gender, cycle of first-line treatment, and type of series of sequential treatments after failure of first-line therapy. Median overall survival from the start of first-line chemotherapy was 30.2 months (95% confidence interval [CI]: 20.9-NA) for sustainable and 12.6 months (95% CI: 9.0-21.2) for unsustainable groups, respectively (p < 0.05). Multivariate analysis identified ECOG-PS:2 and fatigue, an adverse event, as independent predictors of unsustainable GNRI transition (95% CI: 1.29-90.6, odds ratio [OR]: 10.8; 95% CI: 1.06-26.9, OR: 5.34, respectively).

CONCLUSION: Sustaining a high level of GNRI was an important prognostic indicator in patients with mUC receiving first-line chemotherapy. Appropriate intervention for controlling adverse events, including fatigue, may enhance physical strength during cancer treatment.

PMID:36689919 | DOI:10.1159/000529203

The geriatric nutritional risk index predicts complications after nephrectomy for renal cancer

Tue, 13 Dec 2022 00:00:00 +0000

Int Braz J Urol. 2023 Jan-Feb;49(1):97-109. doi: 10.1590/S1677-5538.IBJU.2022.0380.

ABSTRACT

PURPOSE: We examined if malnutrition, as defined by the Geriatric Nutritional Risk Index (GNRI), is independently associated with 30-day postoperative complications in patients undergoing nephrectomy for the treatment of renal cancer.

MATERIALS AND METHODS: Using the American College of Surgeons National Surgical Quality Improvement Program database from 2006-2019, we identified patients ≥65 years old who underwent nephrectomy for renal cancer. The following formula for GNRI was used to define preoperative nutritional status: 1.489 x serum albumin (g/L) + 41.7 x (current body weight [kg]/ ideal body weight [kg]). Based on the GNRI, patients were classified as having no (> 98), moderate (92-98), or severe malnutrition (< 92). After adjusting for potential confounders, multivariable logistic regression analyses were performed to assess the association between GNRI and 30-day postoperative complications. Odds ratios (OR) with 95% confidence intervals (CI) were reported.

RESULTS: A total of 7,683 patients were identified, of which 1,241 (16.2%) and 872 (11.3%) had moderate and severe malnutrition, respectively. Compared to normal nutrition, moderate and severe malnutrition were significantly associated with a greater odds of superficial surgical site infection, progressive renal insufficiency, readmission, extended length of stay, and non-home discharge. Severe malnutrition was also associated with urinary tract infection (OR 2.10, 95% CI 1.31-3.35) and septic shock (OR 2.93, 95% CI 1.21-7.07).

CONCLUSION: Malnutrition, as defined by a GNRI ≤ 98, is an independent predictor of 30-day complications following nephrectomy. The GNRI could be used to counsel elderly patients with renal cancer prior to nephrectomy.

PMID:36512458 | PMC:PMC9881808 | DOI:10.1590/S1677-5538.IBJU.2022.0380

Geriatric Nutritional Risk Index as a Predictor of Prognosis in Metastatic Renal Cell Carcinoma Treated with Nivolumab

Wed, 30 Nov 2022 00:00:00 +0000

Nutr Cancer. 2023;75(2):670-677. doi: 10.1080/01635581.2022.2152061. Epub 2022 Nov 30.

ABSTRACT

BACKGROUND: The Geriatric Nutritional Risk Index (GNRI) has been reported as a screening tool to assess the nutrition-related risk with mortality in older patients and those with the various diseases. However, the prognostic value of GNRI in metastatic renal cell carcinoma (mRCC) patients receiving nivolumab therapy remains unclear.

METHODS: Fifty-six consecutive patients with mRCC receiving nivolumab between September 2013 and August 2020 at our institution were retrospectively analyzed. The survival outcomes and prognostic factors associated with overall survival (OS) were statistically analyzed.

RESULTS: Thirteen and forty-three patients were classified with low (GNRI < 92) and high (GNRI ≥ 92) GNRI, respectively. Patients with low GNRI demonstrated significantly shorter OS (P = 0.0002) than those with high GNRI. In multivariate analysis, GNRI at the time of nivolumab (P = 0.008) was extracted as the predictor for OS in addition to Karnofsky performance status (KPS) (P = 0.016). Integration of the GNRI into the International Metastatic Renal Cell Cancer Database Consortium (IMDC) risk classification improved the c-index from 0.761 to 0.833 (combination of GNRI with IMDC risk classification) and to 0.778 (substitution of GNRI with KPS in IMDC risk classification).

CONCLUSIONS: GNRI was a significant prognostic biomarker in mRCC patients receiving nivolumab.

PMID:36448767 | DOI:10.1080/01635581.2022.2152061

Impact of the controlling nutritional status (CONUT) score on perioperative morbidity and oncological outcomes in patients with bladder cancer treated with radical cystectomy

Sun, 23 Oct 2022 00:00:00 +0000

Urol Oncol. 2023 Jan;41(1):49.e13-49.e22. doi: 10.1016/j.urolonc.2022.09.023. Epub 2022 Oct 21.

ABSTRACT

INTRODUCTION AND OBJECTIVES: To evaluate the impact of the Controlling Nutritional Status (CONUT) score on perioperative morbidity and oncological outcomes of bladder cancer (BC) patients treated with radical cystectomy (RC).

MATERIALS AND METHODS: We retrospectively analyzed a multi-institutional cohort of 347 patients treated with RC for clinical-localized BC between 2005 and 2019. The CONUT-score was defined as an algorithm including serum albumin, total lymphocyte count, and cholesterol. Multivariable logistic regression analyses were performed to evaluate the ability of the CONUT-score to predict any-grade complications, major complications and 30 days readmission. Multivariable Cox' regression models were performed to evaluate the prognostic effect of the CONUT-score on recurrence-free survival (RFS), overall survival (OS), and cancer-specific survival (CSS).

RESULTS: A cut-off value to discriminate between low and high CONUT-score was determined by calculating the receiver operating characteristic (ROC) curve. The area under the curve was 0.72 hence high CONUT-score was defined as ≥3 points. Overall, 112 (32.3%) patients had a high CONUT. At multivariable logistic regression analyses, high CONUT was associated with any-grade complications (OR 3.58, P = 0.001), major complications (OR 2.56, P = 0.003) and 30 days readmission (OR 2.39, P = 0.01). On multivariable Cox' regression analyses, high CONUT remained associated with worse RFS (HR 2.57, P < 0.001), OS (HR 2.37, P < 0.001) and CSS (HR 3.52, P < 0.001).

CONCLUSIONS: Poor nutritional status measured by the CONUT-score is independently associated with a poorer postoperative course after RC and is predictive of worse RFS, OS, and CSS. This simple index could serve as a comprehensive personalized risk-stratification tool identifying patients who may benefit from an intensified regimen of supportive cares.

PMID:36274030 | DOI:10.1016/j.urolonc.2022.09.023

Prognostic nutritional index as a prognostic factor for renal cell carcinoma: A systematic review and meta-analysis

Fri, 05 Aug 2022 00:00:00 +0000

PLoS One. 2022 Aug 5;17(8):e0271821. doi: 10.1371/journal.pone.0271821. eCollection 2022.

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.

PMID:35930538 | PMC:PMC9355260 | DOI:10.1371/journal.pone.0271821

The prognostic value of the Controlling Nutritional Status score on patients undergoing nephrectomy for upper tract urothelial carcinoma or renal cell carcinoma: a systematic review and meta-analysis.

Thu, 28 Jul 2022 04:00:00 +0000

British Journal of Nutrition; 07/28/2022
(AN 158140275); ISSN: 00071145
CINAHL Complete

Nutritional Factors during and after Cancer: Impacts on Survival and Quality of Life

Wed, 27 Jul 2022 00:00:00 +0000

Nutrients. 2022 Jul 19;14(14):2958. doi: 10.3390/nu14142958.

ABSTRACT

The French National Cancer Institute conducted a collective expertise study with researchers and clinical experts from the French Network for Nutrition And Cancer Research (NACRe Network). The objective was to update the state of knowledge on the impacts of nutritional factors on clinical endpoints during or after cancer. Data from 150 meta-analyses, pooled analyses or intervention trials and 93 cohort studies were examined; they concerned 8 nutritional factors, 6 clinical events and 20 cancer locations. This report shows that some nutritional factors have impacts on mortality and on the risks of recurrence or second primary cancer in cancer patients. Therefore, high-risk nutritional conditions can be encountered for certain cancer sites: from the diagnosis and throughout the health care pathways, weight loss (lung and esophageal cancers), malnutrition (lung, esophageal, colorectal, pancreatic, gastric and liver cancers), weight gain (colorectal, breast and kidney cancers) and alcohol consumption (upper aerodigestive cancers) should be monitored; and after cancer treatments, excess weight should be detected (colorectal, breast and kidney cancers). These situations require nutritional assessments, and even support or management by health care professionals, in the context of tertiary prevention. This report also highlights some limitations regarding the existing literature and some needs for future research.

PMID:35889914 | PMC:PMC9323157 | DOI:10.3390/nu14142958

The Association of Controlling Nutritional Status (CONUT) Score with Survival in Patients with Surgically Treated Renal Cell Carcinoma and Upper Tract Urothelial Carcinoma: A Systematic Review and Meta-Analysis.

Fri, 01 Jul 2022 04:00:00 +0000

Nutrition & Cancer; 07/01/2022
(AN 157519988); ISSN: 01635581
CINAHL Complete

Prognostic impact of prognostic nutritional index on renal cell carcinoma: A meta-analysis of 7,629 patients

Mon, 21 Mar 2022 00:00:00 +0000

PLoS One. 2022 Mar 21;17(3):e0265119. doi: 10.1371/journal.pone.0265119. eCollection 2022.

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.

PMID:35312690 | PMC:PMC8936492 | DOI:10.1371/journal.pone.0265119

Clinicopathological and Prognostic Significance of Preoperative Prognostic Nutritional Index in Patients with Upper Urinary Tract Urothelial Carcinoma

Thu, 17 Mar 2022 00:00:00 +0000

Nutr Cancer. 2022;74(8):2964-2974. doi: 10.1080/01635581.2022.2049829. Epub 2022 Mar 17.

ABSTRACT

To investigate the prognostic value of preoperative prognostic nutritional index (PNI) to predict oncological outcome and intravesical recurrence (IVR) in upper tract urothelial carcinoma (UTUC) after radical nephroureterectomy (RNU).

This study involved the clinical data of 255 patients with UTUC who had undergone RNU from 2004 to 2019 at our institution. Patients were grouped according to an optimal value of preoperative PNI. Kaplan-Meier analyses and Cox proportional hazards models were used to analyze the associations of preoperative PNI with progression-free survival (PFS), cancer-specific survival (CSS), overall survival (OS), and IVR.

Patients with low PNI were more likely to be older, have higher tumor stage, higher eGFR, and multifocal lesions. No significant association was found between PNI and CSS, IVR. In subgroup analysis according to the risk stratification, low PNI was associated with worse PFS, CSS, and OS for patients with higher risk. Multivariate analyses showed that elevated PNI was an independent prognostic indicator for PFS (P = 0.014) and OS (P = 0.048).

A low PNI is an independent predictor of PFS and OS in patients with UTUC after RNU. By subgroup analysis, the prognostic value of PNI was limited to patients with higher risk. PNI may become a useful biomarker to predict oncological outcomes in patients with UTUC after RNU.

PMID:35297733 | DOI:10.1080/01635581.2022.2049829

Preoperative nutritional evaluation of prostate cancer patients undergoing laparoscopic radical prostatectomy

Wed, 02 Feb 2022 00:00:00 +0000

PLoS One. 2022 Feb 2;17(2):e0262630. doi: 10.1371/journal.pone.0262630. eCollection 2022.

ABSTRACT

BACKGROUND AND OBJECTIVE: Prostate cancer (PCa) is one of the most common malignant tumors in men. Geriatric Nutritional Risk Index (GNRI) is an objective index for evaluating nutritional status of elderly people over 65 years old. The aim of the current study was to explore the correlation and predictive value between GNRI and postoperative recovery and complications in PCa patients undergoing laparoscopic radical prostatectomy (LRP).

METHODS: Taking 98 as the GNRI boundary value, 96 PCa patients (aged≥65 y) undergoing LRP in the Department of Urology, Affiliated Hospital of North Sichuan Medical College from January 2018 to December 2020 were grouped into malnutrition group (MNg, 34 patients, 35.4%) and normal nutrition group (NNg, 62 patients, 64.6%). Basic information, laboratory examination indexes, operation conditions, postoperative complications and postoperative recovery indexes of patients were recorded and retrospectively analyzed. Clavien-Dindo Classification System (CDCS) was used to assess postoperative complications. T-test was used to analyze differences between the two groups. ROC curve was generated to determine the predictive value of GNRI for postoperative complications.

RESULTS: Percentage of complications was significantly higher in MNg group compared with that in NNg group (P < 0.01). The average grade based on CDCS was significantly lower in NNg group compared with that in MNg group (P < 0.01). Body weight, Body Mass Index (BMI), preoperative hemoglobin value (HGB), serum albumin (ALB) values of MNg and NNg were significantly positively correlated with GNRI (P<0.01). Incidence and severity of postoperative complications of MNg patients were significantly higher compared with those of NNg patients (P<0.05). Average hospitalization cost of MNg patients was higher in MNg patients compared with that of NNg patients (P<0.05). Duration of post-anesthesia care unit (PACU), duration of antibiotic use and duration of indwelling drainage tube were longer in MNg patients compared with those in NNg patients (P<0.05). Furthermore, volume of indwelling drainage tube was higher in MNg patients compared with that in NNg patients (P<0.05).

CONCLUSION: GNRI is an effective and reliable tool for evaluation of preoperative nutritional status of prostate cancer patients. The findings showed that GNRI is correlated with postoperative recovery and complications, and is an effective predictive marker.

PMID:35108317 | PMC:PMC8809613 | DOI:10.1371/journal.pone.0262630

Prognostic and Clinicopathological Correlations of Pretreatment Prognostic Nutritional Index in Renal Cell Carcinoma: A Meta-Analysis

Mon, 24 Jan 2022 00:00:00 +0000

Urol Int. 2022;106(6):567-580. doi: 10.1159/000521353. Epub 2022 Jan 24.

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.

PMID:35073548 | DOI:10.1159/000521353

Implementation of malnutrition quality improvement reveals opportunities for better nutrition care delivery for hospitalized patients.

Sat, 01 Jan 2022 05:00:00 +0000

JPEN Journal of Parenteral & Enteral Nutrition; 01/01/2022
(AN 155254087); ISSN: 01486071
CINAHL Complete

Nutritional Status Impairment Due to Neoadjuvant Chemotherapy Predicts Post-Radical Cystectomy Complications

Tue, 28 Dec 2021 00:00:00 +0000

Nutrients. 2021 Dec 14;13(12):4471. doi: 10.3390/nu13124471.

ABSTRACT

BACKGROUND: Radical cystectomy (RC) is the standard treatment for muscle invasive bladder cancer (MIBC). Neoadjuvant chemotherapy (NAC) is associated with improved patient survival. The impact of NAC on nutritional status is understudied, while the association between malnutrition and poor surgical outcomes is well known. This study aims to examine the association between NAC, nutritional status impairment, and post-operative morbidity.

MATERIALS AND METHODS: We included MIBC patients who underwent RC and received NAC from multiple academic centers in Israel. Cross-sectional imaging was used to measure the psoas muscle area and normalized it by height (smooth muscle index, SMI). Pre- and post-NAC SMI difference was calculated (represents nutritional status change). The primary outcomes were post-RC ileus, infection, and a composite outcome of any complication. Logistic regression models were fit to identify independent predictors of the outcomes.

RESULTS: Ninety-one patients were included in the study. The median SMI change was -0.71 (-1.58, -0.06) cm²/m². SMI decline was significantly higher in patients with post-RC complications (-18 vs. -203, p < 0.001). SMI change was an independent predictor of all complications, ileus, infection, and other complications. The accuracy of SMI change for predicting all complications, ileus, infection, and other complications was 0.85, 0.87, 0.75, and 0.86, respectively.

CONCLUSIONS: NAC-related nutritional deterioration is associated with increased risk of complications after RC. Our results hint towards the need for nutritional intervention during NAC prior to RC.

PMID:34960023 | PMC:PMC8708207 | DOI:10.3390/nu13124471

Multicenter Study of Controlling Nutritional Status (CONUT) Score as a Prognostic Factor in Patients With HIV-Related Renal Cell Carcinoma

Fri, 17 Dec 2021 00:00:00 +0000

Front Immunol. 2021 Nov 30;12:778746. doi: 10.3389/fimmu.2021.778746. eCollection 2021.

ABSTRACT

OBJECTIVE: In recent years, the controlled nutritional status (CONUT) score has been widely recognized as a new indicator for assessing survival in patients with urological neoplasms, including renal, ureteral, and bladder cancer. However, the CONUT score has not been analyzed in patients with HIV-related urological neoplasms. Therefore, we aimed to evaluate the prognostic significance of the CONUT score in patients with HIV-related renal cell carcinoma (RCC).

METHODS: A total of 106 patients with HIV-related RCC were recruited from four hospitals between 2012 and 2021, and all included patients received radical nephrectomy or partial nephrectomy. The CONUT score was calculated by serum albumin, total lymphocyte counts, and total cholesterol concentrations. Patients with RCC were divided into two groups according to the optimal cutoff value of the CONUT score. Survival analysis of different CONUT groups was performed by the Kaplan-Meier method and a log rank test. A Cox proportional risk model was used to test for correlations between clinical variables and cancer-specific survival (CSS), overall survival (OS), and disease-free survival (DFS). Clinical variables included age, sex, hypertension, diabetes, tumor grade, Fuhrman grade, histology, surgery, and CD4+ T lymphocyte count.

RESULT: The median age was 51 years, with 93 males and 13 females. At a median follow-up of 41 months, 25 patients (23.6%) had died or had tumor recurrence and metastasis. The optimal cutoff value for the CONUT score was 3, and a lower CONUT score was associated with the Fuhrman grade (P=0.024). Patients with lower CONUT scores had better CSS (HR 0.197, 95% CI 0.077-0.502, P=0.001), OS (HR 0.177, 95% CI 0.070-0.446, P<0.001) and DFS (HR 0.176, 95% CI 0.070-0.444, P<0.001). Multivariate Cox regression analysis indicated that a low CONUT score was an independent predictor of CSS, OS and DFS (CSS: HR=0.225, 95% CI 0.067-0.749, P=0.015; OS: HR=0.201, 95% CI 0.061-0.661, P=0.008; DFS: HR=0.227, 95% CI 0.078-0.664, P=0.007). In addition, a low Fuhrman grade was an independent predictor of CSS (HR 0.192, 95% CI 0.045-0.810, P=0.025), OS (HR 0.203, 95% CI 0.049-0.842, P=0.028), and DFS (HR 0.180, 95% CI 0.048-0.669, P=0.010), while other factors, such as age, sex, hypertension, diabetes, tumor grade, histology, surgery, and CD4+ T lymphocyte count, were not associated with survival outcome.

CONCLUSION: The CONUT score, an easily measurable immune-nutritional biomarker, may provide useful prognostic information in HIV-related RCC.

PMID:34917092 | PMC:PMC8669761 | DOI:10.3389/fimmu.2021.778746

The Geriatric Nutritional Risk Index Predicts Postoperative Outcomes in Bladder Cancer: A Propensity Score-Matched Analysis

Thu, 02 Dec 2021 00:00:00 +0000

J Urol. 2022 Apr;207(4):797-804. doi: 10.1097/JU.0000000000002342. Epub 2021 Dec 2.

ABSTRACT

PURPOSE: The Geriatric Nutritional Risk Index (GNRI) is a simple screening tool to predict nutrition-related risk of morbidity and mortality in older patients. We assessed whether preoperative GNRI was associated with 30-day complications after radical cystectomy (RC).

MATERIALS AND METHODS: Using the American College of Surgeons National Surgical Quality Improvement Program database, we identified patients 65 years or older who underwent RC for the treatment of bladder cancer between 2007 and 2019. Patients were dichotomized into at-risk (GNRI ≤98) or no-risk (GNRI >98) groups. Using propensity score matching, the 2 groups were compared for baseline differences and 30-day outcomes. We evaluated GNRI as an independent predictor of postoperative complications using multivariable logistic regression analysis.

RESULTS: We identified 2,926 patients eligible for analysis. After propensity score matching, patients in the at-risk GNRI group had higher rates of any complication (p=0.017), blood transfusion (p=0.002), extended length of stay (p=0.004) and nonhome discharge (p <0.001). Multivariable logistic regression analysis revealed that a decreasing GNRI is an independent prognostic factor for mortality (OR 1.05, 95% CI 1.01-1.08, p=0.009), blood transfusion (OR 1.03, 95% CI 1.02-1.04, p <0.001), pneumonia (OR 1.04, 95% CI 1.01-1.07, p=0.013), extended length of stay (OR 1.03, 95% CI 1.02-1.05, p <0.001) and nonhome discharge (OR 1.04, 95% CI 1.03-1.06, p <0.001).

CONCLUSIONS: We demonstrate that nutritional status evaluated by GNRI predicts 30-day complications after RC.

PMID:34854753 | DOI:10.1097/JU.0000000000002342

The prognostic significance of controlling nutritional status (CONUT) score for surgically treated renal cell cancer and upper urinary tract urothelial cancer: a systematic review and meta-analysis

Wed, 24 Nov 2021 00:00:00 +0000

Eur J Clin Nutr. 2022 Jun;76(6):801-810. doi: 10.1038/s41430-021-01014-0. Epub 2021 Nov 23.

ABSTRACT

In order to evaluate the predictive effect of the controlled nutritional status (CONUT) score on the prognosis of patients with renal cell carcinoma (RCC) and upper urinary tract urothelial carcinoma (UTUC), a meta-analysis was performed. This systematic review has been registered on PROSPERO, the registration ID is CRD42021251879. A systematic search of the published literature using PubMed, Web of Science, Cochrane Library, EMBASE, and MEDLINE was performed. The fields of "renal cell cancer," "upper tract urothelial cancer," and "controlling nutritional status" and other fields were used as search terms. STATA 16 software was used to carry out data merging and statistical analysis of binary variables, Q test and χ² tests were used to verify the heterogeneity between the included works of studies. Subgroup analysis and sensitivity analysis were used to explain the sources of heterogeneity between studies. Begg's test was used to assess publication bias between studies. From the first 542 studies retrieved, through strict inclusion and exclusion criteria, 7 studies finally met the requirements and were included in the meta-analysis. Pooled results indicated that high CONUT indicates worse over survival (OS) [HR = 1.70, 95% CI (1.43-2.03), P = 0.02], cancer-specific survival (CSS) [HR = 1.84, 95% CI (1.52-2.23), P = 0.01], recurrence-free survival (RFS) [HR = 1.60, 95% CI (1.26-2.03), P = 0.116], and disease-free survival (DFS) [HR = 1.47, 95% CI (1.20-1.81), P = 0.03]. Based on cancer type, cutoff value, region, and sample size, a subgroup analysis was performed. The results showed that OS and CSS were not affected by the above factors, and the high CONUT score before surgery predicted worse OS and CSS. In conclusion, this meta-analysis revealed that the preoperative CONUT score is a potential independent predictor of the postoperative prognosis of RCC/UTUC patients. A high CONUT predicts worse OS/CSS/DFS and RFS in patients.

PMID:34815539 | DOI:10.1038/s41430-021-01014-0

The prognostic nutritional index predicts the biochemical recurrence of patients treated with robot-assisted laparoscopic radical prostatectomy

Tue, 16 Nov 2021 00:00:00 +0000

Prostate. 2022 Feb;82(2):221-226. doi: 10.1002/pros.24263. Epub 2021 Nov 16.

ABSTRACT

OBJECTIVE: To evaluate the prognostic nutritional index (PNI) in predicting the biochemical recurrence (BCR) of patients treated with robot-assisted laparoscopic radical prostatectomy (RALP).

METHODS: The clinical data of 136 patients treated with RALP in the Department of Urology, The Third Xiangya Hospital of Central South University were retrospectively analyzed. The endpoint of observation was BCR. The area under the receiver operating characteristic (ROC) curve was evaluated to determine the optimal cutoff value of PNI. The correlation of the PNI with BCR was estimated using Kaplan-Meier analysis and Cox proportional hazards model.

RESULTS: The optimal cutoff value of the PNI was 46.03 according to the ROC curve. (95% confidence interval: 0.604-0.805, Youden index = 0.401, sensitivity = 82.5%, specificity = 57.6%, p < 0.01). Multivariate Cox analysis showed that clinical staging, prostate-specific antigen, and PNI were independent prognostic factors for predicting BCR in patients treated with RALP.

CONCLUSION: PNI is an independent prognostic factor for predicting BCR in patients treated with RALP. The incorporation of the PNI into risk assessments may provide additional prognostic information.

PMID:34783377 | DOI:10.1002/pros.24263

First Report of Oncological Outcome and Prognostic Analysis in a First-Line Setting of Short Hydration Gemcitabine and Cisplatin Chemotherapy for Patients with Metastatic Urothelial Carcinoma.

Fri, 01 Oct 2021 04:00:00 +0000

Oncology; 10/01/2021
(AN 152610758); ISSN: 00302414
CINAHL Complete

The Association of Controlling Nutritional Status (CONUT) Score with Survival in Patients with Surgically Treated Renal Cell Carcinoma and Upper Tract Urothelial Carcinoma: A Systematic Review and Meta-Analysis

Tue, 07 Sep 2021 00:00:00 +0000

Nutr Cancer. 2022;74(6):1907-1916. doi: 10.1080/01635581.2021.1974894. Epub 2021 Sep 7.

ABSTRACT

In recent years, Controlling Nutritional Status (CONUT) Score has become widely recognized as a novel index to evaluate the survival in urological neoplasms patients, especially with renal cell carcinoma (RCC) and upper tract urothelial carcinoma (UTUC). The aim of this meta-analysis is to evaluate the prognostic value of CONUT score in patients with RCC and UTUC. PubMed, Web of Science and Embase were searched for data on the association between CONUT score and RCC/UTUC prognosis up to July 29, 2021. Duplicates were excluded, and inclusion/exclusion criteria were applied to all abstracts. We sorted out relevant studies and extracted the risk ratios (RRs) and its 95% confidence interval (CI) for recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS). The relationship between gender and survival outcomes was analyzed using univariate cox regression. We analyzed seven studies including 5410 patients in the meta-analysis. A high CONUT score was associated with poor 5-year RFS (RR = 1.27, 95% CI = 1.13-1.43, P = 0.0001), CSS (RR = 1.22, 95% CI = 1.07-1.39, P = 0.003) and OS (RR = 1.24, 95% CI = 1.10-1.41, P = 0.0005). As a result, the association between CONUT score and survival was statistically significant. In addition, gender was not related to survival outcomes. Our results show that the CONUT score is associated with RCC and UTUC outcomes and can serve as a readily available biomarker for managing this disease.

PMID:34490808 | DOI:10.1080/01635581.2021.1974894

The prognostic value of the Controlling Nutritional Status score on patients undergoing nephrectomy for upper tract urothelial carcinoma or renal cell carcinoma: a systematic review and meta-analysis

Mon, 02 Aug 2021 00:00:00 +0000

Br J Nutr. 2022 Jul 28;128(2):217-224. doi: 10.1017/S0007114521002889. Epub 2021 Aug 2.

ABSTRACT

In recent years, the controlling nutritional status (CONUT) score has increasingly became an effective indicator associated with tumor prognosis. This study was conducted to synthesise data on the prognostic value of CONUT score on patients with upper tract urothelial carcinoma (UTUC) or renal cell carcinoma (RCC) undergoing nephrectomy. We designed and performed a systematic analysis of studies that verified the correlation between preoperative CONUT score and prognosis for UTUC and RCC using PubMed, Web of Science and Embase. The conclusion was clarified by pooled hazard ratios (HR) and 95% confidence intervals (95% CI). Subgroup analysis were further conducted in accordance with different primary tumor. Six studies involving 3529 patients were included in this evidence synthesis, which revealed that the CONUT score had a potential role to predict the survival of UTUC and RCC patients accepting surgery. Pooled analysis showed that the overall survival (OS, HR 2·32, p < 0·0001), cancer-specific survival (CSS, HR 2·68, p < 0·0001) and disease-free survival (DFS, HR 1·62, p < 0·00001) were inferior in the high CONUT score group when compared with low score group. Subgroup analysis revealed that this result was in line with UTUC (OS: HR 1·86, p = 0·02; CSS: HR 2·24, p = 0·01; DFS: HR 1·54, p < 0·00001) and RCC (OS: HR 3·05, p < 0·00001; CSS: HR 3·47, p < 0·00001; DFS: HR 2·21, p = 0·0005) patients respectively. Consequently, the CONUT score is a valuable preoperative index to predict the survival of patients with UTUC or RCC undergoing nephrectomy.

PMID:34338171 | DOI:10.1017/S0007114521002889

Prognostic nutritional index and prognosis in renal cell carcinoma: A systematic review and meta-analysis

Tue, 13 Jul 2021 00:00:00 +0000

Urol Oncol. 2021 Oct;39(10):623-630. doi: 10.1016/j.urolonc.2021.05.028. Epub 2021 Jul 10.

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.

PMID:34253447 | DOI:10.1016/j.urolonc.2021.05.028

Prognostic significance of the controlling nutritional status score in patients with metastatic renal cell carcinoma diagnosed before an era of first-line immune-oncology combination therapies

Wed, 02 Jun 2021 00:00:00 +0000

Jpn J Clin Oncol. 2021 Oct 5;51(10):1570-1576. doi: 10.1093/jjco/hyab078.

ABSTRACT

OBJECTIVE: To explore the prognostic role of the controlling nutritional status score in patients with metastatic renal cell carcinoma.

METHODS: We retrospectively analyzed 107 patients with metastatic renal cell carcinoma who received their diagnosis between 2007 and 2018 and were treated with or without a first-line interferon or tyrosine kinase inhibitor at a single cancer center. The controlling nutritional status score was based on values for albumin, lymphocyte count and total cholesterol at the metastatic renal cell carcinoma diagnosis. Association of the controlling nutritional status score and clinical variables, including the Memorial Sloan-Kettering Cancer Center and the International Metastatic Renal Cell Carcinoma Database Consortium risk classifications, with overall survival was examined using the Cox proportional hazard model. Predictive accuracy of the prognostic factors was assessed using Harrell's concordance index.

RESULTS: First-line interferon and tyrosine kinase inhibitor were given to 48 (45%) and 41 (38%) patients, respectively, and 28 (26%) and 33 (31%) patients underwent cytoreductive nephrectomy and metastasectomy, respectively. During follow-up (median: 36.3 months), 64 patients died. The median controlling nutritional status score was 2 (range: 0-8). A controlling nutritional status score ≥ 2 was significantly associated with shorter overall survival (P < 0.01) independently of the Memorial Sloan-Kettering Cancer Center and International Metastatic Renal Cell Carcinoma Database Consortium risk classifications. Integration of the controlling nutritional status score into the Memorial Sloan-Kettering Cancer Center and International Metastatic Renal Cell Carcinoma Database Consortium risk classifications improved concordance index from 0.702 to 0.770 and from 0.698 to 0.749, respectively.

CONCLUSION: The controlling nutritional status score may serve as a prognostic biomarker objectively reflecting the general physical condition of patients with metastatic renal cell carcinoma treated with or without first-line interferon or tyrosine kinase inhibitor in terms of nutritional and immuno-inflammatory status.

PMID:34075403 | DOI:10.1093/jjco/hyab078

Prognostic Significance of Prognostic Nutritional Index in Patients with Renal Cell Carcinoma: A Meta-Analysis

Tue, 01 Jun 2021 00:00:00 +0000

Nutr Cancer. 2022;74(3):860-868. doi: 10.1080/01635581.2021.1931702. Epub 2021 Jun 1.

ABSTRACT

The prognostic nutrition index (PNI), based on the serum lymphocyte counts and albumin levels, has been introduced as a prognostic factor in various cancer. In the present study, we explore the prognostic significance of PNI in patients with renal cell carcinoma (RCC). A literature search of all publications was conducted using the Cochrane library, PubMed and Embase databases from inception to April 2020. A total of 12 studies consisting of 7,391 patients were enrolled in the present study. We found that low pretreatment PNI is significantly correlated to poor survival, including overall survival (OS) (P < 0.001), cancer-specific survival (CSS) (P = 0.002), progression-free survival/recurrence-free survival/disease-free survival (PFS/RFS/DFS) (P < 0.001). The age (P < 0.001), clear cell histology (P = 0.044), T3-T4 (P = 0.049), and Fuhrman grade 3-4 (P = 0.024) were significantly differed in the low and high pretreatment PNI group. In summary, low pretreatment PNI was associated with adverse clinicopathological features in patients with RCC. Besides, low pretreatment PNI was also an unfavorable factor of OS, CSS, and PFS/RFS/DFS in RCC patients, which could serve as an unfavorable factor. More studies with large participants are required to verify our results.Supplemental data for this article is available online at https://doi.org/10.1080/01635581.2021.1931702.

PMID:34060398 | DOI:10.1080/01635581.2021.1931702

Controlling Nutritional Status Score Evaluates Prognosis in Patients With Non-Muscle Invasive Bladder Cancer

Tue, 01 Jun 2021 00:00:00 +0000

Cancer Control. 2021 Jan-Dec;28:10732748211021078. doi: 10.1177/10732748211021078.

ABSTRACT

OBJECTIVE: We investigated the clinical value of the Controlling Nutritional Status score in evaluating the prognosis of patients with non-muscle invasive bladder cancer.

METHODS: We conducted a retrospective analysis of the clinical data of 88 patients with non-muscle invasive bladder cancer who underwent transurethral resection of bladder tumor or partial cystectomy between January 2011 and May 2015 in a single center. The patients were divided into groups base on high (>1) and low (≤1) Controlling Nutritional Status score.

RESULTS: Clinical and demographic data of the patient groups were analyzed using the Kaplan-Meier method and log-rank test to generate survival curves. Univariate and multivariate analyses were conducted using the Cox proportional hazard model. Among the participants, the male-to-female ratio was 70:18 and median age was 64.5 years (range, 25-84 years). The numbers of patients with Controlling Nutritional Status score of 0, 1, 2, 3, 4, 5, and 6 were 26 (29.55%), 21 (23.86%), 20 (22.73%), 12 (13.64%), 5 (5.68%), 1 (1.14%), and 3 (3.41%), respectively. The 5-year recurrence rate was 29 out of 88 patients (32.95%). The recurrence-free survival of the high-score group was significantly lower than that of the low-score group (P < 0.001). On univariate analysis, age, smoking history, Controlling Nutritional Status score, depth of tumor invasion, pathological grade, and tumor diameter were related to the prognosis of patients with non-muscle invasive bladder cancer. On multivariate analysis, the Controlling Nutritional Status score (hazard ratio, 4.938; 95% confidence interval, 1.392-17.525; P = 0.013) was an independent factor affecting the recurrence-free survival of patients with non-muscle-invasive bladder cancer.

CONCLUSION: Therefore, the Controlling Nutritional Status score could be a simple, cost-effective, and reliable predictor of prognoses among of patients with non-muscle-invasive bladder cancer.

PMID:34060373 | PMC:PMC8204588 | DOI:10.1177/10732748211021078

Predictive Impact of Prognostic Nutritional Index on Pembrolizumab for Metastatic Urothelial Carcinoma Resistant to Platinum-based Chemotherapy

Wed, 31 Mar 2021 00:00:00 +0000

Anticancer Res. 2021 Mar;41(3):1607-1614. doi: 10.21873/anticanres.14922.

ABSTRACT

BACKGROUND/AIM: We investigated the prognostic nutritional index (PNI), comprised of lymphocytes and albumin, as a potential prognosticator of metastatic urothelial carcinoma (mUC) patients receiving pembrolizumab.

PATIENTS AND METHODS: Sixty-five patients were retrospectively enrolled and classified as low (<40) and high (≥40) based on pretreatment PNI. Progression-free survival (PFS), overall survival (OS) and response rates were evaluated.

RESULTS: In the low PNI group, significantly shorter PFS and OS were observed. PNI was shown to be an independent predictor of PFS and OS in the multivariate analysis. C-index for both PFS and OS improved with the addition of PNI to the model described in the KEYNOTE-045 study. Significantly more patients experienced initial disease progression in the low PNI group.

CONCLUSION: PNI is a useful predictor of prognosis and disease progression in mUC patients receiving pembrolizumab.

PMID:33788756 | DOI:10.21873/anticanres.14922

Clinical significance of prognostic nutritional index in renal cell carcinomas

Wed, 17 Mar 2021 00:00:00 +0000

Medicine (Baltimore). 2021 Mar 12;100(10):e25127. doi: 10.1097/MD.0000000000025127.

ABSTRACT

Prognostic nutritional index (PNI) could reflect the nutrition and inflammation status in cancer patients. This study aims to identify the prognostic significance of PNI in patients with renal cell carcinoma (RCC).A total of 694 RCC patients from our institution were included in this study. The prognostic correlation between PNI and overall survival (OS) and recurrence-free survival (RFS) was analyzed respectively using Kaplan-Meier method and univariate and multivariate Cox model. Studies about the association between pretreatment or preoperative PNI and prognosis of RCC were systemically reviewed and a meta-analysis method was performed to further evaluate the pooled prognostic value of PNI in RCC.267 (38.47%) RCC patients had low PNI according to the cut off value (49.08). Low PNI was associated with poor OS (P < .001) and RFS (P < .001), respectively. In the multivariate Cox analysis, PNI was identified to be an independent prognostic factor for OS (hazard ratio [HR] = 2.13, 95%CI: 1.25-3.62, P = .005). Compared to other nutritional indexes, this risk correlation of PNI is better than that of geriatric nutritional risk index (GNRI; HR = 1.19; P = .531), while is no better than that of neutrophil-lymphocyte ratio (NLR; 1/HR = 2.56; P < .001) and platelet-lymphocyte ratio (PLR; 1/HR = 2.85; P < .001) respectively. Meanwhile, additional 4785 patients from 6 studies were included into pooled analysis. For RCC patients who underwent surgery, low preoperative PNI was significantly associated with worse OS (pooled HR = 1.57, 95%CI: 1.37-1.80, P < .001) and worse RFS (pooled HR = 1.69, 95%CI: 1.45-1.96, P < .001). Furthermore, low PNI (<41-51) was also significantly associated with poor OS (HR = 1.78, 95%CI: 1.26-2.53 P < .05) and poor RFS (HR = 2.03, 95%CI: 1.40-2.95, P < .05) in advanced cases treated with targeted therapies.The present evidences show that PNI is an independent prognostic factor in RCC. Low PNI is significant associated with poor prognosis of RCC patients.

PMID:33725913 | PMC:PMC7969234 | DOI:10.1097/MD.0000000000025127

The Controlling Nutritional Status CONUT Score in Patients With Advanced Bladder Cancer After Radical Cystectomy

Wed, 24 Feb 2021 00:00:00 +0000

In Vivo. 2021 Mar-Apr;35(2):999-1006. doi: 10.21873/invivo.12343.

ABSTRACT

BACKGROUND/AIM: The impact of the controlling nutritional status (CONUT) score on oncological outcomes after radical cystectomy (RC) for advanced bladder cancer (BC) is unknown.

PATIENTS AND METHODS: We retrospectively evaluated 115 patients who underwent RC for advanced BC at our department between November 2003 and February 2019. The CONUT score was calculated from serum albumin levels, total lymphocyte counts, and total cholesterol levels. Relapse-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS) after RC were analyzed.

RESULTS: For the CONUT score, the area under curve was 0.651 and the optimal cut-off value determined using the Youden index was 3. The high CONUT group had significantly shorter RFS, CSS, and OS than the low CONUT group. Multivariate analyses showed that the CONUT score was an independent prognostic factor of RFS, CSS, and OS.

CONCLUSION: The CONUT score could be an effective predictor for survival and tolerability following RC for advanced BC.

PMID:33622895 | PMC:PMC8045070 | DOI:10.21873/invivo.12343

Influence of nutritional status and frailty phenotype on health-related quality of life of patients with bladder or kidney cancer

Fri, 19 Feb 2021 00:00:00 +0000

Support Care Cancer. 2021 Sep;29(9):5139-5150. doi: 10.1007/s00520-021-06058-3. Epub 2021 Feb 19.

ABSTRACT

PURPOSE: This research aimed to assess the impact of nutritional status and frailty in the health-related quality of life (HRQoL) of patients with bladder or kidney cancer.

METHODS: This was a cross-sectional study with individuals aged 20 years or older. Frailty phenotype was defined using the criteria of Fried et al. (2001). Patient-Generated Subjective Global Assessment (PG-SGA) classified nutritional status. The European Organization for Research and Treatment of Cancer Quality of life questionnaire Core-30 third version (EORTC QLQ-C30) assessed HRQoL.

RESULTS: Forty-four patients with bladder and 44 with kidney cancer, mostly male, with a mean age of 65.9 and 58.6 years, respectively, were evaluated. Presence of frailty was not different between young and older adults. More than 80% of the robust subjects were well-nourished, while there was a predominance of frail with some degree of malnutrition (p < 0.05). The summary score of HRQoL was worse among the frails than pre-frails and robusts, both in bladder (68.5 vs 86.8 vs 89.5; p = 0.002) and in kidney cancer (54.9 vs 82.9 vs 91.4; p < 0.001), as well as in malnourished compared to well-nourished with bladder (72.9 vs 90.3; p = 0.003) and kidney cancer (69.4 vs 88.3; p = 0.001). After adjusted, frailty and malnutrition continued associated with poor summary score (p < 0.05).

CONCLUSION: These findings indicate that frailty and malnutrition negatively affect HRQoL of patients with bladder or kidney cancer in several aspects.

PMID:33606096 | DOI:10.1007/s00520-021-06058-3

Implementation of malnutrition quality improvement reveals opportunities for better nutrition care delivery for hospitalized patients

Wed, 17 Feb 2021 00:00:00 +0000

JPEN J Parenter Enteral Nutr. 2022 Jan;46(1):243-248. doi: 10.1002/jpen.2086. Epub 2021 Mar 18.

ABSTRACT

BACKGROUND: Gaps in hospital-based nutrition care practices and opportunities to improve care of patients at risk of malnutrition or malnourished have been demonstrated by several US hospitals implementing quality improvement (QI) projects. This study examined the impact of nutrition care process improvements focused on better documentation of identification and diagnosis of malnutrition in 5 hospital services and differences between nutritionally targeted vs nontargeted services.

METHODS: Data on malnutrition risk screening, nutrition assessment, malnutrition diagnosis, and nutrition care plan delivery were collected from 32,723 hospital encounters for patients admitted to the intensive care unit, pulmonology, oncology, urology, and general medicine services (targeted) as well as the rest of the nontargeted hospital services between 2017 and 2019.

RESULTS: Higher rates of morbidity in targeted service patients compared with those in the patient population admitted in the nontargeted services were observed, including higher rates of malnutrition risk (37.43% vs 19.16%, P < .001), higher rates of moderate and severe malnutrition first identified by a registered dietitian nutritionist (20.27% vs 9.67%, P < .001), and malnutrition diagnosis confirmed by an admitting physician (16.72% vs 6.74%, P < .001).

CONCLUSIONS: The findings suggest sustained improvements in confirmed rates of malnutrition identification and diagnosis are achievable. Targeting malnutrition QI efforts to hospital services with higher patient morbidity is an effective method for improving malnutrition diagnosis, in particular in hospitals with limited resources, which in turn can result in improved nutrition care delivery.

PMID:33594704 | PMC:PMC9290569 | DOI:10.1002/jpen.2086

The Potential of Prehabilitation in Radical Cystectomy Pathways: Where Are We Now?

Mon, 01 Feb 2021 05:00:00 +0000

Seminars in Oncology Nursing; 02/01/2021
(AN 148862731); ISSN: 07492081
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