Prognostic Significance of Preoperative Prognostic Nutritional Index in Patients Undergoing Nephrectomy for Nonmetastatic Renal Cell Carcinoma

Objective: The objective of this study was to assess the value of a preoperative Prognostic Nutritional Index (PNI) for predicting the survival of patients with nonmetastatic renal cell carcinoma (RCC) treated with partial or radical nephrectomy. Materials and Methods: The medical records of 480 patients with RCC who underwent partial or radical nephrectomy at 2 institutions between June 1994 and July 2017 were retrospectively reviewed. After the exclusion of 21 patients with lymph node or distant metastasis, the data of 459 patients with nonmetastatic RCC were included. The PNI was calculated using a combination of serum albumin level and lymphocyte count in the peripheral blood, as described previously. The prognostic significance of various clinicopathologic variables, including the PNI, was assessed in univariate and multivariate analyses. Results: The univariate analysis identified anemia, PNI, tumor size, T stage, Fuhrman nuclear grade, sarcomatoid differentiation, and lymphovascular invasion as significant prognostic factors of recurrence-free survival (RFS) and cancer-specific survival (CSS). In the multivariate analysis, anemia ( P =0.010), PNI ( P <0.001), tumor size ( P <0.001), T stage ( P <0.001), Fuhrman nuclear grade ( P =0.023), sarcomatoid differentiation ( P =0.003), and lymphovascular invasion ( P =0.005) were independent prognostic factors for RFS, versus anemia ( P =0.020), PNI ( P =0.002), tumor size ( P <0.001), T stage ( P <0.001), sarcomatoid differentiation ( P <0.001), and lymphovascular invasion ( P =0.018) for CSS. Conclusions: The PNI is an independent prognostic factor for RFS and CSS in patients with nonmetastatic RCC treated with partial or radical nephrectomy. It may, therefore, be a useful tool for predicting recurrence and survival in these patients.