Prognostic Significance of Pre- to Postoperative Dynamics of the Prognostic Nutritional Index for Patients with Renal Cell Carcinoma Who Underwent Radical Nephrectomy

Background This study aimed to examine the prognostic role of Prognostic Nutritional Index (PNI) dynamics in the pre- and postoperative periods for patients with renal cell carcinoma (RCC) who undergo radical nephrectomy (RN). Methods The study analyzed 324 patients with RCC who underwent RN. The overall population was classified into four groups according to four types of pre- to postoperative PNI dynamics as follows: group 1 (low -> low PNI), group 2 (low -> high PNI), group 3 (high -> low PNI), and group 4 (high -> high PNI). The level of PNI was calculated using the following formula: 10 x serum albumin level (g/dL) + 0.005 x absolute lymphocyte counts in blood (/mm(3)). The primary end point was cancer-specific survival (CSS), and the secondary end point was overall survival (OS). Results The patients with higher pre- and postoperative PNI (> 45) had better survival outcomes than those with lower pre- and postoperative PNI (<= 45). Notably, the patients in group 4 showed the best CSS and OS rates, whereas the patients in group 1 had the worst survival outcomes. Furthermore, PNI dynamics were identified as an independent predictor of CSS and OS outcomes, in addition to pre- and postoperative PNI, tumor size, and pathologic T (pT) stage. The patients with localized RCC (<= pT2) showed significant differences in both CSS and OS estimates, whereas the patients with advanced pT stage (>= pT3) demonstrated a difference only in OS outcomes, according to PNI dynamics. Conclusion This study is the first to provide the independent prognostic importance of dynamics of nutritional status for patients with RCC.