Cai W, et al. - The significance of pretreatment prognostic nutritional index (PNI) was determined in patients with metastatic renal cell carcinoma (mRCC) with sorafenib or sunitinib as first-line targeted therapy. Findings suggested that low pretreatment PNI could be a significant risk factor for mRCC patients who received tyrosine kinase inhibitors as first-line target therapy. In addition, it would also increase the accuracy of the established prognostic model.

Methods

• The Kaplan–Meier method was used to estimate the progression-free survival (PFS) and overall survival (OS) of 178 mRCC patients who received first-line therapy of sorafenib or sunitinib.
• The log-rank test was applied to compare the survival outcomes of patients with low pretreatment PNI (PNI < 51.62) and high pretreatment PNI (PNI  ≥ 51.62), and Cox proportional hazard regression model was used to compare PFS and OS between these two groups. 
• With the aid of Harrell concordance index, prognostic accuracy was evaluated.

Results

• The overall median PFS and OS time for all 178 patients were 11 months (95% CI 9–12 months) and 24 months (95% CI 19–33 months), respectively. 
• Findings disclosed that patients with low pretreatment PNI both had significantly shorter median PFS (7 vs 19 months, P < 0.001) and OS (14 vs 50 months, P < 0.001) than those with high PNI.
• Multivariate analysis displayed that pretreatment PNI was an independent predictor of OS (HR 1.658, 95% CI 1.040–2.614, P = 0.033) and an independent predictor of PFS as well (HR 1.842, 95% CI 1.226–2.766, P = 0.003).
• The model built by the addition of pretreatment PNI improved predictive accuracy of PFS and OS compared with the International Metastatic Renal Cell Carcinoma Database Consortium Model (Heng model) (c-index: 0.68 and 0.70).
• PNI might be a preciser factor to predict PFS and OS (0.71 and 0.73), as compared to NLR (neutrophil-to-lymphocyte ratio) (0.69 and 0.72).