Prognostic value of preoperative geriatric nutritional risk index combined with endogenous creatinine clearance in elderly patients with renal clear cell carcinoma
Prognostic value of preoperative geriatric nutritional risk index combined with endogenous creatinine clearance in elderly patients with renal clear cell carcinoma
Objective To investigate the prognostic value of preoperative geriatric nutritional risk index(GNRI)combined with endogenous creatinine clearance(Ccr)in elderly patients with re-nal clear cell carcinoma.Methods From January 2016 to December 2017,a total of 148 elderly patients with renal clear cell carcinoma were admitted to the Department of Urology,the First Affili-ated Hospital of Guangxi Medical University.Based on the follow-up status,the patients were divid-ed into a survival group(122 cases)and a death group(26 cases).Univariate and multivariate Cox regression analyses were used to explore the prognostic factors of elderly patients with renal clear cell carcinoma.Kaplan-Meier was performed to access the correlation between GNRI,Ccr and overall survival time in elderly patients with renal clear cell carcinoma.Receiver operating characteristic curve analysis was conducted to evaluated the predictive performance.Results There were statis-tically significant differences in general data between the two groups,including gender,M stage,T stage,tumor necrosis,albumin and GNRI(P＜0.05).There were statistically significant differences in serum index between the two groups,including alkaline phosphatase,prealbumin and Ccr(P＜0.05).Cox regression analysis demonstrated that the increase of GNRI(HR:0.803,95％CI:0.686-0.939),and Ccr(HR:0.971,95％CI:0.943-0.999)were the protective factors in the prognosis of the elderly patients with renal clear cell carcino-ma.M1 stage(HR:5.132,95％CI:1.021-25.787),T stage and T3,T4 stage(HR:5.179,95％CI:1.249-21.473)tumors were risk factors affecting the prognosis(P＜0.05).Kaplan-Meier survival curve showed that the 5-year survival rate of high GNRI group was higher than that of low GNRI group(x2=15.446,P＜0.001),and the 5-year survival rate of high Ccr group was higher than that of low Ccr group(x2=11.959,P=0.001).The ROC curve indicated the combination of GNRI and Ccr had a good predictive effect on poor prognosis of patients at one year and three years after operation(AUC=0.909,0.755).Conclusions Preoperative decreases in GNRI and Ccr are associated with poor prognosis in elderly patients with renal clear cell carcinoma,and the combination of GNRI and Ccr provides better prediction of treatment efficacy.
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