Impact of the preoperative prognostic nutritional index on survival outcomes in upper tract urothelial carcinomas

PURPOSES: To investigate the value of prognostic nutritional index (PNI) in patients with upper tract urothelial carcinoma (UTUC) who underwent radical nephroureterectomy (RNU). PATIENTS AND METHODS: A total of 717 patients were included in our study from 2003 to 2016. PNI was calculated as 10 × serum albumin level (g/dL) + 0.005 × total lymphocyte count (per mm(3)). Kaplan‐Meier analysis and Cox regression models were adapted to analyze the value of PNI on survival outcomes. RESULTS: The cutoff value of PNI was set as 46.91 and 298 patients (47.6%) had PNI <46.91. The median follow‐up was 50 months. The results suggested that low PNI was significantly associated with worse pathologic features (all P < 0.001). Multivariable Cox regression analysis revealed that PNI < 46.91 was an independent predictor of poor overall survival (Hazard ratios [HR] = 1.777, 95% CI = 1.383‐2.284, P < 0.001), cancer‐specific survival (HR = 1.850, 95% CI = 1.399‐2.445, P < 0.001), and recurrence‐free survival (HR = 1.554, 95% CI = 1.229‐1.964, P < 0.001). CONCLUSIONS: Low preoperative PNI was associated with worse survival outcomes in patients with UTUC. PNI could be an easily assessed blood‐based biomarker to predict the prognosis in patients with UTUC treated with RNU.