Impact of nutritional status on the prognosis of patients with metastatic hormone-naïve prostate cancer: a multicenter retrospective cohort study in Japan
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To investigate the association between the Geriatric Nutritional Risk Index (GNRI) and prognosis of patients with metastatic hormone-naïve prostate cancer (mHNPC) and to design the optimal risk score predicting for prognosis.
We retrospectively reviewed data from the Michinoku Japan Urological Cancer Study Group database, containing information about 656 patients with mHNPC who initially received androgen-deprivation therapy between 2005 and 2017. The baseline GNRI was calculated using serum albumin level and body mass index. Poor nutrition was defined as GNRI < 92.0. The impact of GNRI, CHAARTED criteria, and laboratory parameters on oncological outcomes was investigated using the multivariable Cox regression models. We developed the risk comprising GNRI and laboratory parameters and compared its prognostic performance with the CHAARTED criteria using the receiver operating characteristic curve with the DeLong method.
Of 339 patients with sufficient data, 66 (19%) were diagnosed with poor nutrition. Multivariate analyses showed that GNRI < 92.0 was an independent prognostic factor of cancer-specific survival [hazard ratio (HR) 1.76; 95% confidence interval (CI) 1.04–2.98, P = 0.035] and overall survival (HR 1.80; 95% CI 1.13–2.89, P = 0.013), in addition to hemoglobin (Hb) and lactic dehydrogenase (LDH) levels. We designed the risk score comprising GNRI < 92.0, Hb < 13.0 g/dL, and LDH > 222 IU/L. The predictive value of the risk score was significantly superior to that of the CHAARTED criteria.
Poor nutrition may predict mortality in patients with mHNPC. Risk factors, such as nutritional status and laboratory parameters, may be useful in decision-making regarding aggressive treatments for patients with mHNPC.
KeywordsMetastatic hormone-naïve prostate cancer Malnutrition Geriatric Nutritional Risk Index CHAARTED Survival
We would like to thank Itsuto Hamano, Takuma Narita, Naoki Fujita, Hiromichi Iwamura, Yuki Fujita, Yukie Nishizawa, and the entire staff of the Department of Urology in Hirosaki University for their invaluable help with the data collection. The authors would also like to thank Enago (www.enago.jp) for the English language review.
TO: data analysis, manuscript writing/editing. SH: data collection or management, data analysis, manuscript writing/editing. SN: protocol/project development, data collection or management. MT, TS, SK, SH, MI, TK, SI, JS, HS, KM, and TT: data collection or management. NT, YA, TH, and CO: protocol/project development, supervision.
This work was supported by a Grant-in-Aid for Scientific Research (Grant nos. 15H02563, 15K15579, 17K11118, 17K11119, 17K16768, 17K16770, 17K16771, 18K16681, 18K16682, 18K16717, 18K16718, 18K16719, and 18K09157) from the Japan Society for the Promotion of Science.
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