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Impact of nutritional status on the prognosis of patients with metastatic hormone-naïve prostate cancer: a multicenter retrospective cohort study in Japan

  • Teppei Okamoto
  • Shingo Hatakeyama
  • Shintaro Narita
  • Masahiro Takahashi
  • Toshihiko Sakurai
  • Sadafumi Kawamura
  • Senji Hoshi
  • Masanori Ishida
  • Toshiaki Kawaguchi
  • Shigeto Ishidoya
  • Jiro Shimoda
  • Hiromi Sato
  • Koji Mitsuzuka
  • Tatsuo Tochigi
  • Norihiko Tsuchiya
  • Yoichi Arai
  • Tomonori Habuchi
  • Chikara Ohyama
Original Article
  • 38 Downloads

Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusions

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.

Keywords

Metastatic hormone-naïve prostate cancer Malnutrition Geriatric Nutritional Risk Index CHAARTED Survival 

Notes

Acknowledgements

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.

Author contributions

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.

Funding

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.

Supplementary material

345_2018_2590_MOESM1_ESM.pptx (157 kb)
Supplementary material 1 (PPTX 157 KB)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Teppei Okamoto
    • 1
  • Shingo Hatakeyama
    • 1
  • Shintaro Narita
    • 2
  • Masahiro Takahashi
    • 3
  • Toshihiko Sakurai
    • 4
  • Sadafumi Kawamura
    • 5
  • Senji Hoshi
    • 6
  • Masanori Ishida
    • 7
  • Toshiaki Kawaguchi
    • 8
  • Shigeto Ishidoya
    • 9
  • Jiro Shimoda
    • 7
  • Hiromi Sato
    • 2
  • Koji Mitsuzuka
    • 3
  • Tatsuo Tochigi
    • 5
  • Norihiko Tsuchiya
    • 4
  • Yoichi Arai
    • 3
  • Tomonori Habuchi
    • 2
  • Chikara Ohyama
    • 1
  1. 1.Department of UrologyHirosaki University School of MedicineHirosakiJapan
  2. 2.Department of UrologyAkita University School of MedicineAkitaJapan
  3. 3.Department of UrologyTohoku University School of MedicineSendaiJapan
  4. 4.Department of UrologyYamagata University School of MedicineYamagataJapan
  5. 5.Department of UrologyMiyagi Cancer CenterNatoriJapan
  6. 6.Department of UrologyYamagata Prefectural Central HospitalYamagataJapan
  7. 7.Department of UrologyIwate Prefectural Isawa HospitalOshuJapan
  8. 8.Department of UrologyAomori Prefectural Central HospitalAomoriJapan
  9. 9.Department of UrologySendai City HospitalSendaiJapan

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