"Evidence-based medicine" is convenient and practical! Do you know this prognostic indicator of renal cell carcinoma?

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Guide

Indicators that accurately predict the prognosis of cancer patients are critical
for clinicians to develop the most appropriate treatment strategy and follow-up plan.

Research background

The Prognostic Nutrition Index (PNI), a novel method to assess a patient's immune and nutritional status based on serum lymphocyte count and albumin levels, has been used in several studies to predict the prognosis
of patients with renal cell carcinoma (RCC).
However, due to differences in sample size, patient characteristics, and other factors in existing studies, the effect of PNI on the prognosis of RCC still needs to be further explored
.
To this end, Korean researchers conducted this meta-analysis to assess the diagnostic accuracy and application value
of PNI as a prognostic factor in RCC based on available data.

Study design

Based on the systematic review and meta-analysis priority report entry (PRISMA) statement, the investigators conducted systematic and comprehensive searches of relevant literature in PubMed, Web of Science, Cochrane Library and EMBASE databases, constructed research questions according to PICO principles and screened
literature.
The PNI value was calculated by formula× albumin concentration (g/dL) + lymphocyte count (/^mm3) × 0.
005, and its sensitivity, specificity, comprehensive receiver operating characteristic curve (SROC) and area under the curve (AUC)
were evaluated.

Study results

The meta-analysis included 11 studies
with a total of 7296 RCCs.
Pooled analysis of PNI on the prognostic value of RCC showed a sensitivity of 0.
733 (95% CI 0.
651-0.
802), specificity of 0.
615 (95% CI 0.
528-0.
695), a diagnostic odds ratio (DOR) of 4.
382 (95% CI 3.
148-6.
101), and an AUC of 0.
72 (95% CI 0.
68-0.
76).

Fig.
1 Forest plot of PNI sensitivity and specificity for RCC prognostic value

The results of subgroup analysis showed that the presence or absence of metastasis and the PNI cut-off value (≥50 vs <50) affected the diagnostic accuracy<b10> of PNI in RCC.
Multivariate meta-regression showed significant differences in sensitivity and specificity between PNI and non-metastatic RCC groups (p=0.
035).

Table 1 Univariate and multivariate meta-regression analysis results

Conclusion of the study

This study shows that PNI shows good diagnostic accuracy as a prognostic indicator of RCC, especially in
metastatic RCC.

Editor's comments

PNI is an economical, simple, efficient, and widely used predictor of nutritional and immune status and has been shown to correlate with
the prognosis of a wide range of tumors.
The findings further support that PNI can help clinicians predict clinical outcomes for RCC and warrant clinical rollout
.

References:

Shim SR, Kim SI, Kim SJ, Cho DS.
Prognostic nutritional index as a prognostic factor for renal cell carcinoma: A systematic review and meta-analysis.
PLoS One.
2022 Aug 5; 17(8):e0271821.
doi: 10.
1371/journal.
pone.
0271821.
PMID: 35930538; PMCID: PMC9355260.