Background: The objective of this study was to assess the prognostic value of the Geriatric Nutrition Risk Index (GNRI), a simplified, objective screening parameter of nutrition-related risk for various pathological conditions, on patients with non-metastatic renal cell carcinoma (RCC) who underwent surgical resection. Patients and Methods: This study included 432 consecutive patients with non-metastatic RCC who received complete surgical resection. The prognostic outcomes of these patients were evaluated focusing on the significance of GNRI, calculated from serum albumin and the body mass index. Results: Of the 432 patients, 107 (24.8%) and 325 (75.2%) were classified into low (GNRI ≤ 98) and high (GNRI > 98) nutritional groups, respectively. Both recurrence-free survival and cancer-specific survival in the low nutritional group were significantly poorer compared with those in the high nutritional group. Despite the lack of independent significance as a predictor of recurrence-free survival, GNRI, in addition to microvascular invasion, appeared to be independently associated with cancer-specific survival on multivariate analysis. Conclusion: A low nutritional status evaluated by GNRI may have an unfavorable impact on postoperative cancer control, particularly cancer-specific survival, in non-metastatic RCC patients who received surgical resection.

Abbreviations & Acronyms BMI = body mass index CCI = Charlson Comorbidity Index CIS = carcinoma in situ CSS = cancer-specific survival eGFR = estimated glomerular filtration rate HR = hazard ratio IQR = interquartile range KPS = Karnofsky Performance Status LVI = lymphovascular invasion OS = overall survival PS = performance status RC = radical cystectomy RFS = recurrence-free survival Objectives: To assess the significance of performance status as a prognostic factor after radical cystectomy for urothelial carcinoma of the bladder. Methods: The present study included 730 consecutive patients with urothelial carcinoma of the bladder who underwent radical cystectomy. Clinicopathological outcomes in these patients were analyzed focusing on the impact of performance status, which was assessed using the Karnofsky Performance Status scale before surgery. Patients were classified into groups with Karnofsky Performance Status 90 and 80. Results: A total of 561 (76.8%) and 169 (23.2%) patients were judged to have Karnofsky Performance Status 90 and 80, respectively. During a mean of 52.0 months, disease recurrence and mortality occurred in 257 (35.2%) and 249 (34.1%) patients, respectively, and the 5-year recurrence-free and overall survival rates were 64.1 and 65.3%, respectively. There were significant differences in age, hemoglobin, albumin, estimated glomerular filtration rate, pathological T stage and nodal involvement between the Karnofsky Performance Status 90 and 80 groups. Multivariate analysis showed independent impacts of Karnofsky Performance Status, pathological T stage, nodal involvement and lymphovascular invasion on recurrence-free survival, as well as independent impacts of Karnofsky Performance Status, age, body mass index, hemoglobin, pathological T stage, nodal involvement and lymphovascular invasion on overall survival. Conclusions: The results suggest a significant association between impaired performance status and unfavorable prognosis in patients with urothelial carcinoma of the bladder undergoing radical cystectomy.

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