Prognostic significance of sarcopenia and systemic inflammation for patients with renal cell carcinoma following nephrectomy

Abstract

BackgroundTo clarify the prognostic effect of preoperative sarcopenia and systemic inflammation, and to develop a nomogram for predicting overall survival (OS) of patients with renal cell carcinoma (RCC) following partial or radical nephrectomy.MethodsPatients with RCC following nephrectomy from the First Affiliated Hospital of Soochow University during January 2018 to September 2020 were included in this study. The relationship between sarcopenia and inflammatory markers was identified by logistic regression analysis. Then univariable Cox regression analysis, LASSO regression analysis and multivariable Cox regression analysis were analyzed sequentially to select the independent prognostic factors. Kaplan-Meier survival curves were applied to ascertain the prognostic value. Finally, the identified independent predictors were incorporated in a nomogram, which was internally validated and compared with other methods.ResultsA total of 276 patients were enrolled, and 96 (34.8%) were diagnosed with sarcopenia, which was significantly associated with neutrophil-to-lymphocyte ratio (NLR). Sarcopenia and elevated inflammation markers, i.e., NLR, platelet-to-lymphocyte ratio (PLR) and the modified Glasgow Prognostic Score (mGPS), were independent factors for determining the OS. The model had good discrimination with Concordance index of 0.907 (95% CI: 0.882–0.931), and the calibration plots performed well. Both net reclassification index (NRI) and integrated discriminant improvement (IDI) exhibited better performance of the nomogram compared with clinical stage-based, sarcopenia-based and integrated “NLR+PLR+mGPS” methods. Moreover, decision curve analysis showed a net benefit of the nomogram at a threshold probability greater than 20%.ConclusionsPreoperative sarcopenia was significantly associated with NLR. A novel nomogram with well validation was developed for risk stratification, prognosis tracking and personalized therapeutics of RCC patients.

Neutrophil-to-lymphocyte ratio is associated with sarcopenia risk in overweight maintenance hemodialysis patients

“…Previous research has evaluated the correlation between NLR and the risk of sarcopenia in different populations. For instance, a retrospective study involving 343 Chinese patients with renal cell carcinoma found an association between sarcopenia risk and NLR 18 , which was in line with the findings of Borges et al and Liu et al 29 , 30 . These studies suggested that a higher NLR might contribute to an elevated risk of sarcopenia in patients with hematological or solid cancers.…”

Combination of Sarcopenia and Hypoalbuminemia Is a Poor Prognostic Factor in Surgically Treated Nonmetastatic Renal Cell Carcinoma

“…Furthermore, a recent meta-analysis found that patients with malignant neoplasms, including RCC and sarcopenia, had worse clinical outcomes than those who did not [ 28 ]. Interestingly, recent research has shown that preoperative sarcopenia and elevated systemic inflammatory markers, such as the modified Glasgow Prognostic Score including both CRP and albumin levels, were associated with a decreased survival [ 29 , 30 ]. Furthermore, a recent retrospective study found that patients with localized RCC who had both sarcopenia and hypoalbuminemia prior to surgery had a two-to-three-fold reduction in OS and recurrence-free survival after nephrectomy in an American population [ 22 ].…”