| Objective: This study was conducted to investigate the prognostic significance of a combination of prognostic nutritional index(PNI)and systemic immune-inflammation index(SII)named the PNI、SII score in patients with non-metastatic clear cell renal carcinoma(cc RCC).And the PNI、SII score as a novel indicator and further create a nomogram for predicting the prognosis of patients with non-metastatic cc RCC treated with nephrectomy.Methods: In this research,the clinicopathological and prognostic data of patients with non-metastatic cc RCC who underwent surgery in Yijishan Hospital of Wannan Medical College from October 2011 to December 2017 were retrospectively collected.Overall survival(OS),cancer-specific survival(CSS)and metastasis-free survival(MFS)were used as endpoints.First,the receiver operating characteristic curve(ROC)was used to determine the optimal cut-off values of PNI and SII according to the maximum Youden index.Kaplan-Meier(KM)survival curve was used to evaluate the survival difference between patients grouped according to PNI and SII.Then,the two groups of PNI and SII were assigned a value of 0 or 1according to the results of KM curve analysis,and the PNI、SII score was constructed.Patients were divided into three categories according to the value of their PNI-SII score: PNI-SII score=2(high PNI and low SII),PNI-SII score =0(low PNI and high SII),and PNI-SII score =1(other).Then,the variables were preliminary selected according to Cox univariate analysis and LASSO regression,and the selected variables were further analyzed by Cox multivariate stepwise backward regression analysis.The variables selected by different screening methods were used to construct prediction models,and the AIC(Akaike information criterion)values were compared.Models with smaller AIC values were selected in this study.Then nomograms to predict the survival status(OS,CSS and MFS)were established.The prediction model was compared with various indicators such as traditional T stage and G grade,and the model was evaluated by C index(Concordance indexes,Time-C index),time C index(Time-Concordance indexes,Time-C index),time-dependent receiver working characteristics(Time-dependent receiver operating characteristic,Time-ROC)curve,calibration curve and clinical decision analysis(Decision Curve Analysis,DCA).Results: A total of 233 patients with non-metastatic cc RCC patients were enrolled,with a mean follow-up period of 86.33 months.Up to the last follow-up,death occurred in 22(9.44%)patients,and cancer specific death occurred in 17(7.30%)patients.32(13.73%)patients suffered distant metastasis after surgery.There were 131 cases(56.22%),74 cases(31.76%)and 28 cases(12.02%)in the PNI-SII score 2,1 and 0 groups,respectively.Cox regression analysis showed that a high PNI、SII score was significantly associated with great prognosis and acted as an independent prognostic factor for OS,CSS and MFS(all P < 0.05).The prognostic factors associated with OS,CSS and MFS included age,tumor size,T stage,G grade,and PNI 、 SII score.The nomogram based on the PNI 、 SII score showed good performance in predicting postoperative OS(C-index: 0.908),CSS(C-index: 0.903)and MFS(C-index: 0.809).The time C-index and time-dependent ROC results showed that the nomogram containing the PNI、SII score had better predictive performance than each factor of the model.In addition,the predictive performance of PNI、SII score was better than that of PNI and SII alone.The calibration curve results showed that the constructed nomogram had a good calibration for the prediction results.The clinical decision analysis curve showed that the nomogram model had clinical application value.Conclusions: 1.PNI 、 SII score is an effective prognostic biomarker for patients with non-metastatic cc RCC after surgery.High PNI 、 SII score is a protective factor for postoperative survival of patients.2.The predictive performance of the nomogram including PNI 、 SII score for predicting postoperative survival status of patients is better than that of classical T staging and G staging. |
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