Study On The Prognosis Of Renal Clear Cell Carcinoma With Two Preoperative Immunonutrition Scoring Systems

Objective:At present,studies have shown that immunonutrition factors play an important role in the prognosis of tumors.The purpose of this study was to explore the correlation between preoperative CONUT score and PNI and the clinicopathological features of patients with renal clear cell carcinoma((ccRCC))and their predictive value after operation.Methods:The clinicopathological data of 1 16 patients with renal clear cell carcinoma diagnosed by postoperative pathology in our hospital from June 2013 to December 2016 were analyzed retrospectively.The peripheral venous blood of the patients was collected one week before operation,and the preoperative CONUT score was calculated according to the concentration of albumin,total cholesterol and the total number of lymphocytes,and the preoperative PNI value was calculated according to the concentration of albumin and the total number of lymphocytes.The clinical and pathological indexes of the patients were included in the factors affecting the postoperative survival of renal clear cell carcinoma.According to the ROC curve,the optimal critical values of PNI and CONUT before operation were determined and divided into high and low groups.To investigate the correlation between preoperative PNI,CONUT and clinicopathological features of patients with renal clear cell carcinoma.Cox proportional hazard model was used to analyze the relationship between clinicopathological variables and overall survival time of patients by univariate and multivariate analysis.Logarithmic rank(Log-rangk)test was used to compare the differences between groups,and Kaplan-Meier was used to draw survival curves for independent risk factors affecting ccRCC.Results:1.When PNI is used as a variable,the best critical value is determined by the ROC curve.The area under the ROC curve is 0.766.When PNI is 44.45,the Jordan index is the largest,0.50,the sensitivity is 56.5%,and the specificity is 93.5%.PNI was related to age,serum albumin,total lymphocyte,total cholesterol,pathological T stage and tumor size(maximum tumor diameter).2.When CONUT is used as a variable,the best critical value is determined by the ROC curve.The area under the ROC curve is 0.749.When CONUT is 3,the Yoden index is the largest,0.51,the sensitivity is 60.9%,and the specificity is 90.3%.CONUT was related to age,serum albumin,total lymphocyte.total cholesterol,pathological T stage and Fuhrman nuclear grade.3.Univariate analysis showed that tumor size,pathological T stage,regional lymph node metastasis,vascular invasion,CONUT score,PNI were significantly correlated with overall survival(OS).4.The results of multivariate analysis showed that TNM stage,regional lymph node metastasis,CONUT score and PNI were independent prognostic factors for postoperative overall survival of renal clear cell carcinoma(RCC).The overall survival rate of stage T1-2 was higher than that of stage T3-4;the overall survival rate of patients without regional lymph node involvement was higher than that of patients with regional lymph node involvement;the overall survival time of patients with low CONUT was higher than that of patients with high CONUT,and the overall survival time of patients with high PNI was significantly higher than that of patients with low PNI.Conclusions:CONUT score and PNI are independent factors affecting the survival and prognosis of ccRCC.When CONUT score?3 and PNI<44.45,the overall survival time of ccRCC patients is shorter.CONUT and PNI can be used as effective predictors to evaluate the prognosis of ccRCC.