The Fib-PNI-MLR Score, an Integrative Model of Coagulation Cascades, Nutrition Status, and Systemic Inflammatory Response, Predicts Urological Outcomes After Surgery in Patients With Non-Metastatic Renal Cell Carcinoma

Abstract

Cancer-associated inflammation, activation of coagulation cascades, and malnutrition are closely related to the prognosis of patients with malignancy, including renal cell carcinoma (RCC). This study aimed to investigate the prognostic value of a combination of preoperative plasma fibrinogen, prognostic nutritional index, and monocyte-to-lymphocyte ratio (Fib-PNI-MLR) in patients with non-metastatic RCC undergoing nephrectomy. We retrospectively collected medical data from 829 of the 1,019 cases of RCC. The optimal cutoff values of fibrinogen (≥3.54 vs. <3.54, mg/dl), PNI (<47.03 vs. ≥47.03), and MLR (≥0.29 vs. <0.29) were defined using receiver operating characteristic (ROC) analysis and the Fib-PNI-MLR score (range, 0–3) was determined as the sum of points (0 or 1) assigned to each indicator. As a result, Fib-PNI-MLR was an independent risk factor for overall survival (OS), cancer-specific survival (CSS), and metastatic-free survival (MFS) (all P < 0.05). The concordance-index and area under the curve (AUC) were larger for the Fib-PNI-MLR score than that for other clinical parameters. Subgroup analysis (Fuhrman grade G1+G2 and Fuhrman grade G3+G4; pathologic T1, T2, and T3–4 stage) revealed the significant association of a higher Fib-PNI-MLR score with poor urological outcomes (all P < 0.05). Data indicated that patients with higher Fib-PNI-MLR might benefit from partial nephrectomy. The Fib-PNI-MLR score might serve as a promising prognostic factor in patients with non-metastatic RCC.