[Comparison of preoperative nutritional scoring systems for predicting survival in upper tract urothelial carcinoma]

To investigate the association between preoperative nutritional indicators and survival outcomes in patients with upper tract urothelial carcinoma (UTUC) undergoing radical nephroureterectomy (RNU), and to compare the predictive performance of different nutritional scoring systems.

A retrospective analysis was conducted on UTUC patients who underwent RNU. Nutritional scores [geriatric nutritional risk index (GNRI), prognostic nutritional index (PNI), controlling nutritional status (CONUT), triglycerides-total cholesterol-body weight index (TCBI)] were calculated. Variables with P < 0.10 in univariable Cox regression were entered into multivariable analysis using backward stepwise selection based on the Akaike Information Criterion (AIC) to identify independent predictors and construct a nomogram. Kaplan-Meier curves with log-rank tests and time-dependent ROC curves were applied for survival analysis. A two-sided P < 0.05 was considered statistically significant.

A total of 481 UTUC patients were included. Multivariable analysis identified pathological T3/T4 stage, N1/N2 stage, high World Health Organization/International Society of Urological Pathology (WHO/ISUP) grade, estimated glomerular filtration rate (eGFR), blood transfusion, ureteral management, GNRI, and PNI as independent predictors of overall survival (OS) (P < 0.05). Independent predictors of cancer-specific survival (CSS) included pathological T2-T4 stage, N1/N2 stage, laparoscopic surgical approach, blood transfusion, GNRI, and PNI (P < 0.05). The nomogram constructed based on these independent predictors demonstrated good calibration. Patients with GNRI < 98 or PNI < 52 had significantly shorter OS and CSS (Log-rank P < 0.05). At the end of 60 months, the area under the curve (AUC) values of GNRI and PNI for predicting OS were 0.623 and 0.632, respectively, and for predicting CSS were 0.632 and 0.645, respectively. Time-dependent ROC analysis showed that both indicators had stable predictive performance for CSS, while their predictive ability for OS showed a mild increasing trend over the follow-up time.

Preoperative GNRI and PNI are independently associated with OS and CSS in patients with UTUC after RNU, demonstrating stable predictive performance across different follow-up periods.