Renal cell carcinoma (RCC) accounts for approximately 90% of all kidney malignancies worldwide. RCC still had a high rate of metastasis and mortality rate that the reports showed lung, liver, lymph node, and bone are most of the common metastatic sites in RCC. Malnutrition is a common problem in cancer patients results in poor response to therapy and more comorbidity with relative poor prognosis and lower quality of life. Therefore, we would like to investigate the prognostic value of the Geriatric Nutritional Risk Index (GNRI) in patients with metastatic renal cell carcinoma (mRCC).

Between January 2001 and December 2020, we enrolled 157 patients with mRCC diagnosed in Taichung Veterans General Hospital. The malnutritional status was defined as GNRI < 92.0. Using Kaplan-Meier analyses and Cox proportional hazards models to analyze the risk factors on overall survival (OS). We also used univariate and multivariate Cox hazard regression models to analyze the Hazard Ratio (HR) and 95% Confidence Interval (CI).

105 patients were categorized as normal nutritional status (GNRI ≥ 92) and 52 patients as malnutritional status (GNRI < 92). We used the receiver operating characteristic (ROC) curve for determined the association between GNRI and OS, with area under the curve (AUC) being 0.62. The 5-year survival rate of OS was 38.5% in the normal nutritional group and 17.6% in the malnutritional group. Using the Univariate analysis, malnutritional status was found as an independent risk factor for OS (Hazard Ratio [HR] = 1.93, 95% Confidence Interval [CI] 1.31-2.85), together with ECOG (HR=2.60, 95% CI 2.01-3.38), IMDC risk (HR=2.90, 95% CI 1.99-4.22), and sarcomatoid feature (HR=2.96, 95% CI 1.79-4.90).

Malnutritional status with low GNRI is an independent marker in predicting OS in mRCC patients. ECOG status, IMDC risk score, sarcomatoid feature and whether receiving Metastasectomy are also independent prognostic factors.