Impact of nutritional status on the prognosis of patients with metastatic hormone-naïve prostate cancer

[pjoshea13]

New study from Japan.

Interesting to note non-PCa tests that may affect mortality.

"The baseline GNRI [Geriatric Nutritional Risk Index] was calculated using serum albumin level and body mass index."

There are now countless PCa studies that report an association between high BMI [body mass index] & poorer survival. Visceral fat is hormonally active - in a bad way. Reduction should be beneficial. But albumin?

Years ago, a man who was running a PCa group on the West Coast told me that the best indicator of PCa survival was albumin. Better than any cancer-related test. Something he had observed over the years. Anecdotal.

But albumin is an inverse marker for inflammation (see my inflammation posts). Subclinical inflammation increases mortality risk across the board. Along with C-reactive protein, albumin is used in the Glasgow prognostic score, which tells a hospital which patients are likely to develop "unexpected"

& "GNRI is a simple and accurate tool for predicting the risk of morbidity and mortality in hospitalized elderly patients and should be recorded systematically on admission." [2]

"We designed the risk score comprising GNRI < 92.0, Hb {hemoglobin }< 13.0 g/dL, and LDH{lactic dehydrogenase} > 222 IU/L. The predictive value of the risk score was significantly superior to that of the CHAARTED criteria."

Note "lactic dehydrogenase" is a measure of tissue damage.

Normal hemoglobin is "13.5 to 17.5 grams (g) of hemoglobin per deciliter (dL) "

-Patrick

[1] ncbi.nlm.nih.gov/pubmed/305...

World J Urol. 2018 Dec 4. doi: 10.1007/s00345-018-2590-2. [Epub ahead of print]

Impact of nutritional status on the prognosis of patients with metastatic hormone-naïve prostate cancer: a multicenter retrospective cohort study in Japan.

Okamoto T1, Hatakeyama S2, Narita S3, Takahashi M4, Sakurai T5, Kawamura S6, Hoshi S7, Ishida M8, Kawaguchi T9, Ishidoya S10, Shimoda J8, Sato H3, Mitsuzuka K4, Tochigi T6, Tsuchiya N5, Arai Y4, Habuchi T3, Ohyama C1.

Author information

Abstract

PURPOSE:

To investigate the association between the Geriatric Nutritional Risk Index (GNRI) and prognosis of patients with metastatic hormone-naïve prostate cancer (mHNPC) and to design the optimal risk score predicting for prognosis.

METHODS:

We retrospectively reviewed data from the Michinoku Japan Urological Cancer Study Group database, containing information about 656 patients with mHNPC who initially received androgen-deprivation therapy between 2005 and 2017. The baseline GNRI was calculated using serum albumin level and body mass index. Poor nutrition was defined as GNRI < 92.0. The impact of GNRI, CHAARTED criteria, and laboratory parameters on oncological outcomes was investigated using the multivariable Cox regression models. We developed the risk comprising GNRI and laboratory parameters and compared its prognostic performance with the CHAARTED criteria using the receiver operating characteristic curve with the DeLong method.

RESULTS:

Of 339 patients with sufficient data, 66 (19%) were diagnosed with poor nutrition. Multivariate analyses showed that GNRI < 92.0 was an independent prognostic factor of cancer-specific survival [hazard ratio (HR) 1.76; 95% confidence interval (CI) 1.04-2.98, P = 0.035] and overall survival (HR 1.80; 95% CI 1.13-2.89, P = 0.013), in addition to hemoglobin (Hb) and lactic dehydrogenase (LDH) levels. We designed the risk score comprising GNRI < 92.0, Hb < 13.0 g/dL, and LDH > 222 IU/L. The predictive value of the risk score was significantly superior to that of the CHAARTED criteria.

CONCLUSIONS:

Poor nutrition may predict mortality in patients with mHNPC. Risk factors, such as nutritional status and laboratory parameters, may be useful in decision-making regarding aggressive treatments for patients with mHNPC.

KEYWORDS:

CHAARTED; Geriatric Nutritional Risk Index; Malnutrition; Metastatic hormone-naïve prostate cancer; Survival

PMID: 30511214 DOI: 10.1007/s00345-018-2590-2

[2] ncbi.nlm.nih.gov/pubmed/162...

[cesanon]

hmmm interesting.

Though eating more albumin would not necessarily help.

[Graham49]

The Title and Conclusions include the words "nutritional status" but the paper does not indicate how this might be improved. The Conclusions only mention "aggressive treatment". Do you think they are suggesting less /more aggressive treatments rather than changing diet?

[pjoshea13 in reply to Graham49]

BMI could be reduced via diet, but albumin would involve inflammation reduction.

"nutritional status" implies, to me, something to do with nutrient sufficiency. In an older population, particularly with men living alone, it can seem like too much trouble to prepare a meal. But just how a poor diet relates to GNRI, I don't know.

Perhaps there would be less confusion if we could see the original Japanese text? LOL

-Patrick

[j-o-h-n in reply to pjoshea13]

これは、私があなたに私の言葉で書いていることをあなたに知らせるためにあなたに伝えています。幸運良い健康と良いユーモア。

Good Luck, Good Health and Good Humor.

j-o-h-n Thursday 12/06/2018 6:28 PM EST

[Fitzbruce1 in reply to j-o-h-n]

John- I totally understand and support your theory🤪