Geriatric nutritional risk index as a predictor of prognosis in metastatic renal cell carcinoma treated with nivolumab

Background: We evaluate the role of the Geriatric Nutritional Risk Index (GNRI) as a prognostic factor in metastatic renal cell carcinoma patients receiving nivolumab.Methods: Fifty-six consecutive patients with metastatic renal cell carcinoma receiving nivolumab after tyrosine kinase inhibitor between September 2013 and August 2020 at our institution were retrospectively analyzed. The survival outcomes and prognostic factors associated with overall survival (OS) were statistically analyzed. Results: Median follow-up period was 28.6 months. Median progression-free survival (PFS) and 1- and 3-year PFS rates were 26.4 months, 59.7%, and 19.5%, respectively. Median OS and 1- and 3-year OS rates were 48.1 months, 88.9%, and 74.5%, respectively. Thirteen and forty-three patients were classified with low (GNRI p = 0.0002) and PFS (p = 0.045) than those with high GNRI. In multivariate analysis, GNRI at the time of nivolumab (hazard ratio: 4.38, p = 0.013) was extracted as the predictor for OS in addition to duration from diagnosis to treatment (p = 0.0005) and lymphocyte count (p = 0.026). Integration of the GNRI into the International Metastatic Renal Cell Cancer Database Consortium (IMDC) risk classification improved the c-index from 0.761 to 0.833 (combination of GNRI with IMDC risk classification) and to 0.778 (substitution of GNRI with Karnofsky performance status in IMDC risk classification).Conclusions: GNRI was a significant prognostic biomarker in metastatic renal cell carcinoma patients receiving nivolumab. This simple screening tool could be very useful in clinical practice.