{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T04:54:07Z","timestamp":1791262447343,"version":"4.1.0"},"reference-count":39,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T00:00:00Z","timestamp":1791244800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Nutr."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The prognostic nutritional index (PNI) reflects nutritional-immune status, but the value of a single baseline PNI for predicting biochemical recurrence (BCR) after radical prostatectomy in high-risk localized prostate cancer remains unclear. We aimed to identify postoperative PNI trajectories and compare their BCR predictive value with baseline PNI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We retrospectively included 436 patients. PNI was measured preoperatively (T0) and at 3 (T1) and 12 (T2) months post-surgery. Longitudinal trajectory clustering identified three PNI trajectory classes: persistently high (PHigh,\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f169, 46.4%), persistently low (PLow,\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f146, 40.1%), and declining (Declining,\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f49, 13.5%). Cox regression assessed associations with BCR; a Cox-based time-to-event prediction model was evaluated using time-dependent AUC, IPCW Brier score, and calibration at 3-year and 5-year horizons. A 12-month landmark analysis was performed to address potential guarantee-time bias.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      During median 38.2-month follow-up, 122 (28.0%) developed BCR. Baseline PNI was not independently associated with BCR (continuous HR\u202f=\u202f0.97,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.320; dichotomized HR\u202f=\u202f1.23,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.347). Three trajectories emerged: persistently high (PHigh, 46.4%), persistently low (PLow, 40.1%), and declining (Declining, 13.5%). Relative to PHigh, PLow (HR\u202f=\u202f2.95) and Declining (HR\u202f=\u202f5.80) both had significantly higher BCR risk (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001). A 12-month landmark analysis confirmed these findings (PLow HR\u202f=\u202f2.72,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.002; Declining HR\u202f=\u202f4.79,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f1.24\u202f\u00d7\u202f10\n                      <jats:sup>\u22126<\/jats:sup>\n                      ). The multivariable Cox model combining trajectory, log PSA, surgical margin, and nodal metastasis achieved a 3-year time-dependent AUC of 0.823 (optimism-corrected 0.815) and a 5-year AUC of 0.790 (optimism-corrected 0.781). The Brier score was 0.117 at 3\u202fyears (25.8% improvement over null) and 0.166 at 5\u202fyears; the calibration slope was 1.057 (optimism-corrected 0.989) at 3\u202fyears and 1.001 (optimism-corrected 0.940) at 5\u202fyears.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Postoperative PNI follows three distinct change-pattern subgroups. Dynamic PNI trajectories are strongly associated with BCR risk, whereas a single baseline PNI is not. Patients with persistently low or declining PNI are at high risk, supporting routine PNI monitoring to guide individualized follow-up. These observational findings require prospective multicenter validation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fnut.2026.1963784","type":"journal-article","created":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T04:26:31Z","timestamp":1791260791000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Prognostic value of postoperative dynamic PNI trajectories for biochemical recurrence in patients with high-risk localized prostate cancer: a longitudinal trajectory clustering study"],"prefix":"10.3389","volume":"13","author":[{"given":"Bo","family":"Yu","sequence":"first","affiliation":[{"name":"Department of Urology, The Second Affiliated Hospital of Zunyi Medical University","place":["Zunyi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuchao","family":"Dai","sequence":"additional","affiliation":[{"name":"Department of Urology, Guizhou Medical University Affiliated Hospital","place":["Guiyang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianguo","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Urology, Guizhou Provincial People's Hospital","place":["Guiyang, China"]},{"name":"Graduate School, Zunyi Medical University","place":["Zunyi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,10,6]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"191","DOI":"10.1016\/j.eururo.2023.04.021","article-title":"2022 Update on prostate cancer epidemiology and risk factors\u2014a systematic review","volume":"84","author":"Bergengren","year":"2023","journal-title":"Eur Urol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"474","DOI":"10.1016\/j.jncc.2025.05.002","article-title":"Prostate cancer in China: epidemiological trends, genomic insights, and future directions for optimized 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