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Struck JP, Hupe MC, Heinisch A, Ozimek T, Hennig MJP, Klee M, von Klot C, Kalogirou C, Kuczyk MA, Merseburger AS, Kramer MW. RLC score (R status, lymphovascular invasion, C-reactive protein) predicts survival following radical cystectomy for muscle-invasive bladder cancer. Aktuelle Urol 2022; 53:545-551. [PMID: 33445183 DOI: 10.1055/a-1310-3583] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND CRP-based scoring systems were found to correlate with survival in patients with urooncologic diseases. Our retrospective single-centre study aimed to confirm CRP as a prognostic parameter in patients with bladder cancer (BCa) undergoing radical cystectomy (RC) and, based on the findings, to develop our own outcome score for muscle-invasive bladder cancer (MIBC) patients undergoing RC in order to identify patients with a high risk of mortality. MATERIAL AND METHODS A total of 254 patients who underwent RC at Hanover Medical School between 1996 and 2007 were reviewed with a follow-up until autumn 2013. The clinicopathologic parameters assessed included age, co-morbidities, pre-/postoperative serum levels of CRP, leukocytes, haemoglobin, creatinine, urinary diversion, tumour grading, staging, lymph node status, lymph node density (LND), lymphovascular invasion (LVI), metastases, and resection margin status. The Chi-square test was used for univariate analyses. Kaplan-Meier estimates and the log-rank test were used for survival analyses. Regarding outcome, overall survival (OS) was assessed. RESULTS The multivariate analysis excluding lymph node (LN)-positive and metastatic patients at time of RC showed a significant association of R status (R; p < 0.001), LVI (L; p = 0.021) and preoperative CRP level > 5 mg/l (C; p = 0.008) with OS. Based on these parameters, the RLC score was developed. The median OS in the intermediate, high-risk and very high-risk groups according to the RLC score was 62, 22, and 6.5 months, respectively. The score had a high predictive accuracy of 0.752. CONCLUSION The RLC score identifies BCa patients at a higher risk of overall mortality after RC. Overall, our study supports the role of CRP in prognostic score models for BCa.
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Affiliation(s)
- Julian Peter Struck
- Department of Urology, University-Hospital Schleswig-Holstein, Campus Luebeck, Luebeck
| | - Marie Christine Hupe
- Department of Urology, University-Hospital Schleswig-Holstein, Campus Luebeck, Luebeck
| | - Annika Heinisch
- Department of Urology and Urologic Oncology, Medical School Hannover, Hannover.,Clinic for Obsterics and Gynecology, Muehlenkreiskliniken, Johannes Wesling Klinikum Minden, Minden
| | - Tomasz Ozimek
- Department of Urology, University-Hospital Schleswig-Holstein, Campus Luebeck, Luebeck
| | | | - Melanie Klee
- Department of Urology, University-Hospital Schleswig-Holstein, Campus Luebeck, Luebeck
| | - Christoph von Klot
- Department of Urology and Urologic Oncology, Medical School Hannover, Hannover
| | - Charis Kalogirou
- Department of Urology and Pediatric Urology, Julius-Maximilians-University of Wuerzburg, Wuerzburg
| | - Markus A Kuczyk
- Department of Urology and Urologic Oncology, Medical School Hannover, Hannover
| | - Axel S Merseburger
- Department of Urology, University-Hospital Schleswig-Holstein, Campus Luebeck, Luebeck
| | - Mario W Kramer
- Department of Urology, University-Hospital Schleswig-Holstein, Campus Luebeck, Luebeck
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Frey A, Martin D, D’Cruz L, Fokas E, Rödel C, Fleischmann M. C-Reactive Protein to Albumin Ratio as Prognostic Marker in Locally Advanced Non-Small Cell Lung Cancer Treated with Chemoradiotherapy. Biomedicines 2022; 10:biomedicines10030598. [PMID: 35327399 PMCID: PMC8945805 DOI: 10.3390/biomedicines10030598] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 02/24/2022] [Accepted: 02/28/2022] [Indexed: 01/08/2023] Open
Abstract
Despite the implementation of consolidative immune checkpoint inhibition after definitive chemoradiotherapy (CRT), the prognosis for locally advanced non-small-cell lung cancer (NSCLC) remains poor. We assessed the impact of the C-reactive protein (CRP) to albumin ratio (CAR) as an inflammation-based prognostic score in patients with locally advanced NSCLC treated with CRT. We retrospectively identified and analyzed 52 patients with primary unresectable NSCLC (UICC Stage III) treated with definitive/neoadjuvant CRT between 2014 and 2019. CAR was calculated by dividing baseline CRP by baseline albumin levels and correlated with clinicopathologic parameters to evaluate prognostic impact. After dichotomizing patients by the median, univariate and multivariate Cox regression analyses were performed. An increased CAR was associated with advanced T-stage (p = 0.018) and poor performance status (p = 0.004). Patients with pre-therapeutic elevated CAR had significantly lower hemoglobin and higher leukocyte levels (hemoglobin p = 0.001, leukocytes p = 0.018). High baseline CAR was shown to be associated with worse local control (LPFS, p = 0.006), shorter progression-free survival (PFS, p = 0.038) and overall survival (OS, p = 0.022), but not distant metastasis-free survival (DMFS). Multivariate analysis confirmed an impaired outcome in patients with high CAR (LPFS: HR 3.562, 95% CI 1.294–9.802, p = 0.011). CAR is an easily available and independent prognostic marker after CRT in locally advanced NSCLC. CAR may be a useful biomarker for patient stratification to individualize treatment concepts.
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Affiliation(s)
- Alina Frey
- Department of Radiation Oncology, Hospital of the Johann Wolfgang Goethe University, 60590 Frankfurt, Germany; (A.F.); (D.M.); (L.D.); (E.F.); (C.R.)
| | - Daniel Martin
- Department of Radiation Oncology, Hospital of the Johann Wolfgang Goethe University, 60590 Frankfurt, Germany; (A.F.); (D.M.); (L.D.); (E.F.); (C.R.)
- German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- German Cancer Consortium (DKTK), Partner Site Frankfurt am Main, 60590 Frankfurt, Germany
- Frankfurt Cancer Institute, 60590 Frankfurt, Germany
| | - Louisa D’Cruz
- Department of Radiation Oncology, Hospital of the Johann Wolfgang Goethe University, 60590 Frankfurt, Germany; (A.F.); (D.M.); (L.D.); (E.F.); (C.R.)
| | - Emmanouil Fokas
- Department of Radiation Oncology, Hospital of the Johann Wolfgang Goethe University, 60590 Frankfurt, Germany; (A.F.); (D.M.); (L.D.); (E.F.); (C.R.)
- German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- German Cancer Consortium (DKTK), Partner Site Frankfurt am Main, 60590 Frankfurt, Germany
- Frankfurt Cancer Institute, 60590 Frankfurt, Germany
| | - Claus Rödel
- Department of Radiation Oncology, Hospital of the Johann Wolfgang Goethe University, 60590 Frankfurt, Germany; (A.F.); (D.M.); (L.D.); (E.F.); (C.R.)
- German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- German Cancer Consortium (DKTK), Partner Site Frankfurt am Main, 60590 Frankfurt, Germany
- Frankfurt Cancer Institute, 60590 Frankfurt, Germany
| | - Maximilian Fleischmann
- Department of Radiation Oncology, Hospital of the Johann Wolfgang Goethe University, 60590 Frankfurt, Germany; (A.F.); (D.M.); (L.D.); (E.F.); (C.R.)
- Correspondence:
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Yuk HD, Ku JH. Role of Systemic Inflammatory Response Markers in Urothelial Carcinoma. Front Oncol 2020; 10:1473. [PMID: 32974174 PMCID: PMC7471310 DOI: 10.3389/fonc.2020.01473] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 07/10/2020] [Indexed: 12/19/2022] Open
Abstract
Urothelial carcinoma (UC) can occur in various parts of the urinary tract and occurs in different stages and grades. The disease recurs frequently and is monitored through a series of invasive tests, such as cystoscopy or ureteroscopy, over the lifetime of an individual. Although many researchers have attempted to stratify the risks of UC, with the majority being based on cancer characteristics and host factors such as performance status, a risk classification system has yet to be fully developed. Cancer affects various parts of the body through the systemic immune response, including changes in hormones, the number and ratio of white blood cells and platelets, and C-reactive protein (CRP) or albumin levels under the influence of neuroendocrine metabolism, hematopoietic function, and protein and energy metabolism, respectively. Herein, we reviewed various systemic inflammatory response markers (SIRs) related to UC, including CRP, albumin-globulin ratio, albumin, Glasgow prognostic score (GPS), modified GPS, neutrophil-lymphocyte ratio, and platelet-lymphocyte ratio. Our aim was to summarize the role of various SIRs in the treatment of patients with UC.
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Affiliation(s)
- Hyeong Dong Yuk
- Department of Urology, Seoul National University Hospital, Seoul, South Korea.,College of Medicine, Seoul National University, Seoul, South Korea
| | - Ja Hyeon Ku
- Department of Urology, Seoul National University Hospital, Seoul, South Korea.,College of Medicine, Seoul National University, Seoul, South Korea
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Guo Y, Cai K, Mao S, Zhang J, Wang L, Zhang Z, Liu M, Zhang W, Wu Y, Yan Y, Yao X. Preoperative C-reactive protein/albumin ratio is a significant predictor of survival in bladder cancer patients after radical cystectomy: a retrospective study. Cancer Manag Res 2018; 10:4789-4804. [PMID: 30425573 PMCID: PMC6205524 DOI: 10.2147/cmar.s180301] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Purpose Earlier studies have indicated the prognostic value of the pretreatment C-reactive protein (CRP)/albumin ratio (CAR) in multiple tumor types. The present study attempts to investigate the predictive role of preoperative CAR in patients with bladder cancer after radical cystectomy (RC), and explores its prognostic index value. Patients and methods A total of 131 patients with bladder cancer after RC between 2009 and 2015 were analyzed in the present study. Overall survival (OS) and progression-free survival (PFS) were estimated using the Kaplan–Meier method and Cox regression analyses. Prediction accuracy was evaluated through the area under the receiver operating characteristic curve (AUC). Results The median follow-up time for all patients in the present retrospective study was 39.72 months (15.51–53.26 months). The Kaplan–Meier curve analysis indicated that bladder cancer patients with high preoperative CAR (>0.2) were significantly associated with decreased PFS and OS (all, P<0.001). The multivariate analysis confirmed CAR as a common independent prognostic factor for PFS and OS. Furthermore, the effective combination of CAR and pathological T staging constituted a new index (CART), and was observed to be an independent risk factor for OS (CART score =2, HR=0.264; 95% CI: 0.106–0.660, P=0.004; CART score =3, HR =0.371; 95% CI: 0.208–0.661, P=0.001). However, CART did not show any prognostic significance for PFS. Importantly, the AUC values of CAR for OS and PFS were higher than other conventional clinical indices. Conclusion The present study demonstrated that CAR can be used as a new prognostic indicator of OS and PFS in patients with bladder cancer after RC. Combining the CAR score with pathological T staging as the CART score appears to be a more effective prognostic indicator of poor OS, but not PFS.
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Affiliation(s)
- Yadong Guo
- Department of Urology, Shanghai Tenth People's Hospital, Tongji University, Shanghai, People's Republic of China, ,
| | - Keke Cai
- Department of Urology, First Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China
| | - Shiyu Mao
- Department of Urology, Shanghai Tenth People's Hospital, Tongji University, Shanghai, People's Republic of China, ,
| | - Junfeng Zhang
- Department of Urology, Shanghai Tenth People's Hospital, Tongji University, Shanghai, People's Republic of China, ,
| | - Longsheng Wang
- Department of Urology, Shanghai Tenth People's Hospital, Tongji University, Shanghai, People's Republic of China, ,
| | - Ziwei Zhang
- Department of Urology, Shanghai Tenth People's Hospital, Tongji University, Shanghai, People's Republic of China, ,
| | - Mengnan Liu
- Department of Anhui Medical University, Hefei, People's Republic of China
| | - Wentao Zhang
- Department of Anhui Medical University, Hefei, People's Republic of China
| | - Yuan Wu
- Department of Anhui Medical University, Hefei, People's Republic of China
| | - Yang Yan
- Department of Urology, Shanghai Tenth People's Hospital, Tongji University, Shanghai, People's Republic of China, ,
| | - Xudong Yao
- Department of Urology, Shanghai Tenth People's Hospital, Tongji University, Shanghai, People's Republic of China, ,
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Uhlig A, Seif Amir Hosseini A, Simon J, Lotz J, Trojan L, Schmid M, Uhlig J. Gender Specific Differences in Disease-Free, Cancer Specific and Overall Survival after Radical Cystectomy for Bladder Cancer: A Systematic Review and Meta-Analysis. J Urol 2018; 200:48-60. [PMID: 29477716 DOI: 10.1016/j.juro.2017.11.150] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2017] [Indexed: 01/13/2023]
Abstract
PURPOSE We summarize the evidence on gender specific differences in disease-free, cancer specific and overall survival after radical cystectomy for bladder cancer. MATERIALS AND METHODS We performed a systematic literature search of MEDLINE®, Embase® and the Cochrane Library in July 2017. Studies evaluating gender specific differences in disease-free, cancer specific or overall survival after radical cystectomy for bladder cancer were included in study. Analyses included random effect meta-analysis, subgroup analyses, meta-influence and cumulative meta-analyses. Funnel plots and the Egger test were used to assess publication bias. RESULTS Of the 3,868 studies identified during the literature search 59 published between 1998 and 2017 were included in analysis. Of the studies 30 in a total of 38,321 patients evaluated disease-free survival, 44 in a total of 69,666 evaluated cancer specific survival and 26 in a total of 30,039 evaluated overall survival. Random effect meta-analyses revealed decreased disease-free, cancer specific survival and overall survival in female patients than in their male counterparts. Pooled estimates showed a HR of 1.16 (95% CI 1.06-1.27, p = 0.0018) for disease-free survival, 1.23 (95% CI 1.15-1.31, p <0.001) for cancer specific survival and 1.08 (95% CI 1.03-1.12, p = 0.0004) for overall survival. Subgroup analyses confirmed impaired disease-free, cancer specific and overall survival in female patients in all strata. Publication bias was evident only for studies of cancer specific survival (Egger test p = 0.0029). After adjusting for publication bias by the trim and fill method the corrected pooled estimated HR of cancer specific survival was 1.13 (95% CI 1.05-1.21, p = 0.0012). CONCLUSIONS Female patients who underwent radical cystectomy for bladder cancer demonstrated worse disease-free, cancer specific and overall survival than their male counterparts. The multifactorial etiology might include epidemiological differences, gender specific health care discrepancies and hormonal influences.
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Affiliation(s)
- Annemarie Uhlig
- Department of Urology, University Medical Center Goettingen, Goettingen, Germany.
| | - Ali Seif Amir Hosseini
- Department of Diagnostic and Interventional Radiology, University Medical Center Goettingen, Goettingen, Germany
| | - Jörg Simon
- Department of Urology and Pediatric Urology, Ortenau Hospital, Offenburg, Germany
| | - Joachim Lotz
- Department of Diagnostic and Interventional Radiology, University Medical Center Goettingen, Goettingen, Germany
| | - Lutz Trojan
- Department of Urology, University Medical Center Goettingen, Goettingen, Germany
| | - Marianne Schmid
- Department of Urology, University Medical Center Goettingen, Goettingen, Germany
| | - Johannes Uhlig
- Department of Diagnostic and Interventional Radiology, University Medical Center Goettingen, Goettingen, Germany; Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
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Zhou L, Cai X, Liu Q, Jian ZY, Li H, Wang KJ. Prognostic Role of C-Reactive Protein In Urological Cancers: A Meta-Analysis. Sci Rep 2015; 5:12733. [PMID: 26235332 PMCID: PMC4522672 DOI: 10.1038/srep12733] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 07/03/2015] [Indexed: 02/05/2023] Open
Abstract
Growing evidence suggests serum C-reactive protein (CRP) can serve as a prognostic marker in urological cancers. However, some studies yield contradictory results. Our objective was to determine the relationship between baseline serum CRP and survival outcome in urological cancers. We searched PubMed and EMBASE databases until October 2014 without language restrictions. 44 independent studies investigating the association between baseline serum CRP and cancer-specific survival (CSS) or overall survival (OS) were selected. High CRP yielded a worse survival in renal cell carcinoma, prostate cancer, bladder cancer, and upper urinary tract urothelial carcinoma. Combined results of meta-analyses indicated that CRP was a prognostic factor in urological cancers (CSS: p < 0.01; OS: p < 0.01). Subgroup analyses confirmed the significant association between CRP and prognosis, regardless of race and cutoff value of CRP. Specifically, prognostic impact of CRP was also noted in patients with localized RCC treated with nephrectomy (CSS: p < 0.01) and metastatic RCC treated with molecular-targeted therapy (OS: p < 0.01). In conclusion, serum CRP is an independent prognostic factor in urological cancers and risk stratification by serum CRP level could be helpful for prognostic assessment.
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Affiliation(s)
- Liang Zhou
- Department of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiang Cai
- Department of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qiang Liu
- Department of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhong-Yu Jian
- Department of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hong Li
- Department of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Kun-Jie Wang
- Department of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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