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Ghorai RP, Nayak B, Goel R, Gupta P, Raj R, Kaushal S, Nayyar R, Kumar R, Seth A. The prognostic role of preoperative neutrophil-to-lymphocyte ratio in upper tract urothelial carcinoma. Indian J Urol 2024; 40:191-196. [PMID: 39100608 PMCID: PMC11296577 DOI: 10.4103/iju.iju_22_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 05/07/2024] [Accepted: 05/23/2024] [Indexed: 08/06/2024] Open
Abstract
Introduction The blood-based inflammatory marker, neutrophil-to-lymphocyte ratio (NLR), is a reliable prognostic biomarker for several cancers. Although the literature supports the correlation between preoperative NLR, clinicopathological characteristics, and oncological outcomes in upper tract urothelial carcinoma (UTUC), the cutoff of NLR is still debated. This study aimed to determine the prognostic value of NLR in patients with UTUC. Methods This was a retrospective analysis of prospectively collected data from July 2012 to December 2022 evaluating patients with UTUC who underwent radical nephroureterectomy (RNU). NLR was calculated using the neutrophil and lymphocyte counts obtained a day before the surgery and the cutoff value was set as 2.5. Kaplan-Meier and Cox's proportional hazards regression were used to analyze the association between NLR and the oncological outcomes. Results The study included 91 patients (78 males, 13 females) in the final analysis with a median follow-up of 49 months (8-130). The mean age of the patients with NLR <2.5 and NLR ≥2.5 was 56.88 years and 56.35 years, respectively, and the pathological stage was pT1 in 48%, pT2 in 20.88%, pT3 in 27.47%, and pT4 in 3.30% of the patients. Multivariable Cox regression analysis showed that the preoperative NLR ≥2.5 was significantly associated (Hz = 7.17) with higher T stage, lymphovascular invasion, necrosis, nodal involvement, adjuvant chemotherapy, and worse overall survival (OS) (Hz = 9.87). The Kaplan-Meier analysis revealed an improved OS in patients with NLR <2.5, but a statistically significant difference in the recurrence-free survival was not found. Conclusions Preoperative NLR is an easily available, inexpensive, and important prognostic biomarker of survival in patients with UTUC and has a potential role in risk stratification by predicting adverse clinicopathological characteristics.
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Affiliation(s)
- Rudra Prasad Ghorai
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
| | - Brusabhanu Nayak
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
| | - Ritesh Goel
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
| | - Prashant Gupta
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
| | - Rahul Raj
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Seema Kaushal
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Rishi Nayyar
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
| | - Rajeev Kumar
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
| | - Amlesh Seth
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
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Luo Z, Jiao B, Yan Y, Liu Y, Chen H, Guan Y, Ding Z, Zhang G. A novel nomogram for predicting extraurothelial recurrence in patients with upper urinary tract urothelial carcinoma after radical nephroureterectomy. J Cancer Res Clin Oncol 2023; 149:14241-14253. [PMID: 37555950 DOI: 10.1007/s00432-023-05237-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 07/31/2023] [Indexed: 08/10/2023]
Abstract
PURPOSE We aimed to establish and validate a nomogram for extraurothelial recurrence (EUR) after radical nephroureterectomy (RNU) for upper urinary tract urothelial carcinoma (UTUC). METHODS The data of 521 patients with UTUC after RNU from 2 medical centers were retrospectively studied and were used as training cohort (n = 301) and external validation cohort (n = 220). We used the least absolute shrinkage and selection operator (LASSO) to select variables for multivariable Cox regression, and included independent risk factors into nomogram models predicting EUR-free survival (EURFS). Multiple parameters were used to validate the nomogram, including the concordance index (C-index), the calibration plots, the time-dependent receiver-operator characteristics curve (ROC), and the decision curve analysis (DCA). Patients were stratified into three risk groups according to total points calculated by nomograms. The differences of EURFS in each group were analyzed by the Kaplan-Meier analysis. RESULTS Four variables were screened through LASSO regression. Bladder cancer history, Ki-67, lymphovascular invasion (LVI), and pathological T stage were shown to be independent predictive factors for EUR. The C-indexes of the model were 0.793 and 0.793 in training and validation cohorts, respectively. In comparison with prediction based on categorized pathological T stage, the DCA curves for 5-year EUR exhibited better performance. The 5-year EURFS rates were 92.2%, 63.8%, and 36.2% in patients stratified to the low-, medium-, and high-risk group. CONCLUSION Our study provided a new nomogram to predict the probability of EUR in UTUC patients underwent RNU, with perfect performance in discrimination ability and clinical net benefit. The application of the model may help urologists to choose proper treatment and monitoring.
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Affiliation(s)
- Zhenkai Luo
- Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Binbin Jiao
- Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, China
| | - Yangxuanyu Yan
- China-Japan Friendship School Clinical Medicine, Peking University, Beijing, 100029, China
- Department of Urology, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Yuhao Liu
- China-Japan Friendship School Clinical Medicine, Peking University, Beijing, 100029, China
- Department of Urology, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Haijie Chen
- China-Japan Friendship School Clinical Medicine, Peking University, Beijing, 100029, China
- Department of Urology, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Yunfan Guan
- China-Japan Friendship School Clinical Medicine, Peking University, Beijing, 100029, China
- Department of Urology, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Zhenshan Ding
- Department of Urology, China-Japan Friendship Hospital, Beijing, 100029, China.
| | - Guan Zhang
- Department of Urology, China-Japan Friendship Hospital, Beijing, 100029, China.
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Luo Z, Jiao B, Yan Y, Su C, Pan Y, Zhao H, Bo Y, Zhang G, Ding Z. Risk factors for extraurothelial recurrence in upper tract urothelial carcinoma after radical nephroureterectomy: a retrospective study based on a Chinese population. Front Oncol 2023; 13:1164464. [PMID: 37621681 PMCID: PMC10445394 DOI: 10.3389/fonc.2023.1164464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 07/20/2023] [Indexed: 08/26/2023] Open
Abstract
Objectives The risk factors for extraurothelial recurrence (EUR) after radical nephroureterectomy (RNU) in patients with upper urinary tract urothelial carcinoma (UTUC) are currently inconsistent and unclear. In this study, we aimed to identify these risk factors and develop a grading system for EUR. Methods We retrospectively analyzed 220 patients who underwent RNU for UTUC in our center from January 2009 to December 2020. Overall survival (OS) and extraurothelial recurrence-free survival (EURFS) were compared using the Kaplan-Meier curve with a log-rank test. Univariate and multivariate Cox regression models were applied to identify the independent risk factors related to EUR. Results The median follow-up period was 42 (range: 2-143) months. Of the 220 patients, 61 patients developed EUR in our cohort, which had worse survival outcome. Multivariate Cox regression analysis showed pathologic stage, lymph node (LN) status, lymphovascular invasion (LVI), Ki-67, neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) were independent risk factors for EUR. The Kaplan-Meier curves revealed a significant difference in EUR among the three risk groups. Conclusion Our study suggests that pathologic stage, LN status, LVI, Ki-67, NLR, and PLR are independent risk factors for EUR in UTUC patients after RNU. The development of a grading system for EUR risk stratification may assist urologists in making clinical decisions regarding the management of UTUC.
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Affiliation(s)
- Zhenkai Luo
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Binbin Jiao
- Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yangxuanyu Yan
- Peking University, China-Japan Friendship School Clinical Medicine, Beijing, China
- Department of Urology, China-Japan Friendship Hospital, Beijing, China
| | - Caixia Su
- School of Public Health, Peking University, Beijing, China
| | - Yijin Pan
- Peking University, China-Japan Friendship School Clinical Medicine, Beijing, China
- Department of Urology, China-Japan Friendship Hospital, Beijing, China
| | - Hang Zhao
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yuxuan Bo
- Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Guan Zhang
- Department of Urology, China-Japan Friendship Hospital, Beijing, China
| | - Zhenshan Ding
- Department of Urology, China-Japan Friendship Hospital, Beijing, China
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Kim MH, Yuk HD, Jeong CW, Kwak C, Kim HH, Ku JH. Estimated Glomerular Filtration Rate as a Prognostic Factor in Urothelial Carcinoma of the Upper Urinary Tract: A Systematic Review and Meta-Analysis. J Clin Med 2021; 10:4155. [PMID: 34575266 PMCID: PMC8472261 DOI: 10.3390/jcm10184155] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/03/2021] [Accepted: 09/14/2021] [Indexed: 11/18/2022] Open
Abstract
Preoperative renal function is associated with worse outcomes in patients undergoing radical nephroureterectomy (RNU). The purpose of this systemic review and meta-analysis was to determine the association of preoperative renal function with oncological outcome in patients who underwent RNU. We searched articles published up to March 2021 in PubMed, Scopus, and Embase by combining "urothelial carcinoma", "radical nephroureterectomy", and "estimated glomerular filtration rate". We also manually screened the reference list for publications following general guidelines recommended by the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement. The relationship between preoperative renal function and survival was expressed as overall survival (OS), progression-free survival (PFS), and cancer-specific survival (CSS). This review and meta-analysis included 13 studies involving a total of 4668 patients who received RNU. Pooled analysis showed significant negative association of preoperative renal function with PFS (HR: 1.51, 95% CI: 1.23-1.80, p < 0.00001), CSS (HR: 1.63, 95% CI: 1.38-1.92, p < 0.00001), and OS (HR: 1.22, 95% CI: 1.10-1.35, p < 0.00001). Patients with upper tract urothelial carcinoma (UTUC) who received RNU showed a significant negative association of preoperative renal function with survival.
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Affiliation(s)
| | | | | | | | | | - Ja Hyeon Ku
- Department of Urology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul 03080, Korea; (M.H.K.); (H.D.Y.); (C.W.J.); (C.K.); (H.H.K.)
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Chen WK, Wu ZG, Xiao YB, Wang QQ, Yu DD, Cai J, Zhou CF. Prognostic Value of Site-Specific Metastases and Therapeutic Roles of Surgery and Chemotherapy for Patients With Metastatic Renal Pelvis Cancer: A SEER Based Study. Technol Cancer Res Treat 2021; 20:15330338211004914. [PMID: 33929915 PMCID: PMC8111551 DOI: 10.1177/15330338211004914] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background and Aims: There is a lack of research on metastatic renal pelvis cell carcinoma in the current literature. In this study, we aimed to detect distant metastatic patterns in renal pelvis cell carcinoma, and illustrated the affection of different metastatic sites, surgery to primary site and chemotherapy on prognosis outcomes in patients with diverse conditions. Methods: We collected data between 2010 and 2015 from the Surveillance, Epidemiology and End Results database. Kaplan–Meier analysis with log-rank test was used for survival comparisons. Multivariate Cox regression model was employed to analyze the effect of distant metastatic sites on overall survival (OS) and cancer-specific survival (CSS). Results: A total of 424 patients were included in the analysis, the median follow-up time was 5 months (interquartile range (IQR): 2-12) and 391 deaths (92.2%) in all patients were recorded. Among them, 192 (45.3%), 153 (36.1%), 137 (32.3%) and 127 (30.0%) patients were diagnosed with lung, bone, liver and brain metastases, respectively, while only 12 (2.8%) patients had brain metastases. The bi-organ, tri-organ and tetra-organ metastatic pattern was found in 135 (31.8%), 32 (7.5%) and 11 (2.6%) patients, respectively. The multivariate Cox analyses showed that distant lymph nodes (DL) metastases was not an independent prognostic factor for both OS and CSS (OS: Hazard ratios (HR) = 1.1, 95% CI = 0.8-1.4, P = 0.622; CSS: HR = 1.0, 95% CI = 0.8-1.3, P = 0.906). Besides, there was no significant difference of survival in patients with T3-T4 stage (OS: HR = 0.8, 95% CI = 0.5–1.2, P = 0.296; CSS: HR = 0.8, 95% CI = 0.5–1.2, P = 0.224), N2-3 stage (OS: HR = 0.8, 95% CI = 0.5–1.3, P = 0.351; CSS: HR = 0.7, 95% CI = 0.4–1.2, P = 0.259) and multi-organ metastases (OS: HR = 0.8, 95% CI = 0.5–1.3, P = 0.359; CSS: HR = 0.7, 95% CI = 0.4–1.2, P = 0.179) between surgery to primary site group and no-surgery to primary site group. Conclusion: we described the metastatic patterns of mRPCC and the prognosis outcomes of DL metastases, surgery to primary site and chemotherapy. Our findings provide more information for clinical therapeutic intervention and translational study designs.
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Affiliation(s)
- Wei-Kang Chen
- Department of Andrology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Zhi-Gang Wu
- Department of Andrology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Yun-Bei Xiao
- Department of Andrology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Qin-Quan Wang
- Department of Andrology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Dong-Dong Yu
- Department of Andrology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Jian Cai
- Department of Andrology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Chao-Feng Zhou
- Department of Andrology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
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Yang T, Zhang N, Yang B, He D, Fan J, Fan J. Preintervention risk stratification of renal pelvic cancer and ureteral cancer should differ. Investig Clin Urol 2020; 61:397-404. [PMID: 32665996 PMCID: PMC7329638 DOI: 10.4111/icu.2020.61.4.397] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 02/04/2020] [Indexed: 11/18/2022] Open
Abstract
Purpose To identify different preintervention prognostic factors between renal pelvic cancer (RPc) and ureteral cancer (Uc) and to develop different preintervention risk stratifications for each cancer type. Materials and Methods A total of 1,768 patients with organ-confined upper urinary tract urothelial carcinoma (1,067 patients with RPc and 701 with Uc) who presented between 2004 and 2015 were selected from the Surveillance, Epidemiology, and End Results database. Clinicopathologic characteristics were compared between RPc and Uc. Univariable and multivariable Cox regression models were used to examine the prognostic ability of the clinicopathologic characteristics with respect to oncology outcomes. Results Age greater than 75 years was significantly associated with cancer-specific survival (CSS) in RPc patients but not in Uc patients. Tumor size had a significant influence on CSS in Uc patients but not in RPc patients; in contrast, age had an influence in RPc but not in Uc. Unlike CSS, age was significantly associated with overall survival (OS) in both RPc and Uc. Tumor size had an effect on OS in Uc patients but not in RPc patients. Conclusions The preintervention prognostic factors differed between RPc and Uc. Thus, we should develop separate preintervention risk stratification standards for RPc and Uc. Using these specific preintervention risk stratifications, we may be able to select the most appropriate surgical options for patients in the clinic.
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Affiliation(s)
- Tao Yang
- Department of Urology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Nan Zhang
- Department of Urology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Bo Yang
- Department of Urology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Dalin He
- Department of Urology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Junjie Fan
- Department of Urology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jinhai Fan
- Department of Urology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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Suh J, Jung JH, Jeong CW, Kwak C, Kim HH, Ku JH. Clinical Significance of Pre-treated Neutrophil-Lymphocyte Ratio in the Management of Urothelial Carcinoma: A Systemic Review and Meta-Analysis. Front Oncol 2019; 9:1365. [PMID: 31921631 PMCID: PMC6927426 DOI: 10.3389/fonc.2019.01365] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 11/19/2019] [Indexed: 12/13/2022] Open
Abstract
Purpose: We performed a study-level meta-analysis to summarize the current evidence on the correlation between pretreatment neutrophil-to-lymphocyte ratios (NLR) and oncological outcomes in each type of management for urothelial carcinoma. Method: All articles published until February 2017 in PubMed, Scopus, and EMBASE database were collected and reviewed. The current evidence on correlations between pretreatment NLR and oncological outcomes in each type of management for urothelial carcinoma, including transurethral resection of bladder tumor (TURBT), radical cystectomy (RCx), chemotherapy (CTx), and nephroureterectomy (NUx), were summarized. Results: Thirty-eight studies containing clinical information on 16,379 patients were analyzed in this study. Pooled hazard ratios (HR) and odds ratios (OR) with 95% confidence intervals were calculated after weighing each study. Heterogeneity among the studies and publication bias were assessed. Pretreatment NLR was significantly associated with muscle invasiveness (OR: 4.27), recurrence free survival (RFS, HR: 2.32), and progression-free survival (PFS, HR: 2.45) in TURBT patients. In the RCx patients, high NLR was negatively associated with both disease status (extravesical extension and lymph-node positivity, OR: 1.14 and 1.43, respectively) and oncological outcomes [overall survival (OS), PFS], and cancer specific survival (CSS, HR: 1.18, 1.12, and 1.35, respectively). Pretreatment NLR was negatively correlated with pathologic downstaging (OR: 0.79) and positively correlated with PFS (HR: 1.30) and OS (HR: 1.44) in CTx patients. For patients who underwent NUx, pretreatment NLR was significantly associated with OS (HR: 1.72), PFS (HR: 1.63), and CSS (HR: 1.68). Conclusions: Pretreatment NLR is a useful biomarker for disease aggressiveness, oncological outcome, and treatment response in the management of patients with urothelial carcinoma. More evidence is needed to clarify these results.
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Affiliation(s)
- Jungyo Suh
- Department of Urology, Seoul National University College of Medicine, Seoul, South Korea
- Department of Urology, Seoul Metropolitan Government- Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Jae Hyun Jung
- Department of Urology, Seoul National University College of Medicine, Seoul, South Korea
| | - Chang Wook Jeong
- Department of Urology, Seoul National University College of Medicine, Seoul, South Korea
| | - Cheol Kwak
- Department of Urology, Seoul National University College of Medicine, Seoul, South Korea
| | - Hyeon Hoe Kim
- Department of Urology, Seoul National University College of Medicine, Seoul, South Korea
| | - Ja Hyeon Ku
- Department of Urology, Seoul National University College of Medicine, Seoul, South Korea
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Kuroda K, Asakuma J, Horiguchi A, Kawaguchi M, Shinchi M, Masunaga A, Tasaki S, Sato A, Ito K. Chronic kidney disease and positive surgical margins as prognosticators for upper urinary tract urothelial carcinoma patients undergoing radical nephroureterectomy. Mol Clin Oncol 2019; 10:547-554. [PMID: 30967949 DOI: 10.3892/mco.2019.1829] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 03/18/2019] [Indexed: 11/06/2022] Open
Abstract
Chronic kidney disease (CKD) is a common condition among elderly patients and has been reported to be a biomarker for the presence of malignant disease. In addition, unfavorable outcomes for patients with upper tract urothelial carcinoma (UTUC) undergoing radical nephroureterectomy can be due to independent clinical factors. Therefore, the present study analyzed the clinicopathological data of patients with UTUC, who underwent radical nephroureterectomy at our institution, to clarify whether preoperative CKD and other factors are independent predictors of the shorter disease-specific and/or recurrence-free survival time of these patients. A retrospective review of 187 patients who underwent radical nephroureterectomy was conducted, and patients were followed for at least 3 months postoperatively. The clinicopathological factors that are thought to have potentially significant roles in the progression and metastasis of malignant tumors and for disease-specific and recurrence-free survival were evaluated. Positive surgical margins and an estimation of the glomerular filtration rate (eGFR) of <60 were independent factors for the shorter disease-specific survival time in multivariate analysis with Cox's proportional hazards model [hazard ratio (HR), 2.401: 95% confidence interval (CI), 1.044-5.255; and HR, 2.371: 95% CI, 1.024-5.898, respectively]. Another multivariate analysis also revealed that positive surgical margins (HR, 4.477; 95% CI, 2.042-9.469), and preoperative eGFR <60 (HR, 2.362; 95% CI, 1.067-5.592) were independent factors for the worse recurrence-free survival rate in all patients. Patients with UTUC who had eGFR <60 as well as positive surgical margins had significantly shorter time to disease-specific mortality and extraurothelial recurrence. The present study demonstrated that patients with UTUC undergoing radical nephroureterectomy who have CKD as well as positive surgical margins should be carefully followed up postoperatively.
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Affiliation(s)
- Kenji Kuroda
- Department of Urology, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan
| | - Junichi Asakuma
- Department of Urology, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan
| | - Akio Horiguchi
- Department of Urology, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan
| | - Makoto Kawaguchi
- Department of Urology, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan
| | - Masayuki Shinchi
- Department of Urology, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan
| | - Ayako Masunaga
- Department of Urology, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan
| | - Shinsuke Tasaki
- Department of Urology, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan
| | - Akinori Sato
- Department of Urology, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan
| | - Keiichi Ito
- Department of Urology, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan
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Kim HS, Jeong CW, Kwak C, Kim HH, Ku JH. Association between demographic factors and prognosis in urothelial carcinoma of the upper urinary tract: a systematic review and meta-analysis. Oncotarget 2018; 8:7464-7476. [PMID: 27448978 PMCID: PMC5352335 DOI: 10.18632/oncotarget.10708] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 06/06/2016] [Indexed: 01/23/2023] Open
Abstract
We aimed to assess the prognostic significance of demographic factors, including age, sex, performance status, smoking status, obesity, and race in upper urinary tract urothelial carcinoma (UTUC) patients treated with radical nephroureterectomy through a systematic review and meta-analysis. We conducted PubMed search for all articles published until December 2014 according to Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines. Survival outcomes of interest were intravesical recurrence (IVR) free survival, progression free survival (PFS), cancer-specific survival (CSS), and overall survival (OS). Seventy-nine studies, including numbers of subjects ranging from 24 to 9899, met the inclusion criteria. Advanced age was significantly associated with worse PFS [hazard ratio (HR) 1.01] and OS (HR 1.05). The significant predictors of CSS were age (HR 1.02) and performance status (HR 1.35). Female gender (HR 0.81) and smoking (HR 1.38) were the significant predictors only for IVR free survival. No significant associations with survival outcomes were observed in obesity and race. Our study reveals that age is one of the most important demographic predictor of survival in UTUC. Also, male gender, poor performance status, and smoking are also significantly related to worse survival outcomes. However, large well-designed prospective studies are required to investigate the precise prognostic significance of demographics.
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Affiliation(s)
- Hyung Suk Kim
- Department of Urology, Dongguk University Ilsan Medical Center, Goyang, Korea
| | - Chang Wook Jeong
- Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Cheol Kwak
- Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Hyeon Hoe Kim
- Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Ja Hyeon Ku
- Department of Urology, Seoul National University Hospital, Seoul, Korea
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Koguchi D, Matsumoto K, Ikeda M, Taoka Y, Hirayama T, Murakami Y, Utsunomiya T, Matsuda D, Okuno N, Irie A, Iwamura M. Investigation of estimated glomerular filtration rate and its perioperative change in patients with upper urinary tract urothelial carcinoma: A multi-institutional retrospective study. Asia Pac J Clin Oncol 2018; 14:e420-e427. [PMID: 29436164 DOI: 10.1111/ajco.12856] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 01/04/2018] [Indexed: 11/30/2022]
Abstract
AIM To investigate the association of perioperative estimated glomerular filtration rate (eGFR) with prognosis in patients with upper urinary tract urothoelial caicinoma (UTUC). METHODS A total of 433 patients underwent radical nephroureterectomy with excision of the bladder cuff (RNU) at six hospitals affiliated with Kitasato University in Japan. Patients were divided into three groups each in terms of preoperative eGFR: normal eGFR (>60 mL/min/1.73 m2 ; n = 172), moderately reduced eGFR (45-60 mL/min/1.73 m2 ; n = 147) and severely reduced eGFR (<45 mL/min/1.73 m2 ; n = 114), and with regard to changes between pre- and postoperative eGFR: normal change (increased or <10% decreased; n = 132), moderate change (10%-30% decreased; n = 172) and severe change (>30% decreased; n = 129). Statistical analyses were performed to investigate the association between perioperative eGFR and prognosis. RESULTS Patients in the preoperative normal and moderately reduced eGFR group had significantly better progression-free survival (PFS) and cancer-specific survival (CSS) than those in the severely reduced eGFR group (both; P < 0.001). With regard to changes in postoperative eGFR, PFS and CSS were significantly better in patients in the severe and moderate change group than in those in the normal change group (both; P < 0.001). When adjusted for the effects of clinicopathological features, pathologic factors were associated with both PFS and CSS, but perioperative eGFR were not independent prognostic factors. CONCLUSIONS Patients with preoperative normal and moderately reduced eGFR and those with severe and moderate change in postoperative eGFR appeared to have a significantly better prognosis.
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Affiliation(s)
- Dai Koguchi
- Department of Urology, Kitasato University School of Medicine, Kanagawa, Japan.,Department of Urology, Kitasato University Medical Center, Saitama, Japan
| | - Kazumasa Matsumoto
- Department of Urology, Kitasato University School of Medicine, Kanagawa, Japan
| | - Masaomi Ikeda
- Department of Urology, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
| | - Yoshinori Taoka
- Department of Urology, Kitasato University Medical Center, Saitama, Japan
| | - Takahiro Hirayama
- Department of Urology, Kitasato University School of Medicine, Kanagawa, Japan
| | - Yasukiyo Murakami
- Department of Urology, Kanagawa Prefectural Federation of Agricultural Cooperatives for Health and Welfare Sagamihara Kyodo Hospital, Kanagawa, Japan
| | - Takuji Utsunomiya
- Department of Urology, Kanagawa Prefectural Federation of Agricultural Cooperatives for Health and Welfare Sagamihara Kyodo Hospital, Kanagawa, Japan
| | | | - Norihiko Okuno
- Department of Urology, National Hospital Organization Sagamihara Hospital, Kanagawa, Japan
| | - Akira Irie
- Department of Urology, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
| | - Masatsugu Iwamura
- Department of Urology, Kitasato University School of Medicine, Kanagawa, Japan
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11
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Cao J, Zhao X, Zhong Z, Zhang L, Zhu X, Xu R. Prognostic Value of Pre-operative Renal Insufficiency in Urothelial Carcinoma: A Systematic Review and Meta-Analysis. Sci Rep 2016; 6:35214. [PMID: 27725745 PMCID: PMC5057078 DOI: 10.1038/srep35214] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 09/27/2016] [Indexed: 02/05/2023] Open
Abstract
The effect of pre-operative renal insufficiency on urothelial carcinoma (UC) prognosis has been investigated by numerous studies. While the majority report worse UC outcomes in patients with renal insufficiency, the results between the studies differed wildly. To enable us to better estimate the prognostic value of renal insufficiency on UC, we performed a systematic review and meta-analysis based on the published literature. A total of 16 studies which involved 5,232 patients with UC, investigated the relationship between pre-operative renal insufficiency and disease prognosis. Estimates of combined hazard ratio (HR) for bladder urothelial carcinoma recurrence, cancer-specific survival (CSS) and overall survival (OS) were 1.65 (95% CI, 1.11–2.19), 1.59 (95% CI, 1.14–2.05) and 1.45 (95% CI, 1.19–1.71), respectively; and for upper urinary tract urothelial carcinoma recurrence, CSS and OS were 2.27 (95% CI, 1.42–3.12), 1.02 (95% CI, 0.47–1.57) and 1.52 (95% CI, 1.05–1.99), respectively. Our results indicate that UC patients with pre-operative renal insufficiency tend to have higher recurrence rates and poorer survival compared to those with clinically normal renal function, thus renal function should be closely monitored in these patients. The impact of intervention for renal insufficiency on the prognosis of UC needs to be further studied.
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Affiliation(s)
- Jian Cao
- Department of Urology, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, Hunan 410011, P.R. China.,MRC Centre for Reproductive Health, Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh EH16 4TJ, United Kingdom
| | - Xiaokun Zhao
- Department of Urology, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, Hunan 410011, P.R. China
| | - Zhaohui Zhong
- Department of Urology, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, Hunan 410011, P.R. China
| | - Lei Zhang
- Department of Urology, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, Hunan 410011, P.R. China
| | - Xuan Zhu
- Department of Urology, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, Hunan 410011, P.R. China
| | - Ran Xu
- Department of Urology, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, Hunan 410011, P.R. China
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12
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Ito K, Asakuma J, Kuroda K, Tachi K, Sato A, Horiguchi A, Seguchi K, Asano T. Preoperative risk factors for extraurothelial recurrence in N0M0 patients with renal pelvic cancer treated by radical nephroureterectomy. Mol Clin Oncol 2016; 4:530-536. [PMID: 27073656 DOI: 10.3892/mco.2016.754] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 01/22/2016] [Indexed: 02/01/2023] Open
Abstract
The prediction of extraurothelial recurrence (EUR) before radical nephroureterectomy (RNU) is difficult for patients with upper tract urothelial carcinoma. If EUR can be predicted preoperatively, it may be possible to determine the need for neoadjuvant chemotherapy or the surgical strategy. Our previous study identified preoperative risk factors for EUR in ureteral cancer, while the present study identified preoperative risk factors for EUR in renal pelvic cancer (RPC). The preoperative factors were reviewed in 71 N0M0 patients with RPC treated by RNU between 1999 and 2013. Preoperative clinical background data, laboratory test results, including inflammatory indices, lactate dehydrogenase (LDH), and estimated glomerular filtration rate, and radiological findings were subjected to multivariate analyses to identify independent predictive factors for EUR. The 3-year EUR-free survival (EURFS) rate was 81.9%, and univariate analysis showed that clinical T (cT) stage ≥3, white blood cell counts ≥7600/µl, neutrophil counts ≥4,500/µl, neutrophil-to-lymphocyte ratio ≥2.0, and LDH ≥210 IU/l were significantly associated with EURFS. Additionally, a cT stage ≥3 (P=0.0244) and LDH ≥210 IU/l (P=0.0322) were independent predictors for EUR. When patients were stratified into three groups according to the number of risk factors, the 3-year EURFS rates were 94.5, 76.3, and 33.3% for the low-, intermediate-, and high-risk patient groups, respectively. In conclusion, cT stage ≥3 and LDH ≥210 IU/l were preoperative predictive factors of EUR in patients with RPC. High-risk patients may be candidates for neoadjuvant chemotherapy and low-risk patients may be candidates for RNU without lymph node dissection.
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Affiliation(s)
- Keiichi Ito
- Department of Urology, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan
| | - Junichi Asakuma
- Department of Urology, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan
| | - Kenji Kuroda
- Department of Urology, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan
| | - Kazuyoshi Tachi
- Department of Urology, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan
| | - Akinori Sato
- Department of Urology, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan
| | - Akio Horiguchi
- Department of Urology, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan
| | - Kenji Seguchi
- Department of Urology, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan
| | - Tomohiko Asano
- Department of Urology, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan
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13
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Cheng YC, Huang CN, Wu WJ, Li CC, Ke HL, Li WM, Tu HP, Li CF, Chang LL, Yeh HC. The Prognostic Significance of Inflammation-Associated Blood Cell Markers in Patients with Upper Tract Urothelial Carcinoma. Ann Surg Oncol 2015; 23:343-51. [PMID: 26242371 DOI: 10.1245/s10434-015-4781-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Indexed: 12/24/2022]
Abstract
BACKGROUND Inflammation-related parameters based on blood cells, including white blood cell (WBC) count, neutrophil-lymphocyte ratio, platelet count, and red cell distribution width (RDW), have been shown to be associated with prognosis in many cancers. However, no previous study evaluated these inflammation-associated markers simultaneously in upper tract urothelial carcinoma (UTUC). METHODS A total of 195 patients with UTUC who received radical nephroureterectomy between 2005 and 2010 were included retrospectively as the derivation cohort to investigate the impact of inflammation markers on overall survival (OS) and cancer-specific survival (CSS). In turn, another independent set of 225 patients were used for validation. Finally, we performed survival analysis in the combined cohort consisting of 420 UTUC patients. RESULTS The predictive value of RDW and WBC count on outcome was replicable in different cohorts. Multivariate analysis showed high RDW was independently associated with poor OS (P < 0.001), and WBC count was a significant prognosticator for both OS and CSS (both P < 0.001). In subgroup analysis, we found the prognostic significance of RDW for OS was limited in organ-confined disease (≤pT2 without pN+). More importantly, a clear survival difference can be demonstrated by combining RDW and WBC count with other known prognostic factors in the risk stratification model. CONCLUSIONS RDW and WBC count have the advantage of their common accessibility and are useful markers to predict outcome of UTUC in the preoperative setting. RDW and WBC count could provide additional prognostic value and help physicians identify patients at high risk for mortality and formulate individualized treatment strategy.
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Affiliation(s)
- Yen-Chen Cheng
- School of Post-Baccalaureate Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chun-Nung Huang
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wen-Jeng Wu
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Urology, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan.,Center for Infectious Disease and Cancer Research, Kaohsiung Medical University, Kaohsiung, Taiwan.,Center for Stem Cell Research, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ching-Chia Li
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
| | - Hung-Lung Ke
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wei-Ming Li
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Urology, Ministry of Health and Welfare Pingtung Hospital, Pingtung, Taiwan
| | - Hung-Pin Tu
- Department of Public Health and Environmental Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chien-Feng Li
- Department of Pathology, Chi Mei Medical Center, Tainan, Taiwan.,Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan.,National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan
| | - Lin-Li Chang
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Microbiology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hsin-Chih Yeh
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan. .,Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. .,Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. .,Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan.
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14
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Steers WD. This Month in Adult Urology. J Urol 2014. [DOI: 10.1016/j.juro.2014.03.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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