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LiYa L, XinSheng Z, Xiang H, Zhao L, Lu L, XiuMing L, Ye L, Jing C, KeMing Z, HongChi W, Jing X, Yang C, Xiu C, HongBo L, ShuQin Y, Fang L, YingHua L. A cross-sectional survey study on the correlation analysis of nutritional status and intestinal flora in patients with esophageal cancer. Front Nutr 2024; 11:1424039. [PMID: 39070256 PMCID: PMC11275563 DOI: 10.3389/fnut.2024.1424039] [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: 04/27/2024] [Accepted: 06/25/2024] [Indexed: 07/30/2024] Open
Abstract
Objective This study aims to examine the nutritional status of individuals diagnosed with esophageal cancer and compare the nutritional indicators and intestinal flora between malnourished and non-malnourished patients. The findings aim to contribute to the early prevention of malnutrition and the development of interventions targeting the intestinal flora to treat esophageal cancer. Methods An 80-patient sample of hospitalized individuals with esophageal cancer was selected from the radiotherapy department of our hospital between July 2021 and July 2022 to evaluate NRS2002 scores and PG-SGA scores. This cross-sectional analysis aimed to examine the disparities in dietary nutrient intake, blood indicators, body composition, and fecal intestinal flora between malnourished and non-malnourished patients with esophageal cancer. Additionally, we randomly selected 40 cases to predict and analyze the relationship between intestinal flora and malnutrition. Results The incidence of nutritional risk and malnutrition in patients with esophageal cancer was 62.5% and 60%, respectively. The low intake of carbohydrates and dietary fiber in the malnutrition group was statistically significant compared to those in the non-malnutrition group (P < 0.05). The albumin (ALB) level was lower in the malnutrition group than in the non-malnutrition group, while the C-reactive protein (CRP) level was higher; these differences were also statistically significant (P < 0.05). The basal metabolic rate, phase angle, body cell mass, muscle mass, skeletal muscle index, and fat-free mass index in the malnutrition group all decreased compared to the non-malnutrition group. The extracellular water/total body water was higher than that in the non-malnutrition group, which was also statistically significant (P < 0.05). As shown by 16S rDNA sequencing of fecal intestinal flora, there was no significant difference in α and β diversity between the malnutrition and non-malnutrition groups; at the genus level, significant differences were observed for Selimonas, Clostridioides, Dielma, Lactobacillus, and [Eubacterium]_siraeum_group. However, Dielma, Sellimonas, and Clostridioides were significantly lower in the malnutrition group than in the non-malnutrition group, while Anaerococcus, Atopobium, Eubacterium_siraeum_group, and Lactobacillus were significantly higher in the malnutrition group. Correlation analysis between different genera and clinical indicators showed that Lactobacillus was positively correlated with ALB, dietary energy, intracellular water/total body water (ICW/TBW), phase angle (PA), muscle mass (MM), skeletal muscle mass (SMM), body cell mass (BCM), basal metabolic rate (BMR), appendicular skeletal muscle mass (ASMM), total body water (TBW), fat-free mass index (FFMI), skeletal muscle index (SMI), fat-free mass (FFM), Weight, body mass index (BMI) (r > 0, P < 0.05), but negatively correlated with PG-SGA score, NRS2002 score, and extracellular water/total body water (ECW/TBW) (r < 0, P < 0.05). Based on PG-SGA, there was only a low accuracy for identifying nutrient deficiency (most areas under curve (AUC) values fell within 0.5 to 0.7, or even lower), with Lachnoclostridium's AUC being 0.688 (CI = 0.518-0.858) and Lactobacillus_salivarius_g_Lactobacillus's AUC being 0.257 (CI = 0.098-0.416). A KEGG functional analysis based on 16S data indicated potential differences affecting glucose metabolism pathways and the synthesis or division of DNA, influencing the onset, development, and prognosis of esophageal cancer patients. Conclusion Esophageal cancer patients are more likely to be malnourished. The nutritional status of these patients is closely linked to the intake of carbohydrates and fiber, albumin levels, inflammation levels, and lean body mass. Furthermore, the patient's intestinal flora composition plays a significant role in their nutritional well-being. Consequently, modulating the intestinal flora holds promise as a potential therapeutic approach for addressing malnutrition in esophageal cancer patients. Clinical trial registration ChiCTR2100048141.
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Affiliation(s)
- Li LiYa
- Department of Nutrition, The First Medical Center, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Zhang XinSheng
- Department of Nutrition, The First Medical Center, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Huang Xiang
- Department of Radiation Oncology, Fifth Medical Center, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Liu Zhao
- Department of Nutrition, The First Medical Center, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Liu Lu
- Department of Nutrition, The First Medical Center, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Lv XiuMing
- Department of Clinical Nutrition, Hebei Yanda Hospital, Langfang, China
| | - Li Ye
- Department of Radiation Oncology, Fifth Medical Center, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Chen Jing
- Department of Radiation Oncology, Fifth Medical Center, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Zhang KeMing
- Department of Nutrition, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Wang HongChi
- Department of Radiation Oncology, Fifth Medical Center, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Xia Jing
- Department of Endocrinology, Jiangyin Hospital of Traditional Chinese Medicine, Wuxi, China
| | - Cong Yang
- Department of Radiation Oncology, Fifth Medical Center, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Cui Xiu
- Department of Nutrition, The Second Affiliated Hospital of Guilin Medical University, Guilin, China
| | - Long HongBo
- Department of Nutrition, Fangshan Hospital Beijing University of Chinese Medicine, Beijing, China
| | - You ShuQin
- Department of Endocrinology, Ili Kazakh Autonomous Prefecture, Huocheng County Hospital of Traditional Chinese Medicine, Yili, China
| | - Liu Fang
- Department of Radiation Oncology, Fifth Medical Center, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Liu YingHua
- Department of Nutrition, The First Medical Center, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
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Song L, Wu Q, Bai S, Zhao J, Qi J, Zhang J. Comparison of the diagnostic efficacy of systemic inflammatory indicators in the early diagnosis of ovarian cancer. Front Oncol 2024; 14:1381268. [PMID: 39015497 PMCID: PMC11250249 DOI: 10.3389/fonc.2024.1381268] [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: 02/03/2024] [Accepted: 06/18/2024] [Indexed: 07/18/2024] Open
Abstract
Background This study aimed to determine the diagnostic accuracy of CA125, HE4, systemic immune-inflammation index (SII), prognostic nutritional index (PNI), fibrinogen-to-albumin ratio (FAR), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), and the combination of the six inflammatory-nutritional markers for ovarian cancer (OC) to identify the best diagnostic indicator for OC early diagnosis. An extensive study was performed to establish the connection between these indicators and the pathological aspects of OC. Methods A total of 170 individuals were included in this study, with 87 diagnosed with OC and 83 with benign ovarian tumors (BOTs). The diagnostic abilities of the variables were evaluated by calculating sensitivity, specificity, and area under the ROC curves. Through the use of DCA, we evaluated the variables' clinical value in the discrimination of ovarian masses. Results All markers showed significant diagnostic power for OC. CA125, HE4, SII, FAR, and MLR levels significantly increased from the BOTs group to the early-stage OC group. The advanced-stage OC group had significantly lower PNI values compared to the early-stage OC group but significantly higher levels of CA125, HE4, SII, NLR, and FAR. Moreover, the OC group with lymph node metastasis exhibited significantly higher levels of CA125, HE4, SII, NLR, PLR, and FAR, in contrast to the non-metastatic group, while PNI levels were significantly lower. Categorical factors, such as histological grade and pathological classification, showed noticeable discrepancies in CA125 and HE4 levels. NLR was significantly different among the pathological type groups. Among the six inflammatory-nutritional markers, the FAR displayed the greatest diagnostic value. In the analysis of logistic regression, it was observed that a combination marker containing all six inflammatory-nutritional markers exhibited a notably higher AUC value (0.881; 95% CI, 0.823 - 0.926) than any of the individual marker. Conclusion PNI, NLR, PLR, MLR, SII, and FAR showed excellent diagnostic performance for OC. The combination of these markers demonstrated a superior diagnostic capability compared to each individual one. The systemic inflammatory indicators may be helpful to diagnose OC.
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Affiliation(s)
- Liyun Song
- Department of Gynecology, Hebei General Hospital, Shijiazhuang, China
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Inoue Y, Yamada T, Fujihara A, Miyashita M, Shiraishi T, Okumi M, Hongo F, Ukimura O. Treatment impact of newly approved therapeutic agents for metastatic urothelial carcinoma in Japan: a single-center retrospective study. Sci Rep 2023; 13:16580. [PMID: 37789182 PMCID: PMC10547746 DOI: 10.1038/s41598-023-43901-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 09/29/2023] [Indexed: 10/05/2023] Open
Abstract
Although recent clinical trials of new therapeutic agents for metastatic urothelial carcinoma have shown prolonged overall survival, there are few real-world evidence. To assess the impact of new therapeutic agents, we performed retrospective analysis for consecutive 158 metastatic urothelial carcinoma patients who performed systemic therapy in our institution between May 2008 and August 2023. We defined a period from May 2008 to December 2017, when pembrolizumab was first introduced to the clinical setting in the new therapeutic agents for metastatic urothelial carcinoma in Japan, as "pre new drug era" and a period from January 2018 to August 2023 as "post new drug era". We compared overall survival between pre- and post- new drug era using Kaplan-Meier method with log rank test. Median overall survival of pre- and post- new drug era were 14.5 months (95% confidence intervals: 11.6-16.7) and 23.1 months (95% confidence intervals: 14.5-NA), respectively (p < 0.001). Five-year survival rate of pre- and post- new drug era was 7.0% (95% confidence intervals: 2.3-15.3) and 36.3% (95% confidence intervals: 21.4-51.5), respectively. Multivariable Cox proportional hazards regression analysis of factors associated with overall survival showed that enfortumab vedotin administration, administration of second-line or more systemic therapy, best overall response of SD, PR and CR in first-line systemic therapy, higher serum albumin and lower CRP were factors for overall survival prolongation. Introduction of new therapeutic agents for metastatic urothelial carcinoma contributed to the improvement of overall survival in comparison with the era without these agents.
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Affiliation(s)
- Yuta Inoue
- Department of Urology, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, 602-8566, Japan.
| | - Takeshi Yamada
- Department of Urology, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Atsuko Fujihara
- Department of Urology, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Masatsugu Miyashita
- Department of Urology, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Takumi Shiraishi
- Department of Urology, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Masayoshi Okumi
- Department of Urology, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Fumiya Hongo
- Department of Urology, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Osamu Ukimura
- Department of Urology, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, 602-8566, Japan
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Song L, Qi J, Zhao J, Bai S, Wu Q, Xu R. Diagnostic value of CA125, HE4, and systemic immune-inflammation index in the preoperative investigation of ovarian masses. Medicine (Baltimore) 2023; 102:e35240. [PMID: 37713838 PMCID: PMC10508492 DOI: 10.1097/md.0000000000035240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 08/24/2023] [Indexed: 09/17/2023] Open
Abstract
This study aimed to ascertain the diagnostic accuracy of CA125, HE4, systemic immune-inflammation index (SII), fibrinogen-to-albumin ratio (FAR), prognostic nutritional index (PNI), and their combination for ovarian cancer (OC) to discover an optimal combined diagnostic index for early diagnosis of OC. A thorough investigation was conducted to ascertain the correlation between these markers and the pathological characteristics of OC, thereby providing a foundation for early identification and treatment of this disorder. One hundred seventy patients with documented OC and benign ovarian tumors (BOTs) treated at Hebei General Hospital between January 2019 and December 2022 were included in this retrospective study. Data analysis was conducted using IBM SPSS Statistics version V26.0, MedCalc Statistical Software version 19.4.0, and the R Environment for Statistical Computing software (R Foundation for Statistical Computing). Isolated CA125 showed the best application value for differentiating benign ovarian tumors from OC when the defined variables were compared separately. The combination of CA125, HE4, FAR, SII, and PNI displayed a greater area under the operating characteristic curve curve than any one of them or other combinations of the 5 variables. Compared to CA125 alone, the combination of CA125, HE4, FAR, SII, and PNI showed a slight gain in sensitivity (83.91%), negative predictive value (83.91%), accuracy (85.88%), and a decrease in negative likelihood ratio (0.180%). Higher preoperative CA125, HE4, SII, and FAR levels, and lower PNI levels predicted a higher probability of advanced OC progression and lymph node metastasis. FAR has better application value than other inflammation-related markers (PNI and SII). This study suggests that preoperative serum SII, PNI, and FAR may be clinically valuable markers in patients with OC. FAR has better application value than other inflammation-related markers (PNI and SII). As we delve deeper into the inflammatory mechanisms associated with tumors, we may discover more effective combinations of tumor and inflammatory biomarkers.
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Affiliation(s)
- Liyun Song
- Department of Gynecology, Hebei General Hospital, Shijiazhuang, China
| | - Jie Qi
- Department of Gynecology, Hebei General Hospital, Shijiazhuang, China
| | - Jing Zhao
- Department of Gynecology, Hebei General Hospital, Shijiazhuang, China
| | - Suning Bai
- Department of Gynecology, Hebei General Hospital, Shijiazhuang, China
| | - Qi Wu
- Department of Gynecology, Hebei General Hospital, Shijiazhuang, China
| | - Ren Xu
- Department of Gynecology, Hebei General Hospital, Shijiazhuang, China
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Wang J, Huang D, Wang Y, Yuan Q, Chen X, Cheng Y. Pretreatment plasma fibrinogen and serum albumin levels predict therapeutic efficacy of concurrent radiochemotherapy for esophageal squamous cell cancer. Front Oncol 2022; 12:1021214. [PMCID: PMC9610838 DOI: 10.3389/fonc.2022.1021214] [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: 08/17/2022] [Accepted: 09/15/2022] [Indexed: 11/13/2022] Open
Abstract
PurposeEvidence implies that plasma fibrinogen and serum albumin level (FA score) based on plasma fibrinogen and serum albumin is related to cancer prognosis. However, the association between the FA score and therapeutic efficacy of concurrent radiochemotherapy in esophageal squamous cell carcinoma (ESCC) has not yet been evaluated. This study aimed to assess the role of pretreatment FA score in predicting the therapeutic efficacy of concurrent radiochemotherapy for patients with esophageal squamous cell cancer.MethodsThis retrospective study evaluated 154 patients with ESCC who underwent concurrent radiochemotherapy. Receiver operating characteristic curve (ROC) analysis was used to determine the appropriate cut-off values, and multivariate analysis and Kaplan-Meier curve were used to evaluate prognosis.ResultsFA score was significantly associated with the N stage and M stage (P = 0.015 and 0.042, respectively). Chi-square analysis/Fisher’s exact tests revealed a correlation between the FA score and curative effect (P < 0.001), and higher FA score was associated with poorer treatment effect. Multivariate analysis indicated that FA score (P < 0.001) was predictor of overall survival (OS). Kaplan-Meier curve demonstrated that pretreatment FA score was significantly associated with the OS of ESCC: Patient with higher FA score has lower median OS.ConclusionsThe FA score is a reliable prognostic predictor that could assess the curative effect and OS benefit of concurrent radiochemotherapy in patients with ESCC.
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Affiliation(s)
- Jijin Wang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangzhou, China
| | - Di Huang
- Department of Radiation Oncology, Qilu Hospital of Shandong University, Jinan, China
| | - Yuanyuan Wang
- Department of Oncology, Linyi People’s Hospital, Dezhou, China
| | - Qianqian Yuan
- Department of Oncology, Tengzhou Central People’s Hospital, Zaozhuang, China
| | - Xue Chen
- Department of Minimally Invasion Oncology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- *Correspondence: Yufeng Cheng, ; Xue Chen,
| | - Yufeng Cheng
- Department of Radiation Oncology, Qilu Hospital of Shandong University, Jinan, China
- *Correspondence: Yufeng Cheng, ; Xue Chen,
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Decreased Preoperative Serum AGR as a Diagnostic Marker of Poor Prognosis after Radical Surgery of Upper Urinary Tract and Bladder Cancers from a Pooled Analysis of 9,002 Patients. DISEASE MARKERS 2022; 2022:6575605. [PMID: 36105255 PMCID: PMC9467785 DOI: 10.1155/2022/6575605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 08/01/2022] [Indexed: 11/18/2022]
Abstract
A growing number of studies have regarded the preoperative serum albumin-to-globulin ratio (AGR) as a prognostic indicator of urothelial carcinoma (UC) following radical surgery. However, a pooled analysis of AGR's effect on UC prognosis was still insufficient. Up to January 2022, a systematic search was conducted using PubMed, Embase, Web of Science, and Cochrane Library. Stata SE software was applied in this study. The reviewers collected the hazard ratio (HR) with 95% confidence interval (CI) for overall survival (OS), cancer-specific survival (CSS), recurrence-free survival (RFS), progression-free survival (PFS), and metastasis-free survival (MFS). A total of 9,002 patients from 12 retrospective studies were included in this analysis. The results showed that preoperative serum AGR was significantly associated with the OS (HR = 1.85, 95%CI = 1.43 to 2.39), CSS (HR = 2.38, 95%CI = 1.69 to 3.34), RFS (HR = 1.64, 95%CI = 1.29 to 2.08), PFS (HR = 2.16, 95%CI = 1.43 to 3.27), and MFS (HR = 3.00, 95%CI = 1.63 to 5.53) of patients with UC following radical surgery. Sensitivity analysis indicated the stability of the results. Subgroup analysis revealed that preoperative low AGR was seen as a risk factor for OS (HR = 1.90, 95%CI = 1.34 to 2.69), CSS (HR = 2.13, 95%CI = 1.40 to 3.26), and RFS (HR = 1.60, 95%CI = 1.24 to 2.07) in upper tract urothelial carcinoma (UTUC), but it was only a risk factor for CSS (HR = 2.95, 95%CI = 1.14 to 7.60) in bladder cancer (BC). Besides, preoperative AGR cut − value ≤ 1.4 could not be deemed as a stable prognostic indicator for RFS (HR = 2.07, 95%CI = 0.71 to 6.04) in UC. However, the predictive ability of AGR cut − value > 1.4 was stable. All in all, preoperative low AGR was considered as a risk factor for UC. AGR level can be regarded as a prognostic indicator for OS, CSS, and RFS in UTUC but only for CSS in BC. AGR greater than 1.4 can be a great cut-off value for predicting the prognosis of UC patients with radical operation.
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Xie H, Yuan G, Liu M, Huang S, Wei L, Tang S, Gan J. Pretreatment Albumin-to-Fibrinogen Ratio is a Promising Biomarker for Predicting Postoperative Clinical Outcomes in Patients with Colorectal Cancer. Nutr Cancer 2022; 74:2896-2909. [PMID: 35193433 DOI: 10.1080/01635581.2022.2042572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE To evaluate the prognostic value of pretreatment albumin-to-fibrinogen ratio (AFR) in colorectal cancer (CRC). METHODS This retrospective study included 657 CRC patients who underwent surgical resection in 2012-2014. Kaplan-Meier survival curve and Cox proportional hazards model were used to determine independent predictors. Receiver operating characteristic curve analysis was used to assess and compare the ability of indicators to predict survival. RESULTS The optimal cutoff value of AFR was 8.3. Compared with high AFR group, low AFR group had shorter progression-free survival (PFS) (65.32% vs 52.28%, p < 0.001) and overall survival (OS) (67.47% vs 56.14%, p = 0.001). In the stratified analysis of TNM stage, AFR had good prognostic discrimination for early- and advanced-stage patients. Multivariate analysis suggested that AFR was an independent prognostic factor of PFS [hazard ratio (HR) = 1.385, 95% confidence interval (CI) = 1.043-1.839, p = 0.024) and OS (HR = 1.342, 95% CI = 1.022-1.763, p = 0.034) for CRC patients. AFR had better prognostic prediction ability than other inflammation-related markers. The AFR-based nomograms had good predictive capabilities. CONCLUSIONS Pretreatment AFR is an independent prognostic factor for CRC patients undergoing surgical resection and is superior to other established inflammation-related markers.
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Affiliation(s)
- Hailun Xie
- Department of Colorectal and Anal Surgery, The First Affiliated Hospital, Guangxi Medical University, Nanning, P.R. China
| | - Guanghui Yuan
- Department of Colorectal and Anal Surgery, The First Affiliated Hospital, Guangxi Medical University, Nanning, P.R. China
| | - Mingxiang Liu
- Department of Colorectal and Anal Surgery, The First Affiliated Hospital, Guangxi Medical University, Nanning, P.R. China
| | - Shizhen Huang
- Department of Colorectal and Anal Surgery, The First Affiliated Hospital, Guangxi Medical University, Nanning, P.R. China
| | - Lishuang Wei
- Department of Respiratory Medicine, The First Affiliated Hospital, Guangxi Medical University, Nanning, P.R. China
| | - Shuangyi Tang
- Department of Pharmacy, The First Affiliated Hospital, Guangxi Medical University, Nanning, P.R. China
| | - Jialiang Gan
- Department of Colorectal and Anal Surgery, The First Affiliated Hospital, Guangxi Medical University, Nanning, P.R. China
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Mao W, Wang K, Wu Y, Ni J, Zhang H, Wang Y, Wu Z, Liu R, Geng J, Chen S, Chen M. Prognostic Significance of Modified Advanced Lung Cancer Inflammation Index in Patients With Renal Cell Carcinoma Undergoing Laparoscopic Nephrectomy: A Multi-Institutional, Propensity Score Matching Cohort Study. Front Nutr 2022; 8:781647. [PMID: 35127784 PMCID: PMC8811296 DOI: 10.3389/fnut.2021.781647] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 12/24/2021] [Indexed: 12/19/2022] Open
Abstract
Background We conducted a multi-institutional clinical study to assess the prognostic value of the advanced lung cancer inflammatory index (ALI) and modified ALI (mALI) in patients with renal cell carcinoma (RCC). Methods We collected 440 patients who underwent laparoscopic nephrectomy at three centers from 2014 to 2019. ALI was defined as body mass index (BMI) × serum albumin (ALB)/neutrophil-to-lymphocyte ratio (NLR) and mALI as L3 muscle index × ALB/NLR. Kaplan-Meier curves, receiver operating characteristic (ROC) curves and Cox survival analysis were used to assess the effect of ALI and mALI on overall survival (OS). In addition, we performed 1:1 propensity score matching (PSM) for the high mALI and low mALI groups to further explore the impact of mALI on survival in RCC patients. Results The optimal cut-off values for ALI and mALI were 40.6 and 83.0, respectively. Based on the cut-off values, we divided the patients into high ALI and low ALI groups, high mALI and low mALI groups. ALI and mALI were significantly associated with the AJCC stage, Fuhrman grade, T stage, and M stage. Low ALI (p = 0.002) or low mALI (p < 0.001) was associated with poorer prognosis. ROC curves showed that mALI was a better predictor of OS than ALI. Multivariate Cox regression analysis showed that low mALI (aHR = 2.22; 95% CI 1.19–4.13, p = 0.012) was an independent risk factor for OS in RCC patients who underwent nephrectomy, while ALI (aHR = 1.40; 95% CI 0.73–2.66, p = 0.309) was not significantly associated. Furthermore, after PSM analysis, we found that mALI remained an independent risk factor for OS (aHR = 2.88; 95% CI 1.33–6.26, p = 0.007) in patients with RCC. Conclusions For RCC patients undergoing laparoscopic nephrectomy, low ALI and low mALI were associated with poor prognosis, and preoperative mALI can be used as a potential independent prognostic indicator for RCC patients.
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Affiliation(s)
- Weipu Mao
- Department of Urology, Shidong Hospital of Yangpu District, Shanghai, China
- Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, China
| | - Keyi Wang
- Department of Urology, Shidong Hospital of Yangpu District, Shanghai, China
| | - Yuan Wu
- Department of Urology, Hefei Cancer Hospital, Chinese Academy of Sciences, Hefei, China
| | - Jinliang Ni
- Department of Urology, School of Medicine, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
| | - Houliang Zhang
- Department of Urology, School of Medicine, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
| | - Yidi Wang
- Department of Urology, School of Medicine, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
| | - Zonglin Wu
- Department of Urology, Shidong Hospital of Yangpu District, Shanghai, China
| | - Ruiji Liu
- Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, China
| | - Jiang Geng
- Department of Urology, School of Medicine, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
- Jiang Geng
| | - Shuqiu Chen
- Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, China
- Shuqiu Chen
| | - Ming Chen
- Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, China
- *Correspondence: Ming Chen
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Hou S, Jin C, Yang M, Chu H, Shi B, Xie R, Chen Y, Lin N. Prognostic value of hematological pre-albumin to fibrinogen ratio in patients with glioma. World Neurosurg 2022; 160:e442-e453. [PMID: 35051638 DOI: 10.1016/j.wneu.2022.01.048] [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: 09/24/2021] [Accepted: 01/11/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Hematological biomarkers that reflect host nutritional and inflammation status have been identified to be independent prognostic factors in various malignancies. The aim of the present study was to determine the predictive value of preoperative albumin (ALB), fibrinogen (FIB), pre-albumin (pALB), Albumin to fibrinogen ratio (AFR) and pre-albumin to fibrinogen ratio (PFR) for the prognosis of patients with glioma. METHOD X-tile software was used to identify cut-off values of these parameters. Kaplan-Meier survival analysis, univariate and multivariate analyses based on Cox proportional hazards regression model were used to determine whether these markers were associated with the prognosis of patients with glioma. In addition, the Harrell concordance index with variables was used to evaluate the prognostic accuracy. RESULTS The results indicated that PFR (HR = 2.827, 95% CI: 1.353-6.122, p = 0.006) is the only independent prognostic factor in patients of glioma along with clinicopathological grade and age. C-index of predicted nomogram including PFR (0.719) for glioma patients was higher than that without PFR (0.699). CONCLUSIONS Our findings demonstrated that circulating preoperative PFR might be a potential negative independent prognostic biomarker for glioma individuals.
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Affiliation(s)
- Shiqiang Hou
- Department of Neurosurgery, The affiliated Chuzhou hospital of Anhui Medical University, The First People's Hospital Chuzhou, Chuzhou 239000, China
| | - Chunjing Jin
- Laboratory Medicine Center, The affiliated Chuzhou hospital of Anhui Medical University, The First People's Hospital Chuzhou, Chuzhou 239000, China
| | - Minfeng Yang
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong 999007, China
| | - Haidan Chu
- Laboratory Medicine Center, Affiliated Hospital of Nantong University, Nantong 226001, China
| | - Beitian Shi
- Department of Neurosurgery, The affiliated Chuzhou hospital of Anhui Medical University, The First People's Hospital Chuzhou, Chuzhou 239000, China
| | - Ruiyu Xie
- Laboratory Medicine Center, The affiliated Chuzhou hospital of Anhui Medical University, The First People's Hospital Chuzhou, Chuzhou 239000, China
| | - Yinan Chen
- Department of Neurosurgery, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, Hefei 230036, China.
| | - Ning Lin
- Department of Neurosurgery, The affiliated Chuzhou hospital of Anhui Medical University, The First People's Hospital Chuzhou, Chuzhou 239000, China.
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Yoshino M, Ishihara H, Ishiyama Y, Tachibana H, Toki D, Yamashita K, Kobayashi H, Fukuda H, Yoshida K, Takagi T, Iizuka J, Ishida H, Kondo T, Tanabe K. Albumin-to-Alkaline Phosphatase Ratio as a Novel Prognostic Marker of Nivolumab Monotherapy for Previously Treated Metastatic Renal Cell Carcinoma. In Vivo 2021; 35:2855-2862. [PMID: 34410978 DOI: 10.21873/invivo.12573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 06/23/2021] [Accepted: 06/25/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND/AIM The relationship between albumin-to-alkaline phosphatase ratio (AAPR) and the outcome of patients with metastatic renal cell carcinoma (mRCC) treated with immune checkpoint inhibitors remains unresolved. We aimed to clarify the prognostic role of AAPR in nivolumab monotherapy for previously treated mRCC. PATIENTS AND METHODS We retrospectively evaluated 60 patients with mRCC treated with nivolumab after failure of at least one molecular targeted therapy. The patients were stratified into two groups based on the baseline AAPR. The threshold of AAPR was determined using receiver-operating characteristics and Youden index analyses. Overall survival (OS), progression-free survival (PFS), and objective response rate (ORR) of nivolumab therapy were compared between the high and low AAPR groups. RESULTS The threshold of AAPR was set at 0.3, and 20 patients (33%) were assigned to the low AAPR group. The median OS and PFS were significantly lower in the low AAPR group than those in the high group (OS: 8.3 months vs. not reached, p<0.0001; PFS: 2.9 vs. 10.4 months, p=0.0006). Moreover, ORR was significantly lower in the low AAPR group than in the high group (16% vs. 45%, p=0.0397). Multivariate analyses further showed that AAPR was an independent factor for OS [HR=0.27 (95% CI=0.09-0.77), p=0.0151] but not for PFS (p=0.174). CONCLUSION Baseline AAPR was significantly associated with outcome in patients with mRCC receiving nivolumab monotherapy and may, therefore, constitute an effective prognostic factor for nivolumab treatment.
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Affiliation(s)
- Maki Yoshino
- Department of Urology, Tokyo Women's Medical University Medical Center East, Arakawa, Japan
| | - Hiroki Ishihara
- Department of Urology, Tokyo Women's Medical University Medical Center East, Arakawa, Japan
| | - Yudai Ishiyama
- Department of Urology, Tokyo Women's Medical University Medical Center East, Arakawa, Japan
| | - Hidekazu Tachibana
- Department of Urology, Tokyo Women's Medical University Medical Center East, Arakawa, Japan
| | - Daisuke Toki
- Department of Urology, Tokyo Women's Medical University Medical Center East, Arakawa, Japan
| | - Kaori Yamashita
- Department of Urology, Tokyo Women's Medical University Medical Center East, Arakawa, Japan
| | - Hirohito Kobayashi
- Department of Urology, Tokyo Women's Medical University Medical Center East, Arakawa, Japan
| | - Hironori Fukuda
- Department of Urology, Tokyo Women's Medical University, Shinjuku, Japan
| | - Kazuhiko Yoshida
- Department of Urology, Tokyo Women's Medical University, Shinjuku, Japan
| | - Toshio Takagi
- Department of Urology, Tokyo Women's Medical University, Shinjuku, Japan
| | - Junpei Iizuka
- Department of Urology, Tokyo Women's Medical University, Shinjuku, Japan
| | - Hideki Ishida
- Department of Urology, Tokyo Women's Medical University, Shinjuku, Japan
| | - Tsunenori Kondo
- Department of Urology, Tokyo Women's Medical University Medical Center East, Arakawa, Japan;
| | - Kazunari Tanabe
- Department of Urology, Tokyo Women's Medical University, Shinjuku, Japan
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11
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López-Cortés R, Gómez BB, Vázquez-Estévez S, Pérez-Fentes D, Núñez C. Blood-based protein biomarkers in bladder urothelial tumors. J Proteomics 2021; 247:104329. [PMID: 34298186 DOI: 10.1016/j.jprot.2021.104329] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 07/15/2021] [Indexed: 12/16/2022]
Abstract
Bladder cancer (BC) is the fifth most common cancer with a high prevalence rate. It is classically classified in two groups, namely non-muscle invasive (NMIBC) and muscle invasive (MIBC). NMIBC accounts for 75% of cases and has a better prognosis than MIBC. However, 30-50% of the NMIBC patients will show recurrences throughout their lives, and about 10-20% of them will progress to MIBC, with frequent metastasis and a reduced survival rate. The diagnosis of bladder cancer is confirmed by direct visualization of the tumour and other mucosal abnormalities with endoscopic excision using cystoscopy and transurethral resection of the bladder (TURBT). An adequate TURBT requires complete resection of all visible tumour with appropriate sampling of the bladder to assess the depth of invasion. However, for many years, researchers have attempted to identify and utilise urinary markers for bladder cancer detection. Voided urine cytology has been the mainstay of urine-based diagnosis of bladder cancer since originally described by Papanicolau and Marshall. Nonetheless, urine cytology has several drawbacks, including a poor sensitivity for low-grade/stage tumours, a lack of interobserver consistency and a variable range of readings (e.g., atypical, atypical-suspicious, non-diagnostic). These shortcomings have inspired the search for more sensitive bladder cancer biomarkers. To bring precision medicine to genitourinary oncology, the analysis of the plasma/serum wide genome and proteome offers promising possibilities.
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Affiliation(s)
- Rubén López-Cortés
- Research Unit, Hospital Universitario Lucus Augusti (HULA), Servizo Galego de Saúde (SERGAS), ES27002 Lugo, Spain
| | - Benito Blanco Gómez
- Urology Division, Hospital Universitario Lucus Augusti (HULA), Servizo Galego de Saúde (SERGAS), ES27002, Lugo, Spain
| | - Sergio Vázquez-Estévez
- Oncology Division, Hospital Universitario Lucus Augusti (HULA), Servizo Galego de Saúde (SERGAS), ES27002 Lugo, Spain
| | - Daniel Pérez-Fentes
- Urology Division, Complejo Hospitalario Universitario de Santiago de Compostela (CHUS), Servizo Galego de Saúde (SERGAS), ES15706 Santiago de Compostela, Spain
| | - Cristina Núñez
- Research Unit, Hospital Universitario Lucus Augusti (HULA), Servizo Galego de Saúde (SERGAS), ES27002 Lugo, Spain.
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12
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Shen C, Zhou K, Wang W, Zhang Y, Liu X. The prognostic value of preoperative serum albumin in patients with bladder urothelial carcinoma undergoing transurethral resection of bladder tumor: A prospective cohort study. Medicine (Baltimore) 2021; 100:e26548. [PMID: 34232194 PMCID: PMC8270602 DOI: 10.1097/md.0000000000026548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 05/25/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND To evaluate whether the preoperative serum albumin level can predict the survival outcome in patients with bladder urothelial carcinoma (BUC) undergoing transurethral resection of bladder tumor (TURBT). METHODS Four hundred fifty six newly diagnosed patients with BUC who underwent TURBT between January 2014 and December 2017 were retrospectively enrolled. Patients were categorized into low albumin (<40 g/L) and high albumin (≥40 g/L) groups. Survival was estimated using the Kaplan-Meier method and compared using the log-rank test. Univariate and multivariate Cox proportional analyses were used to determine the hazard ratios (HRs) for overall survival (OS). Of patients with available data, 108 (24%) and 348 (76%) patients were classified into the low albumin (<40 g/L) and high albumin (≥40 g/L) groups, respectively. RESULTS The results of the Kaplan-Meier analysis and log-rank test showed a significantly worse 5-year OS (P = .003) in the low albumin group than in the high albumin group. In the multivariate Cox regression analysis, after adjusting for confounding variables, the preoperative albumin level remained an independent predictor for 5-year OS (HR: 0.434, 95% confidence interval: 0.221-0.852; P = .015). CONCLUSION Our study determined that a low preoperative albumin level predicted poor OS in patients with BUC who underwent TURBT. Preoperative serum albumin is an inexpensive and easily available marker that has the potential to be a good prognostic factor for predicting mortality in patients with BUC treated with TURBT.
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Affiliation(s)
- Chen Shen
- Department of Urology, Tianjin Medical University General Hospital, Tianjin, China
- Department of Urology, the Second Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Kechong Zhou
- Department of Urology, Tianjin Medical University General Hospital, Tianjin, China
| | - Wei Wang
- Department of Urology, Tianjin Medical University General Hospital, Tianjin, China
- Department of Urology, the Second Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Yue Zhang
- Department of Urology, the Second Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Xiaoqiang Liu
- Department of Urology, Tianjin Medical University General Hospital, Tianjin, China
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13
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Yang L, Gao J, Zhou Y, Tao Z, He J, Yang J, Wang R, Zhang Y, Huang Y, Zhou L, Sun B. Prognostic Value of the Albumin-to-Alkaline Phosphatase Ratio before Chemoradiotherapy in Patients with Nonmetastatic Nasopharyngeal Carcinoma. Chemotherapy 2021; 66:40-46. [PMID: 33601377 DOI: 10.1159/000513058] [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: 08/22/2020] [Accepted: 11/13/2020] [Indexed: 12/24/2022]
Abstract
INTRODUCTION The aim of this study was to evaluate the prognostic value of the albumin-to-alkaline phosphatase ratio (AAPR) in patients with nonmetastatic nasopharyngeal carcinoma (NPC). METHODS Patients with nonmetastatic NPC who underwent chemoradiotherapy (CRT) were retrospectively analyzed. The AAPR was calculated using the last value of albumin to alkaline phosphatase that was measured within 1 week before CRT. The optimal cutoff value for the AAPR value was determined by an X-tile plot. Propensity score matching (PSM) was performed to balance the differences of the baseline characteristics. The Kaplan-Meier method and log-rank test were used to calculate the survival. A Cox proportional hazards regression model was conducted for the multivariate analysis. RESULTS Totally, 87 patients with nonmetastatic NPC who underwent CRT were included in the analysis. The optimal cutoff level for the AAPR was 0.46. The group with an AAPR ≤0.46 was more likely to have poorer overall survival (OS), progression-free survival (PFS), and distant metastasis-free survival (DMFS) (p = 0.023, p = 0.031 and p = 0.027, for OS, PFS, and DMFS, respectively). In Cox proportional hazards analysis, high AAPR was a better prognostic predictor. CONCLUSION AAPR may be a reliable prognostic index for nonmetastatic NPC patients.
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Affiliation(s)
- Liping Yang
- The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Jing Gao
- The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China,
| | - Yan Zhou
- The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Zhenchao Tao
- The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Jian He
- The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Jing Yang
- The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Ru Wang
- The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Yangyang Zhang
- The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Yifan Huang
- The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Lingran Zhou
- The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Bin Sun
- The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
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14
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Prognostic Value of Pretreatment Albumin-to-Alkaline Phosphatase Ratio in Cancer: A Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2020; 2020:6661097. [PMID: 33376729 PMCID: PMC7746449 DOI: 10.1155/2020/6661097] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 11/19/2020] [Accepted: 12/01/2020] [Indexed: 02/06/2023]
Abstract
Background Recently, it has been reported that the pretreatment albumin-to-alkaline phosphatase ratio (AAPR) is related to the prognosis of various cancers. The purpose of this systematic review and meta-analysis was to explore the prognostic value of pretreatment AAPR on clinical outcomes in cancer. Methods PubMed, Web of Science, Cochrane Library, and Embase were systematically searched for relevant research before May 2020. Stata 12 was utilized to extract the data and the characteristics of each study and to generate a pooled hazard ratio (HR) and 95% confidence interval (CI) to assess the relationship between pretreatment AAPR and survival outcomes. Results We included 16 eligible published articles involving 5,716 patients. We found that low pretreatment AAPR was associated with poor overall survival (HR = 2.12, 95% CI: 1.80–2.50, P < 0.001), cancer-specific survival (HR = 2.89, 95% CI: 1.46–5.71, P < 0.001), disease-free survival (HR = 1.91, 95% CI: 1.43–2.53, P < 0.001), and progression-free survival (HR = 1.93, 95% CI: 1.49–2.52, P < 0.001). However, there was no statistical relationship between pretreatment AAPR and recurrence-free survival, distant-metastasis-free survival, or locoregional relapse-free survival. The correlation between pretreatment AAPR and overall survival did not change significantly when possible confounders were stratified. The sensitivity analysis showed that this study was reliable. Conclusions Low pretreatment AAPR was significantly associated with adverse clinical outcomes of cancer. Pretreatment AAPR could be a valuable noninvasive prognostic indicator for cancer.
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Zhao Z, Xie S, Feng B, Zhang S, Sun Y, Guo H, Yang R. Preoperative Risk Classification Using Neutrophil-to-Lymphocyte Ratio and Albumin for Upper Tract Urothelial Carcinoma Treated with Radical Nephroureterectomy. Cancer Manag Res 2020; 12:9023-9032. [PMID: 33061597 PMCID: PMC7526009 DOI: 10.2147/cmar.s274332] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 09/03/2020] [Indexed: 12/27/2022] Open
Abstract
Purpose To improve the preoperative prediction of the outcomes of patients diagnosed with upper tract urothelial carcinoma (UTUC) treated with radical nephroureterectomy (RNU), we explored various preoperative laboratory factors and established a prognostic risk stratification method. Patients and Methods We retrospectively reviewed 232 UTUC patients who underwent RNU from September 2010 to October 2019 and analyzed their comprehensive clinicopathologic data and preoperative blood-based biomarkers. Kaplan–Meier analysis, receiver-operating characteristic (ROC) curves analysis and Cox regression analysis were performed to assess the relationship between these factors and the prognosis. Results The median follow-up and age were 24 months and 68.5 years, respectively. Preoperative elevated neutrophil-to-lymphocyte ratio (NLR > 3.44) and decreased albumin (ALB < 39.8 g/L) were negatively correlated with progression-free survival (PFS), cancer-specific survival (CSS) and overall survival (OS) in both univariate and multivariate analyses. Patients were sorted into three groups based on their NLR and ALB: the low-risk group (neither elevated NLR nor decreased ALB), intermediate-risk group (either elevated NLR or decreased ALB) and high-risk group (elevated NLR and decreased ALB). Their 5-year PFS rates were 77.8%, 52.6% and 32.3%; their 5-year CSS rates were 97.7%, 71.4% and 32.9%; and their 5-year OS rates were 92.7%, 70.4% and 29.2%, respectively (all P < 0.0001). ROC curves analysis showed that NLR plus ALB had a more accurate prognostic value (P < 0.05). Conclusion Preoperative risk classification using NLR and ALB was identified as an independent prognostic factor for patients with UTUC. The combination of NLR and ALB may help to determine the most appropriate treatment options before RNU.
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Affiliation(s)
- Zihan Zhao
- Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Institute of Urology, Nanjing University, Nanjing, People's Republic of China
| | - Shangxun Xie
- Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Institute of Urology, Nanjing University, Nanjing, People's Republic of China
| | - Baofu Feng
- Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Institute of Urology, Nanjing University, Nanjing, People's Republic of China
| | - Shiwei Zhang
- Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Institute of Urology, Nanjing University, Nanjing, People's Republic of China
| | - Yifan Sun
- Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Institute of Urology, Nanjing University, Nanjing, People's Republic of China
| | - Hongqian Guo
- Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Institute of Urology, Nanjing University, Nanjing, People's Republic of China
| | - Rong Yang
- Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Institute of Urology, Nanjing University, Nanjing, People's Republic of China
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Omura S, Taguchi S, Miyagawa S, Matsumoto R, Samejima M, Ninomiya N, Masuda K, Nakamura Y, Yamaguchi T, Kinjo M, Tambo M, Okegawa T, Higashihara E, Fukuhara H. Prognostic significance of the albumin-to-globulin ratio for upper tract urothelial carcinoma. BMC Urol 2020; 20:133. [PMID: 32859201 PMCID: PMC7456038 DOI: 10.1186/s12894-020-00700-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 08/19/2020] [Indexed: 01/26/2023] Open
Abstract
Background Although the albumin-to-globulin ratio (AGR) is a promising biomarker for various malignancies, few studies have investigated its prognostic significance for upper tract urothelial carcinoma (UTUC). Methods This retrospective study conformed to the REporting recommendations for tumour MARKer prognostic studies (REMARK) guideline. We reviewed 179 patients with UTUC who underwent radical nephroureterectomy at our institution between 2008 and 2018. Associations of preoperative clinicopathological factors, including the AGR, with cancer-specific survival (CSS) and overall survival (OS) were assessed. The Cox proportional hazards model was used for univariate and multivariable analyses. AGR was dichotomized as < 1.25 and ≥ 1.25, according to the most discriminatory cutoff determined from the receiver operating characteristic curve analysis. Results During a median follow-up of 34 months after surgery, 37 patients died from UTUC and 13 died of other causes. The preoperative AGR significantly correlated with pathological T stage, pathological N stage, and adjuvant chemotherapy. Multivariate analyses demonstrated that a decreased (< 1.25) preoperative AGR was an independent poor prognostic factor for both CSS (hazard ratio [HR] = 2.81, P < 0.01) and OS (HR = 2.09, P < 0.05). Conclusions Preoperative AGR < 1.25 might serve as a useful prognostic marker for patients with UTUC undergoing radical nephroureterectomy.
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Affiliation(s)
- Shota Omura
- Department of Urology, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Satoru Taguchi
- Department of Urology, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan.
| | - Shogo Miyagawa
- Department of Urology, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Ryuki Matsumoto
- Department of Urology, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Mio Samejima
- Department of Urology, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Naoki Ninomiya
- Department of Urology, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Kazuki Masuda
- Department of Urology, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Yu Nakamura
- Department of Urology, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Tsuyoshi Yamaguchi
- Department of Urology, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Manami Kinjo
- Department of Urology, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Mitsuhiro Tambo
- Department of Urology, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Takatsugu Okegawa
- Department of Urology, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Eiji Higashihara
- Department of ADPKD Research, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Hiroshi Fukuhara
- Department of Urology, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan
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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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Mori K, Janisch F, Mostafaei H, Lysenko I, Kimura S, Egawa S, Shariat SF. Prognostic value of preoperative blood-based biomarkers in upper tract urothelial carcinoma treated with nephroureterectomy: A systematic review and meta-analysis. Urol Oncol 2020; 38:315-333. [PMID: 32088103 DOI: 10.1016/j.urolonc.2020.01.015] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 01/23/2020] [Accepted: 01/27/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE This systematic review and meta-analysis assessed the prognostic value of preoperative blood-based biomarkers in patients with upper tract urothelial carcinoma (UTUC) treated with nephroureterectomy. METHODS PUBMED, Web of Science, Cochrane Library, and Scopus databases were searched in June 2019 according to the Preferred Reporting Items for Systematic Review and Meta-analysis statement. Studies were deemed eligible if they compared cancer-specific survival in UTUC patients with and without pretreatment laboratory abnormalities. Formal meta-analyses were performed for this outcome. RESULTS The review identified 54 studies with 23,118 patients, of these, 52 studies with 22,513 patients were eligible for the meta-analysis. Several preoperative blood-based biomarkers were significantly associated with cancer-specific survival as follows: neutrophil-lymphocyte ratio (pooled hazard ratio [HR]: 1.66, 95% confidence interval [CI]: 1.34-2.06), C-reactive protein (pooled HR: 1.17, 95% CI: 1.07-1.29), platelet-lymphocyte ratio (pooled HR: 1.68, 95% CI: 1.30-2.17), white blood cell (pooled HR: 1.58, 95% CI: 1.02-2.46), De Ritis ratio (pooled HR: 2.40, 95% CI: 1.92-2.99), fibrinogen (pooled HR: 2.23, 95% CI: 1.86-2.68), albumin-globulin ratio (pooled HR: 3.00, 95% CI: 1.87-4.84), hemoglobin (pooled HR: 1.51, 95% CI: 1.22-1.87), and estimate glomerular filtration rate (pooled HR: 1.52, 95% CI: 1.19-1.94). The Cochrane's Q test and I2 test revealed significant heterogeneity for neutrophil-lymphocyte ratio, C-reactive protein, white blood cell, hemoglobin, and estimated glomerular filtration rate (P = 0.022; I2 = 50.7%, P = 0.000; I2 = 80.4%, P = 0.000; I2 = 88.3%, P = 0.010; I2 = 62.0%, P = 0.000; I2 = 83.9%, respectively). CONCLUSIONS Several pretreatment laboratory abnormalities in patients with UTUC were associated with increased risks of cancer-specific mortality. Therefore, blood-based biomarkers may have the potential to serve as prognostic factors to assist patients and physicians in selecting appropriate treatment strategies for UTUC. However, considering the study limitations including heterogeneity and retrospective nature of the primary data, the conclusions should be interpreted with caution.
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Affiliation(s)
- Keiichiro Mori
- Department of Urology, Medical University of Vienna, Vienna, Austria; Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Florian Janisch
- Department of Urology, Medical University of Vienna, Vienna, Austria; Department of Urology, Medical University of Hamburg, Hamburg, Germany
| | - Hadi Mostafaei
- Department of Urology, Medical University of Vienna, Vienna, Austria; Research Center for Evidence Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ivan Lysenko
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Shoji Kimura
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Shin Egawa
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Shahrokh F Shariat
- Department of Urology, Medical University of Vienna, Vienna, Austria; Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia; Department of Urology, Weill Cornell Medical College, New York, NY, USA; Department of Urology, University of Texas Southwestern, Dallas, TX, USA; Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria; Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic.
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Zhang C, Li Y, Ji R, Zhang W, Zhang C, Dan Y, Qian H, He A. The Prognostic Significance Of Pretreatment Albumin/alkaline Phosphatase Ratio In Patients With Stage IB-IIA Cervical Cancer. Onco Targets Ther 2019; 12:9559-9568. [PMID: 32009792 PMCID: PMC6859168 DOI: 10.2147/ott.s225294] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 10/04/2019] [Indexed: 12/12/2022] Open
Abstract
Background Pretreatment albumin/alkaline phosphatase ratio (AAPR) has been discussed about its prognostic value in several malignancies, whereas its role in cervical cancer remains unclear. In this study, we attempt to explore the prognostic significance of the AAPR in stage IB-IIA cervical cancer patients who underwent a radical hysterectomy. Patients and methods A total of 230 cervical cancer patients were enrolled in this retrospective study. The threshold value of AAPR was determined by receiver operating characteristic (ROC) curve. Kaplan-Meier survival analysis and multivariate analysis were performed to identify independent prognostic predictors of disease-free survival (DFS) and overall survival (OS). Results The optimal cut-off value of the preoperative AAPR was 0.68. Patients with AAPR<0.68 showed obviously inferior OS and DFS than those with AAPR>0.68 according to Kaplan-Meier curves (DFS: P = 0.011; OS: P = 0.017). In multivariate analysis, the preoperative AAPR showed to be an independent predictive factor for disease-free survival (DFS: P = 0.015) and overall survival (OS: P = 0.019). Moreover, subgroup analysis revealed that the lower AAPR was correlated with worse prognosis in patients with histologic grade I-II; but in those with histologic grade III, there was no significant difference between the two groups. Conclusion Preoperative AAPR was a potentially valuable prognostic index in stage IB-IIA cervical cancer patients. Further prospective studies are required to validate its prognostic value.
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Affiliation(s)
- Can Zhang
- Department of Gynecology Oncology, Tumor Hospital Affiliated to Nantong University, Nantong, People's Republic of China
| | - Yong Li
- Department of Gynecology Oncology, Tumor Hospital Affiliated to Nantong University, Nantong, People's Republic of China
| | - Rui Ji
- Department of Gynecology Oncology, Tumor Hospital Affiliated to Nantong University, Nantong, People's Republic of China
| | - Weiling Zhang
- Department of Gynecology Oncology, Tumor Hospital Affiliated to Nantong University, Nantong, People's Republic of China
| | - Chenfei Zhang
- Department of Medical Oncology, Tumor Hospital Affiliated to Nantong University, Nantong, People's Republic of China
| | - Youli Dan
- Department of Oncology, Medical College of Nantong University, Nantong, People's Republic of China
| | - Hongyan Qian
- Cancer Research Centre Nantong, Tumor Hospital Affiliated to Nantong University, Nantong, People's Republic of China
| | - Aiqin He
- Department of Gynecology Oncology, Tumor Hospital Affiliated to Nantong University, Nantong, People's Republic of China
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Xue W, Tan P, Xu H, Yang L, Wei Q. Impact of the preoperative prognostic nutritional index on survival outcomes in upper tract urothelial carcinomas. Cancer Med 2019; 8:2971-2978. [PMID: 31070304 PMCID: PMC6558464 DOI: 10.1002/cam4.2161] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 03/28/2019] [Indexed: 02/05/2023] Open
Abstract
PURPOSES To investigate the value of prognostic nutritional index (PNI) in patients with upper tract urothelial carcinoma (UTUC) who underwent radical nephroureterectomy (RNU). PATIENTS AND METHODS A total of 717 patients were included in our study from 2003 to 2016. PNI was calculated as 10 × serum albumin level (g/dL) + 0.005 × total lymphocyte count (per mm3 ). Kaplan-Meier analysis and Cox regression models were adapted to analyze the value of PNI on survival outcomes. RESULTS The cutoff value of PNI was set as 46.91 and 298 patients (47.6%) had PNI <46.91. The median follow-up was 50 months. The results suggested that low PNI was significantly associated with worse pathologic features (all P < 0.001). Multivariable Cox regression analysis revealed that PNI < 46.91 was an independent predictor of poor overall survival (Hazard ratios [HR] = 1.777, 95% CI = 1.383-2.284, P < 0.001), cancer-specific survival (HR = 1.850, 95% CI = 1.399-2.445, P < 0.001), and recurrence-free survival (HR = 1.554, 95% CI = 1.229-1.964, P < 0.001). CONCLUSIONS Low preoperative PNI was associated with worse survival outcomes in patients with UTUC. PNI could be an easily assessed blood-based biomarker to predict the prognosis in patients with UTUC treated with RNU.
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Affiliation(s)
- Wenbin Xue
- Department of Urology & Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Ping Tan
- Department of Urology & Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Hang Xu
- Department of Urology & Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Lu Yang
- Department of Urology & Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Qiang Wei
- Department of Urology & Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
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Suyama T, Kanbe S, Maegawa M, Shimizu H, Nakajima K. Prognostic significance of inflammation-based prognostic scoring in patients with upper urinary tract urothelial carcinoma. Int Braz J Urol 2019; 45:541-548. [PMID: 31038863 PMCID: PMC6786111 DOI: 10.1590/s1677-5538.ibju.2018.0251] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 02/24/2019] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES To investigate whether Glasgow Prognostic Score has prognostic significance in patients with upper urinary urothelial carcinoma. PATIENTS AND METHODS We retrospectively reviewed the clinical records of 74 patients with upper urinary urothelial carcinoma. We set the cut-off value for C-reactive protein as 1.0mg/dL, and 3.5mg/dL for albumin as Glasgow Prognostic Score. Their blood data including albumin and C-reactive protein for Glasgow Prognostic Score and cytokeratin 19 fragment 21-1 as a tumor marker were measured before starting treatment. The patients were stratified into three groups with Glasgow Prognostic Score: The Group-1, albumin ≥3.5g/dL and C-reactive protein < 1.0mg/dL; Group-2, albumin < 3.5g/dL or C-reactive protein ≥1.0mg/dL; Group-3, albumin < 3.5g/dL and C-reactive protein ≥1.0mg/dL. RESULTS The median follow-up for all patients was 26.9 months (range: 10.9-91.1 months), during which 37 (50%) patients died. There was a signifi cant difference in the estimated survival rate among the 3 groups stratified by Glasgow Prognostic Score. The estimated survival rate in the Group-1 was significantly higher than those in Groups 2 and 3. In the univariate analysis C-reactive protein, serum cytokeratin 19 fragment 21-1 and Glasgow Prognostic Score were significant predictors of overall survival. On the multivariate analysis, serum cytokeratin 19 fragment 21-1 and Glasgow Prognostic Score were independently associated with shorter overall survival. CONCLUSION Our review suggests Glasgow Prognostic Score may play as a prognostic predictor for upper urinary urothelial carcinoma.
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Affiliation(s)
- Taisuke Suyama
- Department of Genitourinary, Sanaikai General Hospital (IMS), Japan
| | - Shigeki Kanbe
- Department of Genitourinary, Toho University Omori Medical Center, Japan
| | - Masanobu Maegawa
- Department of Genitourinary, Sanaikai General Hospital (IMS), Japan
| | - Hirofumi Shimizu
- Department of Genitourinary, Sanaikai General Hospital (IMS), Japan
| | - Koichi Nakajima
- Department of Genitourinary, Toho University Omori Medical Center, Japan
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Itami Y, Miyake M, Tatsumi Y, Gotoh D, Hori S, Morizawa Y, Iida K, Ohnishi K, Nakai Y, Inoue T, Anai S, Tanaka N, Shimada K, Hirao S, Fujimoto K. Preoperative predictive factors focused on inflammation-, nutrition-, and muscle-status in patients with upper urinary tract urothelial carcinoma undergoing nephroureterectomy. Int J Clin Oncol 2019; 24:533-545. [PMID: 30604161 DOI: 10.1007/s10147-018-01381-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 12/13/2018] [Indexed: 12/25/2022]
Abstract
OBJECTIVE The present study evaluated the clinical relevance of an integrative preoperative assessment of inflammation-, nutrition-, and muscle-based markers for patients with upper urinary tract urothelial carcinoma (UTUC) undergoing curative nephroureterectomy (NUx). METHODS The study enrolled 125 patients and the preoperative variables assessed included age, body mass index, neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), serum fibrinogen level (Fib), C-reactive protein (CRP), modified Glasgow prognostic score, serum albumin level (Alb), prognostic nutritional index (PNI), skeletal muscle index (SMI), psoas muscle index (PMI), and peak expiratory flow (PEF). The correlations among the variables and their prognostic values after NUx were evaluated. RESULTS Five inflammation markers (NLR, MLR, PLR, Fib and CRP) were positively correlated. Fib was positively correlated with NLR, PLR and CRP, but inversely correlated with SMI. PNI was inversely correlated with age and the four inflammation markers (p < 0.001). Age was not significantly correlated with the inflammation markers, but older age was associated with lower Alb, PNI, SMI, PMI, and PEF. Disease-specific survival was independently predicted by preoperative ipsilateral hydronephrosis and low PNI. Overall survival was independently associated with high Fib and low PNI. CONCLUSION The preoperative inflammation-, nutrition-, and muscle-based markers would be useful risk assessment tools for UTUC.
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Affiliation(s)
- Yoshitaka Itami
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan.,Department of Urology, Hirao Hospital, 6-28 Hyoubu-cho, Kashihara, Nara, 634-0076, Japan
| | - Makito Miyake
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan.
| | - Yoshihiro Tatsumi
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Daisuke Gotoh
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Shunta Hori
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Yousuke Morizawa
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Kota Iida
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Kenta Ohnishi
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Yasushi Nakai
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Takeshi Inoue
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Satoshi Anai
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Nobumichi Tanaka
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Keiji Shimada
- Department of Pathology, Nara City Hospital, 1-50-1 Higashi kidera-cho, Nara, Nara, 630-8305, Japan
| | - Shuya Hirao
- Department of Urology, Hirao Hospital, 6-28 Hyoubu-cho, Kashihara, Nara, 634-0076, Japan
| | - Kiyohide Fujimoto
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
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Xu H, Tan P, Jin X, Ai J, Lin T, Lei H, Yang L, Wei Q. Validation of the preoperative controlling nutritional status score as an independent predictor in a large Chinese cohort of patients with upper tract urothelial carcinoma. Cancer Med 2018; 7:6112-6123. [PMID: 30485712 PMCID: PMC6308095 DOI: 10.1002/cam4.1902] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 10/30/2018] [Accepted: 11/10/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Pretreatment controlling nutritional status (CONUT) score is a novel index which was used to predict outcomes in cancer patients. We aim to explore the prognostic significance of CONUT score in patients with upper tract urothelial carcinoma (UTUC) after radical nephroureterectomy (RNU). PATIENTS AND METHODS A total of 662 UTUC patients between 2004 and 2016 were retrospectively analyzed. Patients were categorized into three groups based on CONUT score (Normal: 0-1; Light: 2-4; Moderate/severe: 5-12). Associations of CONUT score with oncological outcomes were analyzed using Logistic and Cox regression analysis. Harrell concordance index was used to assess the predictive accuracy of the multivariate models. Subgroup analyses were conducted according to tumor grade and stage. RESULTS The median follow-up duration was 41 months. Multivariate Logistic analysis showed that high CONUT score was independently associated with high-grade disease, high pT stage, lymphovascular invasion, sessile carcinoma, variant histology, and positive surgical margins (each P < 0.05). Multivariate analysis demonstrated that CONUT score 5-12 was an independent factor for worse cancer-specific survival (CSS, hazard ratio [HR]:2.39, 95% confidence interval [CI] 1.55-3.68, P < 0.0001), disease recurrence-free-survival (RFS, HR: 1.80, 95% CI 1.24-2.60, P = 0.002), and overall survival (OS, HR: 2.26, 95% CI 1.53-3.34, P < 0.0001). The estimated c-index of the multivariate models for CSS, RFS, and OS increased from 0.755, 0.715 and 0.745 to 0.772, 0.723, and 0.756 when CONUT score supplemented. Subgroup analyses showed that especially in patients with high-grade carcinoma and advanced stage (≥pT3), higher CONUT score predicts decreased CSS, RFS, and OS (all P < 0.05). CONCLUSION Preoperative CONUT score is a negative independent prognostic indicator for both pathologic and survival outcomes in UTUC, especially in those with high-grade carcinoma and advanced stage. Adding this parameter into our clinical prediction model is appropriate so as to improve its predictive accuracy.
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Affiliation(s)
- Hang Xu
- Department of Urology, Institute of UrologyWest China Hospital, Sichuan UniversityChengduChina
| | - Ping Tan
- Department of Urology, Institute of UrologyWest China Hospital, Sichuan UniversityChengduChina
| | - Xi Jin
- Department of Urology, Institute of UrologyWest China Hospital, Sichuan UniversityChengduChina
| | - Jianzhong Ai
- Department of Urology, Institute of UrologyWest China Hospital, Sichuan UniversityChengduChina
| | - Tianhai Lin
- Department of Urology, Institute of UrologyWest China Hospital, Sichuan UniversityChengduChina
| | - Haoran Lei
- Department of Urology, Institute of UrologyWest China Hospital, Sichuan UniversityChengduChina
| | - Lu Yang
- Department of Urology, Institute of UrologyWest China Hospital, Sichuan UniversityChengduChina
| | - Qiang Wei
- Department of Urology, Institute of UrologyWest China Hospital, Sichuan UniversityChengduChina
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Zhang Y, Wang L, Lin S, Wang R. Preoperative albumin-to-globulin ratio as a significant prognostic indicator in urologic cancers: a meta-analysis. Cancer Manag Res 2018; 10:4695-4708. [PMID: 30410403 PMCID: PMC6199965 DOI: 10.2147/cmar.s178271] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background Emerging studies reported that preoperative albumin-to-globulin ratio (AGR) correlated with tumor progression and prognosis in several types of cancer. The aim of this study was to systematically explore the association between preoperative AGR and clinical outcomes in cancers of the urinary system. Methods Relevant articles were searched in PubMed, Embase and Web of Science by two independent investigators from inception to June 1, 2018. Eligible studies were selected based on predetermined selection criteria. Summarized HRs or ORs and 95% CIs were calculated for prognosis and clinicopathologic features with the fixed-effects or random-effects models. Results Eight cohort studies comprising 2,668 patients were included for analysis. The pooled results showed that a low AGR significantly correlated with poor OS (HR: 0.38, 95% CI: 0.27-0.48, P<0.001), worse cancer-specific survival (CSS) (HR: 0.36, 95% CI: 0.22-0.50, P<0.001) and inferior event-free survival (EFS) (HR: 0.36, 95% CI: 0.25-0.48, P<0.001) in urologic cancers. In addition, patients in low and high AGR groups showed significant differences in lymphovascular invasion (P<0.001), pT status (P<0.001) and pN status (P<0.001). Conclusion Preoperative AGR might be a valuable, cheap and reproducible prognostic bio-marker in urologic cancers following surgical resection.
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Affiliation(s)
- Yi Zhang
- Department of General Surgery, The First People's Hospital of Neijiang, Neijiang 641000, Sichuan Province, China,
| | - Lijuan Wang
- Department of Nephrology, Shangrao People's Hospital, Shangrao 334000, Jiangxi Province, China
| | - Shibu Lin
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Hainan Medical College, Haikou 570102, Hainan Province, China
| | - Rong Wang
- Department of General Surgery, The First People's Hospital of Neijiang, Neijiang 641000, Sichuan Province, China,
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Xu H, Tan P, Ai J, Huang Y, Lin T, Yang L, Wei Q. Prognostic Impact of Preoperative Albumin–Globulin Ratio on Oncologic Outcomes in Upper Tract Urothelial Carcinoma Treated With Radical Nephroureterectomy. Clin Genitourin Cancer 2018; 16:e1059-e1068. [DOI: 10.1016/j.clgc.2018.06.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 06/05/2018] [Accepted: 06/10/2018] [Indexed: 02/06/2023]
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The prognostic significance of Albumin-to-Alkaline Phosphatase Ratio in upper tract urothelial carcinoma. Sci Rep 2018; 8:12311. [PMID: 30120312 PMCID: PMC6097991 DOI: 10.1038/s41598-018-29833-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 07/19/2018] [Indexed: 02/05/2023] Open
Abstract
To assess the prognostic impact of pretreatment albumin-to-alkaline phosphatase ratio (AAPR) in patients with upper tract urothelial carcinoma (UTUC), the data of 692 patients, operated between 2003 and 2016 in our center, were retrospectively assessed. The threshold of AAPR was defined as 0.58 by using the receiver-operating curve analysis. Overall survival (OS), cancer-specific survival (CSS), and recurrence-free survival (RFS) were evaluated using the Kaplan-Meier method. And the univariate and multivariate Cox’s regression models were performed to identify independent prognostic predictors. The results showed that AAPR <0.58 was significantly related to higher pT stage and grade, concomitant variant histology, anemia and larger tumor size. Additionally, patients with a lower AAPR had an inferior survival outcomes than those with an AAPR ≥0.58 (all P < 0.001). Multivariate analysis suggested that the lower AAPR was also an independent risk factor for poor OS (HR 1.587, 95%CI: 1.185–2.126; P = 0.002), CSS (HR 1.746, 95%CI: 1.249–2.440; P = 0.001), and RFS (HR 1.337, 95%CI: 1.027–1.739; P = 0.031). Moreover, subgroup analysis demonstrated the lower AAPR was related to worse prognosis in high-grade UTUC patients; but in those with low-grade disease, no relationship between them was observed. In conclusion, our results found that the decreased AAPR was independently related to poor survival outcomes in UTUC patients. Using the AAPR for subclassification of high-grade UTUC seems to further identify a poor prognostic group and contribute to clinical decisions making.
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Otsuka M, Kamasako T, Uemura T, Takeshita N, Shinozaki T, Kobayashi M, Komaru A, Fukasawa S. Prognostic role of the preoperative serum albumin : globulin ratio after radical nephroureterectomy for upper tract urothelial carcinoma. Int J Urol 2018; 25:871-878. [DOI: 10.1111/iju.13767] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 06/28/2018] [Indexed: 01/22/2023]
Affiliation(s)
- Masafumi Otsuka
- Prostate Center and Division of Urology; Chiba Cancer Center; Chiba Japan
| | - Tomohiko Kamasako
- Prostate Center and Division of Urology; Chiba Cancer Center; Chiba Japan
| | - Toshihiro Uemura
- Prostate Center and Division of Urology; Chiba Cancer Center; Chiba Japan
| | | | - Tetsuo Shinozaki
- Prostate Center and Division of Urology; Chiba Cancer Center; Chiba Japan
| | - Masayuki Kobayashi
- Prostate Center and Division of Urology; Chiba Cancer Center; Chiba Japan
| | - Atsushi Komaru
- Prostate Center and Division of Urology; Chiba Cancer Center; Chiba Japan
| | - Satoshi Fukasawa
- Prostate Center and Division of Urology; Chiba Cancer Center; Chiba Japan
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28
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Xu WY, Zhang HH, Xiong JP, Yang XB, Bai Y, Lin JZ, Long JY, Zheng YC, Zhao HT, Sang XT. Prognostic significance of the fibrinogen-to-albumin ratio in gallbladder cancer patients. World J Gastroenterol 2018; 24:3281-3292. [PMID: 30090008 PMCID: PMC6079291 DOI: 10.3748/wjg.v24.i29.3281] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 06/16/2018] [Accepted: 06/27/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate the prognostic role of fibrinogen-to-albumin ratio (FAR) on patients with gallbladder cancer (GBC) in this study.
METHODS One hundred and fifty-four GBC patients were retrospectively analyzed, who received potentially curative cholecystectomy in our institute from March 2005 to December 2017. Receiver operating characteristic curve (ROC curve) was used to determine the optimal cut-offs for these biomarkers. In addition, Kaplan-Meier survival analysis as well as multivariate analysis were applied for prognostic analyses.
RESULTS ROC curve revealed that the optimal cut-off value for FAR was 0.08. FAR was significantly correlated with age (P = 0.045), jaundice (P < 0.001), differentiation (P = 0.002), resection margin status (P < 0.001), T stage (P < 0.001), TNM stage (P < 0.001), and CA199 (P < 0.001) as well as albumin levels (P < 0.001). Multivariate analysis indicated that the resection margin status [hazard ratio (HR): 2.343, 95% confidence interval (CI): 1.532-3.581, P < 0.001], TNM stage (P = 0.035), albumin level (HR = 0.595, 95%CI: 0.385-0.921, P = 0.020) and FAR (HR: 2.813, 95%CI: 1.765-4.484, P < 0.001) were independent prognostic factors in GBC patients.
CONCLUSION An elevated preoperative FAR was significantly correlated with unfavorable overall survival in GBC patients, while an elevated preoperative albumin level was a protective prognostic factor for patients with GBC. The preoperative FAR could be used to predict the prognosis of GBC patients, which was easily accessible, cost-effective and noninvasive.
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Affiliation(s)
- Wei-Yu Xu
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Hao-Hai Zhang
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Jian-Ping Xiong
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Xiao-Bo Yang
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Yi Bai
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Jian-Zhen Lin
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Jun-Yu Long
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Yong-Chang Zheng
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Hai-Tao Zhao
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Xin-Ting Sang
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
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Huang J, Wang Y, Yuan Y, Chen Y, Kong W, Chen H, Zhang J, Huang Y. Preoperative serum pre-albumin as an independent prognostic indicator in patients with localized upper tract urothelial carcinoma after radical nephroureterectomy. Oncotarget 2018; 8:36772-36779. [PMID: 27906675 PMCID: PMC5482696 DOI: 10.18632/oncotarget.13694] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 11/09/2016] [Indexed: 12/31/2022] Open
Abstract
Purpose To investigate the prognostic value of preoperative pre-albumin and albumin level in patients with localized upper tract urothelial carcinoma (UTUC) undergoing radical nephroureterectomy. Methods and Materials Between January 2003 and June 2013, we evaluated data on 425 patients with nonmetastatic UTUC (Ta-4N0/+M0) who underwent radical nephroureterectomy at our institution. Low pre-albumin level was defined as <20 mg/dl, while hypoalbuminemia was defined as albumin <35 g/L. The associations of preoperative low pre-albumin level and hypoalbuminemia with clinical and pathologic variables were assessed. Univariable and multivariable analyses using the Cox regression model were performed to determine prognostic factors that were associated with cancer specific survival (CSS) and overall survival (OS). The Harrell concordance index with variables only or combined pre-albumin data were used to evaluate the prognostic accuracy. Results Compared with patients with high pre-albumin level, patients with low pre-albumin level were more likely to have older age, higher tumor stage, higher rate of diabetes, regional lymph node metastasis and lymphovascular invasion. Meanwhile, hypoalbuminemia was only associated with diabetes. Multivariate analysis identified decreased preoperative pre-albumin level as an independent prognostic factor for CSS (HR 1.85, 95% CI 1.14-3.00, p=0.013) and OS (HR 1.73, 95% CI 1.12-2.70, p=0.015), but not preoperative hypoalbuminemia. The estimated c-index of the multivariate model for CSS and OS increased from 0.771 and 0.760 without pre-albumin to 0.775 and 0.765 when pre-albumin added. Conclusions Low preoperative pre-albumin level but not preoperative hypoalbuminemia is a negative independent prognostic factor for survival outcome in patients with UTUC undergoing radical nephroureterectomy.
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Affiliation(s)
- Jiwei Huang
- Department of Urology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yanqing Wang
- Department of Urology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yichu Yuan
- Department of Urology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - YongHui Chen
- Department of Urology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Wen Kong
- Department of Urology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Haige Chen
- Department of Urology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jin Zhang
- Department of Urology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yiran Huang
- Department of Urology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Effect of Malnutrition on Radical Nephroureterectomy Morbidity and Mortality: Opportunity for Preoperative Optimization. Clin Genitourin Cancer 2018; 16:e807-e815. [PMID: 29550201 DOI: 10.1016/j.clgc.2018.02.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 02/01/2018] [Accepted: 02/18/2018] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Nutritional status has been increasingly recognized as an important predictor of prognosis and surgical outcomes for cancer patients. We evaluated the effect of preoperative malnutrition on the development of surgical complications and mortality after radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC). MATERIALS AND METHODS Using data from the American College of Surgeons National Surgical Quality Improvement Program, we evaluated the association of poor nutritional status with 30-day postoperative complications and overall mortality after RNU from 2005 to 2015. The preoperative variables suggestive of poor nutritional status included hypoalbuminemia (< 3.5 g/dL), weight loss within 6 months before surgery (> 10%), and a low body mass index. RESULTS A total of 1200 patients were identified who had undergone RNU for UTUC. The overall complication rate was 20.5% (n = 246), and mortality rate was 1.75% (n = 21). On univariate analysis, patients who experienced a postoperative complication were more likely to have hypoalbuminemia (25.0% vs. 11.4%; P < .001) and weight loss (3.7% vs. 1.0%; P = .003). After controlling for baseline characteristics and comorbidities, hypoalbuminemia was found to be a significant independent predictor of postoperative complications (odds ratio, 2.09; 95% confidence interval, 1.29-3.38; P = .003). Hypoalbuminemia was also a significant independent predictor of mortality (odds ratio, 4.31; 95% confidence interval, 1.45-12.79; P = .008) on multivariable regression analysis. CONCLUSION Our results have shown that hypoalbuminemia is a significant predictor of surgical complications and mortality after RNU for UTUC. This finding supports the importance of patients' preoperative nutritional status in this population and suggests that effective nutritional interventions in the preoperative setting could improve patient outcomes.
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张 玥, 李 飞, 杨 帆, 曾 文, 林 昊, 翟 启, 苏 明, 陈 自, 谭 万. [Prognostic value of preoperative serum albumin in patients with non-muscle-invasive bladder cancer undergoing transurethral resection of bladder tumor]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2018; 38:192-197. [PMID: 29502059 PMCID: PMC6743875 DOI: 10.3969/j.issn.1673-4254.2018.02.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To assess the value of preoperative serum albumin level in predicting the survival of patients with non-muscle-invasive bladder cancer (NMIBC) undergoing transurethral resection of bladder tumor (TURBT). METHODS Two hundred and sixteen newly diagnosed patients with NMIBC who underwent TURBT between January, 2007 and April, 2012 were retrospectively analyzed. The patients were categorized into low albumin (<40 g/L) and normal albumin (≥40 g/L) groups. The patient survival was estimated using the Kaplan-Meier method, and univariate and multivariate Cox proportional analyses were used to determine the hazard ratios (HRs) for the overall survival (OS). RESULTS Of the patients with available data, 82 (39%) and 127 (61%) patients were classified into low albumin (<40 g/L) and normal albumin (≥40 g/L) groups, respectively. Kaplan-Meier analysis showed a significantly worse 5-year OS in low albumin group than in normal albumin group (P=0.017). In the multivariate Cox regression analysis, after adjusting for confounding variables, the preoperative albumin level remained as an independent predictor for 5-year OS (HR: 3.102, 95%CI: 1.200-8.020, P=0.020). CONCLUSION A low preoperative albumin level predicts a poor 5-year OS in patients with NMIBC who underwent TURBT. Preoperative serum albumin can be a good prognostic factor for predicting survival of the patients with NMIBC treated with TURBT.
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Affiliation(s)
- 玥 张
- />南方医科大学南方医院泌尿外科,广东 广州 510515Department of Urology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 飞 李
- />南方医科大学南方医院泌尿外科,广东 广州 510515Department of Urology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 帆 杨
- />南方医科大学南方医院泌尿外科,广东 广州 510515Department of Urology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 文利 曾
- />南方医科大学南方医院泌尿外科,广东 广州 510515Department of Urology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 昊 林
- />南方医科大学南方医院泌尿外科,广东 广州 510515Department of Urology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 启良 翟
- />南方医科大学南方医院泌尿外科,广东 广州 510515Department of Urology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 明强 苏
- />南方医科大学南方医院泌尿外科,广东 广州 510515Department of Urology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 自豪 陈
- />南方医科大学南方医院泌尿外科,广东 广州 510515Department of Urology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 万龙 谭
- />南方医科大学南方医院泌尿外科,广东 广州 510515Department of Urology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
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Huang J, Yuan Y, Wang Y, Chen Y, Kong W, Xue W, Chen H, Zhang J, Huang Y. Preoperative prognostic nutritional index is a significant predictor of survival in patients with localized upper tract urothelial carcinoma after radical nephroureterectomy. Urol Oncol 2017; 35:671.e1-671.e9. [DOI: 10.1016/j.urolonc.2017.07.028] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 07/09/2017] [Accepted: 07/22/2017] [Indexed: 11/28/2022]
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Inamoto T, Matsuyama H, Sakano S, Ibuki N, Takahara K, Komura K, Takai T, Tsujino T, Yoshikawa Y, Minami K, Nagao K, Inoue R, Azuma H. The systemic inflammation-based Glasgow Prognostic Score as a powerful prognostic factor in patients with upper tract urothelial carcinoma. Oncotarget 2017; 8:113248-113257. [PMID: 29348903 PMCID: PMC5762588 DOI: 10.18632/oncotarget.22641] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 10/30/2017] [Indexed: 12/19/2022] Open
Abstract
Introduction and Objective The combination of C-reactive protein and albumin, the Glasgow Prognostic Score (GPS), had independent prognostic value in patients with varying cancers, except for upper tract urothelial carcinoma (UTUC). The aim of this study was to describe the relationship between GPS and survival in patients with UTUC after adjustment for other prognostic factors. Materials and Methods We queried 2 UTUC databases. Retrospective clinical series on patients with localized UTUC managed by nephroureterectomy with bladder cuff, for whom data from the Yamaguchi Uro-Oncology Group and Osaka Medical College registry, including age, presence of bladder cancer, pT stage, lymphovascular invasion, C-reactive protein (CRP) and albumin, were analyzed. The GPS was constructed by combining CRP and albumin. Cancer specific survival (CSS) and overall survival (OS) and relative excess risk of death were estimated by GPS categories after adjusting for gender, age, ECOG performance status (PS), grade, and lymphovascular invasion (LVI). Results Seven hundred and twenty four UTUC patients were identified. Our final cohort included 574 patients; of these, 29.2% died during a maximum follow up of 16.7 years. The estimated mean 10-year CSS of patients with GPS of scre-0, -1, and -2 was 99.5, 95.1, and 75.9 months, respectively. Patients with GPS of score-2 had poorest 10-year estimated mean OS of 67.6 months (57.2–77.9). Raised GPS also had a significant association with excess risk of cancer death at 10 years (GPS 2: Relative Excess Risk = 1.74, 95% CI 1.20–2.54) after adjusting for gender, patients’ age, ECOG PS, and tumor focality. C-index of GPS both for CSS and OS were superior to patients’ age and tumor focality, and comparable to grade. Conclusions The GPS is an independent prognostic factor for CSS and OS after surgery with curative intent for localized UTUC. It significantly increases the accuracy of established prognostic factors. The GPS may provide a meaningful adjunct for patient counseling and clinical trial design.
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Affiliation(s)
- Teruo Inamoto
- Department of Urology, Osaka Medical College, Osaka, Japan
| | - Hideyasu Matsuyama
- Department of Urology, Graduate School of Medicine, Yamaguchi University, Ube, Japan
| | - Shigeru Sakano
- Department of Urology, Graduate School of Medicine, Yamaguchi University, Ube, Japan
| | - Naokazu Ibuki
- Department of Urology, Osaka Medical College, Osaka, Japan
| | | | | | - Tomoaki Takai
- Department of Urology, Osaka Medical College, Osaka, Japan
| | - Takuya Tsujino
- Department of Urology, Osaka Medical College, Osaka, Japan
| | - Yuki Yoshikawa
- Department of Urology, Osaka Medical College, Osaka, Japan
| | | | - Kazuhiro Nagao
- Department of Urology, Graduate School of Medicine, Yamaguchi University, Ube, Japan
| | - Ryo Inoue
- Department of Urology, Graduate School of Medicine, Yamaguchi University, Ube, Japan
| | - Haruhito Azuma
- Department of Urology, Osaka Medical College, Osaka, Japan
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Cui J, Chen S, Bo Q, Wang S, Zhang N, Yu M, Wang W, Han J, Zhu Y, Shi B. Preoperative prognostic nutritional index and nomogram predicting recurrence-free survival in patients with primary non-muscle-invasive bladder cancer without carcinoma in situ. Onco Targets Ther 2017; 10:5541-5550. [PMID: 29200869 PMCID: PMC5702160 DOI: 10.2147/ott.s146990] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background and objectives Among the cancers of the urogenital system, bladder cancer is ranked second both in incidence and mortality, and hence, a more accurate estimate of the prognosis for individual patients with non-muscle-invasive bladder cancer (NMIBC) is urgently needed. Prognostic nutritional index (PNI) which is based on serum albumin levels and peripheral lymphocyte count has been confirmed to have prognostic value in various cancers. The aim of this study was to clarify the prognostic value of PNI in patients with NMIBC. Methods Data of 329 patients with NMIBC were evaluated retrospectively. Recurrence-free survival (RFS) was assessed using the Kaplan–Meier method, and the equivalences of survival curves were tested by log-rank tests. The univariate and multivariate analyses were performed using the Cox proportional hazards regression model. Discrimination of the nomogram was measured by the concordance index. A p-value of <0.05 was considered statistically significant. Results In univariate analysis, age, tumor focality, tumor size, tumor grade, pathological T stage and preoperative PNI were significantly associated with RFS. Multivariate analysis identified PNI as an independent predictor of RFS in patients with NMIBC. According to these independent predictors, a nomogram for the prediction of recurrence was developed. Conclusion PNI can be regarded as an independent prognostic factor for predicting RFS in NMIBC. The nomogram could be useful to improve personalized therapy for patients with NMIBC.
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Affiliation(s)
| | | | - Qiyu Bo
- Department of First Operating Room, Qilu Hospital of Shandong University
| | | | | | | | | | - Jie Han
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute Affiliated to Shandong University, Jinan, People's Republic of China
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Significance of multiple preoperative laboratory abnormalities as prognostic indicators in patients with urothelial carcinoma of the upper urinary tract following radical nephroureterectomy. Int J Clin Oncol 2017; 23:151-157. [PMID: 28856495 DOI: 10.1007/s10147-017-1184-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 08/18/2017] [Indexed: 01/28/2023]
Abstract
BACKGROUND The aim of this study was to investigate the prognostic significance of multiple preoperative laboratory abnormalities in upper urinary tract urothelial carcinoma (UUTUC) patients. METHODS This study included a total of 135 consecutive patients with clinically localized UUTUC who underwent radical nephroureterectomy (RNU). The impact of several preoperative blood-based markers in addition to conventional clinical factors on extravesical recurrence-free survival (eRFS) in these patients was retrospectively evaluated. RESULTS Despite the lack of a significant correlation between conventional clinical factors and any of the postoperative pathologic parameters, preoperative laboratory abnormalities were shown to have a significant impact on some pathological factors reflecting an aggressive phenotype as follows-C-reactive protein (CRP) level on pathological stage, De Ritis (aspartate transaminase/alanine transaminase) ratio on nodal involvement, and neutrophil-lymphocyte ratio (NLR) on pathological stage. During the observation period of this study (median 36.1 months), extravesical disease recurrence was detected in 44 (32.6%) of the 135 patients with a 5-year eRFS rate of 62.1%. Of several factors examined, the CRP level, De Ritis ratio, and NRL were significantly correlated with eRFS on univariate analysis. Of these significant factors, the De Ritis ratio and NRL were identified as independent predictors of eRFS on multivariate analysis. Moreover, there were significant differences in eRFS according to the positive numbers of these two independent risk factors. CONCLUSIONS These findings suggest that it is important to consider laboratory abnormalities, particularly the De Ritis ratio and NLR, to predict disease recurrence following RNU in patients with clinically localized UUTUC.
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Chen P, Wang C, Cheng B, Nesa EU, Liu Y, Jia Y, Qu Y, Jiang Z, Han J, Cheng Y. Plasma fibrinogen and serum albumin levels (FA score) act as a promising prognostic indicator in non-small cell lung cancer. Onco Targets Ther 2017; 10:3107-3118. [PMID: 28790844 PMCID: PMC5488757 DOI: 10.2147/ott.s138854] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Evidence implies that preoperative plasma fibrinogen and serum albumin are associated with cancer prognosis. We aimed to explore the prognostic values of the score based on plasma fibrinogen and serum albumin levels (FA score) in non-small cell lung cancer (NSCLC), and to compare that with prognostic nutritional index (PNI). PATIENTS AND METHODS In all, 182 patients pathologically diagnosed with NSCLC were included in this study. Kaplan-Meier survival analysis and multivariate analysis were used in the prognostic analyses. RESULTS High FA score was related to smoking (P=0.005), poor differential grade (P=0.002), and advanced T stage (P<0.001) and tumor, node, and metastases stage (P=0.011). Low PNI showed association with advanced T stage (P=0.030). Kaplan-Meier survival analysis indicated that high FA score and low PNI were associated with poor progression-free survival (PFS; for the FA score, P<0.001; for PNI, P=0.001) and overall survival (OS; for the FA score, P<0.001; for PNI, P=0.013), respectively. Multivariate analysis revealed that FA score was an independent predictor for PFS (P=0.003) and OS (P=0.001) in NSCLC patients. CONCLUSION The FA score could act as a more promising prognostic predictor than PNI in NSCLC patients who underwent pneumonectomy.
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Affiliation(s)
- Pengxiang Chen
- Department of Radiation Oncology, Qilu Hospital of Shandong University, Jinan
| | - Cong Wang
- Department of Radiation Oncology, Qilu Hospital of Shandong University, Jinan
| | - Bo Cheng
- Medical College of Qingdao University, Qingdao
| | - Effat Un Nesa
- Department of Radiation Oncology, Qilu Hospital of Shandong University, Jinan
| | - Yuan Liu
- Department of Radiation Oncology, Qilu Hospital of Shandong University, Jinan
| | - Yibin Jia
- Department of Radiation Oncology, Qilu Hospital of Shandong University, Jinan
| | - Yan Qu
- Department of Radiation Oncology, Qilu Hospital of Shandong University, Jinan
| | - Ziying Jiang
- Department of Radiation Oncology, Qilu Hospital of Shandong University, Jinan
| | - Jie Han
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong University, Jinan, People's Republic of China
| | - Yufeng Cheng
- Department of Radiation Oncology, Qilu Hospital of Shandong University, Jinan
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Xu HJ, Ma Y, Deng F, Ju WB, Sun XY, Wang H. The prognostic value of C-reactive protein/albumin ratio in human malignancies: an updated meta-analysis. Onco Targets Ther 2017; 10:3059-3070. [PMID: 28790840 PMCID: PMC5488759 DOI: 10.2147/ott.s137002] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Purpose This study aims to investigate the prognostic value of pretreatment C-reactive protein/albumin ratio (CAR) in human malignancies by an updated meta-analysis. Methods PubMed, Web of Science, Cochrane Library and Wanfang databases were searched. Pooled hazard ratios (HRs) and odds ratios (ORs) with their corresponding 95% confidence intervals (CIs) were used as effective values. Results A total of 25 studies with 12,097 patients were included in this meta-analysis. Pooled results showed that high pretreatment CAR was associated with poor overall survival (OS) (HR =1.99, 95% CI: 1.65–2.40, P=0.000) and poor disease-free survival (HR =1.55, 95% CI: 1.34–1.79, P=0.000). In addition, high pretreatment CAR was associated with increased 5-year mortality (OR =2.74, 95% CI: 2.11–3.55, P=0.000). Moreover, subgroup analysis demonstrated that high CAR was associated with poor OS despite variations in publication year, country, sample size, CAR cut-off value and treatment. However, high CAR was associated with poor OS in human malignancies except colorectal cancer (HR =1.64, 95% CI: 0.96–2.80, P=0.069). Conclusion High pretreatment CAR indicates poor prognosis in human malignancies except colorectal cancer. Thus, pretreatment CAR serves as a prognostic marker in human malignancies and could be used in the evaluation of prognosis in clinical work.
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Affiliation(s)
- Hong-Jun Xu
- Department of Gastroenterology, Affiliated Hospital of Beihua University, Jilin, Jilin province, China
| | - Yan Ma
- Department of Gastroenterology, Affiliated Hospital of Beihua University, Jilin, Jilin province, China
| | - Fang Deng
- Department of Gastroenterology, Affiliated Hospital of Beihua University, Jilin, Jilin province, China
| | - Wen-Bo Ju
- Department of Gastroenterology, Affiliated Hospital of Beihua University, Jilin, Jilin province, China
| | - Xin-Yi Sun
- Department of Gastroenterology, Affiliated Hospital of Beihua University, Jilin, Jilin province, China
| | - Hua Wang
- Department of Gastroenterology, Affiliated Hospital of Beihua University, Jilin, Jilin province, China
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Cui J, Yu M, Zhang N, Wang S, Zhu Y, Chen S, Zhu K, Du J, Zhao H, Liu X, Chen P, Wang W, Zhang D, Shi B. Prognostic scores based on the preoperative plasma fibrinogen and serum albumin level as a prognostic factor in patients with upper urinary tract urothelial carcinoma. Oncotarget 2017; 8:68964-68973. [PMID: 28978171 PMCID: PMC5620311 DOI: 10.18632/oncotarget.16483] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 03/15/2017] [Indexed: 01/12/2023] Open
Abstract
This study is to clarify the prognostic value of preoperative plasma fibrinogen and serum albumin level, as known as FA score, in a cohort of Chinese patients with upper urinary tract urothelial carcinoma (UTUC). We retrospectively evaluated clinicopathological data on 169 patients who underwent surgery between 2006 and 2013. The FA score was calculated based on cutoff values of 3.53g/L for fibrinogen and 43.56 g/L for albumin. Overall survival and cancer specific survival was assessed using the Kaplan-Meier method and the equivalences of the curves were tested by log-rank tests. The Cox proportional hazards regression model was applied in univariate and multivariate analyses. In univariate analysis, tumor size, tumor grade, pathological T stage and FA score were significantly associated with overall survival and cancer specific survival, and multivariate Cox proportional hazards regression analysis identified FA score (score 1: HR=3.486, 95%CI 1.358-8.948, p=0.009; HR=3.485, 95%CI 1.363-8.913, p=0.009, respectively; score 2: HR=5.509, 95%CI 2.144-14.158, p<0.001; HR=5.521, 95%CI 2.074-14.697, p=0.001, respectively) was an independent predictor for overall survival and cancer specific survival. The evaluation of preoperative FA score can be regarded as an independent prognostic factor for predicting overall survival and cancer specific survival in UTUC. The fibrinogen and albumin levels are low cost and easy accessibility in clinical practice.
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Affiliation(s)
- Jianfeng Cui
- Department of Urology, Qilu Hospital of Shandong University, Jinan, P.R. China
| | - Meng Yu
- Department of Urology, Qilu Hospital of Shandong University, Jinan, P.R. China
| | - Ning Zhang
- Department of Urology, Qilu Hospital of Shandong University, Jinan, P.R. China
| | - Shiyu Wang
- Department of Urology, Qilu Hospital of Shandong University, Jinan, P.R. China
| | - Yaofeng Zhu
- Department of Urology, Qilu Hospital of Shandong University, Jinan, P.R. China
| | - Shouzhen Chen
- Department of Urology, Qilu Hospital of Shandong University, Jinan, P.R. China
| | - Kejia Zhu
- Department of Urology, Qilu Hospital of Shandong University, Jinan, P.R. China
| | - Jian Du
- Department of Urology, Qilu Hospital of Shandong University, Jinan, P.R. China
| | - Hongda Zhao
- Department of Urology, Qilu Hospital of Shandong University, Jinan, P.R. China
| | - Xigao Liu
- Department of Urology, Qilu Hospital of Shandong University, Jinan, P.R. China
| | - Pengxiang Chen
- Department of Radiation Oncology, Qilu Hospital, Shandong University, Jinan, P.R. China
| | - Wenbo Wang
- School of Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China
| | - Dongqing Zhang
- Department of Urology, Qilu Hospital of Shandong University, Jinan, P.R. China
| | - Benkang Shi
- Department of Urology, Qilu Hospital of Shandong University, Jinan, P.R. China
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Sun X, Wang J, Liu J, Chen S, Liu X. Albumin concentrations plus neutrophil lymphocyte ratios for predicting overall survival after curative resection for gastric cancer. Onco Targets Ther 2016; 9:4661-9. [PMID: 27536130 PMCID: PMC4973773 DOI: 10.2147/ott.s108631] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background In patients with gastric cancer (GC), survival is poor, given the late diagnosis. Risk-stratifying these patients earlier could help improve care. We determined whether combining preoperative albumin concentration and the neutrophil lymphocyte ratio (COA-NLR) could predict overall survival (OS) better than other prognostic indexes. Methods We calculated the COA-NLR and other prognostic indexes with data obtained within 1 week before surgery in a retrospective analysis of patients with GC undergoing curative resection between September 2000 and November 2012. Patients with concentrations of hypoalbuminemia above 35 g/L and an NLR value of 2.3 or higher were given a score of 2. Patients with one of these conditions or neither were allocated scores of 1 or 0, respectively. Patients were monitored until July 2014. Results OS in the 873 eligible patients was 44.9% in patients with a COA-NLR score of 0, 29.8% in patients with a score of 1, and 20.3% in patients with a score of 2 (P<0.001). The COA-NLR score was independently associated with OS (hazard ratio, 1.35; 95% confidence interval, 1.12 to 1.63; P=0.002). Moreover, the area under the receiver operating characteristics curve was 0.62 for the COA-NLR, which was significantly higher (<0.001) than that of the NLR ratio (0.60), the Glasgow prognostic score (0.58), and the platelet lymphocyte ratio (0.54). The COA-NLR was especially accurate for patients with stage I–II GC and the three values (0, 1, and 2) divided patients into subgroups more accurately than did the other indexes (area under the curve value: 0.66, P<0.001). Conclusion The preoperative COA-NLR index is useful for predicting postoperative OS in patients with GC and can be used to guide targeted therapy.
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Affiliation(s)
- Xiaowei Sun
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine; Department of Gastric and Pancreatic Surgery
| | - Juncheng Wang
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine; Department of Hepatobiliary Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China
| | - Jianjun Liu
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine; Department of Gastric and Pancreatic Surgery
| | - Shangxiang Chen
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine; Department of Gastric and Pancreatic Surgery
| | - Xuechao Liu
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine; Department of Gastric and Pancreatic Surgery
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Tanriverdi O, Avci N, Oktay E, Kalemci S, Pilanci KN, Cokmert S, Menekse S, Kocar M, Sen CA, Akman T, Ordu C, Goksel G, Meydan N, Barutca S. Pretreatment Serum Albumin Level is an Independent Prognostic Factor in Patients with Stage IIIB Non-Small Cell Lung Cancer: A Study of the Turkish Descriptive Oncological Researches Group. Asian Pac J Cancer Prev 2016; 16:5971-6. [PMID: 26320482 DOI: 10.7314/apjcp.2015.16.14.5971] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Several prognostic factors have been studied in NSCLC, although it is unknown which is most useful. In this study, we aimed to investigate whether pre-treatment serum albumin level has prognostic value in patients with Stage IIIB NSCLC. MATERIALS AND METHODS This cross-sectional study included a total of 204 patients with Stage IIIB NSCLC who met the inclusion criteria. Pre-treatment serum albumin levels and demographic, clinical, and histological characteristics, as well as laboratory variables were recorded. A cut-off value was defined for serum albumin level and the patients were stratified into four groups on thios basis. RESULTS The majority of the patients was males and smokers, with a history of weight loss, and squamous histological type of lung cancer. The mean serum albumin level was 3.2±1.7 g/dL (range, 2.11-4.36 g/dL). A cut-off value 3.11 g/dL was set and among the patients with a lower level, 68% had adenocarcinoma and 82% were smokers. The patients with low serum albumin levels had a lower response rate to e first-line chemotherapy with a shorter progression-free survival and overall survival. Multivariate analysis showed that low serum albumin level was an independent poor prognostic factor for NSCLC. CONCLUSIONS This study results suggest that low serum albumin level is an independent poor prognostic factor in patients with Stage IIIB NSCLC, associated with reduction in the response rate to first-line therapy and survival rates.
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Affiliation(s)
- Ozgur Tanriverdi
- Department of Medical Oncology, Sitki Kocman University Faculty of Medicine, Mugla, Turkey E-mail :
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Yuksel OH, Akan S, Urkmez A, Yildirim C, Sahin A, Verit A. Preoperative Glasgow prognostic score as a predictor of primary bladder cancer recurrence. Mol Clin Oncol 2016; 5:201-206. [PMID: 27330798 DOI: 10.3892/mco.2016.901] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 04/27/2016] [Indexed: 11/06/2022] Open
Abstract
The correlation between systemic inflammatory markers and malignancies has been assessed by a number of recent studies. The aim of this study was to prospectively assess preoperative inflammation markers and Glasgow prognostic scores (GPS) in patients who underwent surgery for primary bladder cancer (BC), and evaluate the predictive value of GPS for disease recurrence and progression. A total of 38 patients (mean age, 60.16±9.71 years; range, 33-76 years) who were treated in our department between May, 2014 and August, 2015 were enrolled in the present study. Preoperatively, patient information regarding gender, body mass index, serum C-reactive protein (CRP) and albumin levels, GPS and comorbidities, were collected and recorded. Transurethral resection of the bladder was performed, followed by histopathological evaluation of the resected material. The tumor size, stage and grade and the presence of necrosis were determined. According to the international TNM classification, the results of the histopathological analysis were as follows: Ta low- (n=24) and high-grade (n=4); and T1 low- (n=2) and high-grade (n=8). The median follow-up period was 10.1 months (range, 6-12 months). During this period, recurrence was observed in 10 cases and disease progression was detected in 1 patient. Hypoalbuminemia was encountered in 40% of the cases with recurrence, which was significantly higher compared with that in patients without recurrence (7.1%; P=0.031). In patients who had recurrence, a GPS of 1-2 points and tumor necrosis were more frequently detected compared with those without recurrence (60 vs. 7.1%, P=0.002; and 80 vs. 7.1%, P=0.001, respectively). Excluding a cystectomized case with a diagnosis of muscle-invasive BC, disease progression was not detected in any of the cases with recurrence during follow-up. Therefore, we consider that GPS and serum markers of systemic inflammatory response may be used as predictors of recurrence in patients with transitional cell BC.
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Affiliation(s)
- Ozgur Haki Yuksel
- Department of Urology, Fatih Sultan Mehmet Research and Training Hospital, TR-34752 Istanbul, Turkey
| | - Serkan Akan
- Department of Urology, Fatih Sultan Mehmet Research and Training Hospital, TR-34752 Istanbul, Turkey
| | - Ahmet Urkmez
- Department of Urology, Haydarpasa Numune Research and Training Hospital, TR-34668 Istanbul, Turkey
| | - Caglar Yildirim
- Department of Urology, Fatih Sultan Mehmet Research and Training Hospital, TR-34752 Istanbul, Turkey
| | - Aytac Sahin
- Department of Urology, Fatih Sultan Mehmet Research and Training Hospital, TR-34752 Istanbul, Turkey
| | - Ayhan Verit
- Department of Urology, Fatih Sultan Mehmet Research and Training Hospital, TR-34752 Istanbul, Turkey
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Systemic Inflammatory Response Based on Neutrophil-to-Lymphocyte Ratio as a Prognostic Marker in Bladder Cancer. DISEASE MARKERS 2016; 2016:8345286. [PMID: 26880857 PMCID: PMC4736380 DOI: 10.1155/2016/8345286] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 11/04/2015] [Indexed: 12/18/2022]
Abstract
A growing body of evidence suggests that systemic inflammatory response (SIR) in the tumor microenvironment is closely related to poor oncologic outcomes in cancer patients. Over the past decade, several SIR-related hematological factors have been extensively investigated in an effort to risk-stratify cancer patients to improve treatment selection and to predict posttreatment survival outcomes in various types of cancers. In particular, one readily available marker of SIR is neutrophil-to-lymphocyte ratio (NLR), which can easily be measured on the basis of absolute neutrophils and absolute lymphocytes in a differential white blood cell count performed in the clinical setting. Many investigators have vigorously assessed NLR as a potential prognostic biomarker predicting pathological and survival outcomes in patients with urothelial carcinoma (UC) of the bladder. In this paper, we aim to present the prognostic role of NLR in patients with UC of the bladder through a thorough review of the literature.
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Zhang B, Yu W, Zhou LQ, He ZS, Shen C, He Q, Li J, Liu LB, Wang C, Chen XY, Fan Y, Hu S, Zhang L, Han WK, Jin J. Prognostic Significance of Preoperative Albumin-Globulin Ratio in Patients with Upper Tract Urothelial Carcinoma. PLoS One 2015; 10:e0144961. [PMID: 26681341 PMCID: PMC4682975 DOI: 10.1371/journal.pone.0144961] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 11/25/2015] [Indexed: 12/24/2022] Open
Abstract
Background Preoperative albumin-globulin ratio (AGR) reflects both malnutrition and systemic inflammation in cancer patients. In particular, systemic inflammation has been reported to contribute to tumor progression and poor oncological outcome in various malignancies. However, the prognostic value of preoperative AGR in upper tract urothelial carcinoma (UTUC) has not been examined. Methods We retrospectively reviewed medical data of 187 operable UTUC patients in a Chinese cohort with a high incidence of chronic kidney disease (CKD). AGR was calculated as [AGR = albumin/(serum total protein—albumin)]. The associations of preoperative AGR with clinicopathologic characteristics and prognosis were assessed. Multivariate analyses using Cox regression models were performed to determine the independent prognostic factors. Results The median (IQR) preoperative AGR was 1.50 (1.30–1.70), and the optimal cutoff value was determined to be 1.45 according to the receiver operating curve analysis. Low AGR was significantly associated with female gender, high CKD stage and tumor grade (P < 0.05). Eighty-three patients died before the follow-up endpoint. Kaplan-Meier analysis showed that an AGR < 1.45 predicted significantly poorer overall and cancer-specific survivals compared to an AGR ≥ 1.45 (P < 0.001 and P = 0.008, respectively). Multivariate analyses showed that an AGR < 1.45 was an independent risk factor for poorer overall and cancer-specific survivals (P = 0.002 and P = 0.015, respectively). Conclusions Preoperative AGR can act as an effective biomarker with easy accessibility for evaluating the prognosis of patients with UTUC. AGR should be applied in UTUC patients for risk stratification and determination of optimal therapeutic regimens.
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Affiliation(s)
- Bo Zhang
- Department of Urology, Peking University First Hospital, Beijing, People’s Republic of China
- Institute of Urology, Peking University, Beijing, People’s Republic of China
- National Urological Cancer Center, Beijing, People’s Republic of China
| | - Wei Yu
- Department of Urology, Peking University First Hospital, Beijing, People’s Republic of China
- Institute of Urology, Peking University, Beijing, People’s Republic of China
- National Urological Cancer Center, Beijing, People’s Republic of China
| | - Li-Qun Zhou
- Department of Urology, Peking University First Hospital, Beijing, People’s Republic of China
- Institute of Urology, Peking University, Beijing, People’s Republic of China
- National Urological Cancer Center, Beijing, People’s Republic of China
| | - Zhi-Song He
- Department of Urology, Peking University First Hospital, Beijing, People’s Republic of China
- Institute of Urology, Peking University, Beijing, People’s Republic of China
- National Urological Cancer Center, Beijing, People’s Republic of China
| | - Cheng Shen
- Department of Urology, Peking University First Hospital, Beijing, People’s Republic of China
- Institute of Urology, Peking University, Beijing, People’s Republic of China
- National Urological Cancer Center, Beijing, People’s Republic of China
| | - Qun He
- Department of Urology, Peking University First Hospital, Beijing, People’s Republic of China
- Institute of Urology, Peking University, Beijing, People’s Republic of China
- National Urological Cancer Center, Beijing, People’s Republic of China
| | - Jun Li
- Department of Urology, Peking University First Hospital, Beijing, People’s Republic of China
- Institute of Urology, Peking University, Beijing, People’s Republic of China
- National Urological Cancer Center, Beijing, People’s Republic of China
| | - Li-Bo Liu
- Department of Urology, Peking University First Hospital, Beijing, People’s Republic of China
- Institute of Urology, Peking University, Beijing, People’s Republic of China
- National Urological Cancer Center, Beijing, People’s Republic of China
| | - Cong Wang
- Peking University Health Science Center, Beijing, People’s Republic of China
| | - Xiao-Yu Chen
- Peking University Health Science Center, Beijing, People’s Republic of China
| | - Yu Fan
- Department of Urology, Peking University First Hospital, Beijing, People’s Republic of China
- Institute of Urology, Peking University, Beijing, People’s Republic of China
- National Urological Cancer Center, Beijing, People’s Republic of China
| | - Shuai Hu
- Department of Urology, Peking University First Hospital, Beijing, People’s Republic of China
- Institute of Urology, Peking University, Beijing, People’s Republic of China
- National Urological Cancer Center, Beijing, People’s Republic of China
| | - Lei Zhang
- Department of Urology, Peking University First Hospital, Beijing, People’s Republic of China
- Institute of Urology, Peking University, Beijing, People’s Republic of China
- National Urological Cancer Center, Beijing, People’s Republic of China
| | - Wen-Ke Han
- Department of Urology, Peking University First Hospital, Beijing, People’s Republic of China
- Institute of Urology, Peking University, Beijing, People’s Republic of China
- National Urological Cancer Center, Beijing, People’s Republic of China
- * E-mail: (WKH); (JJ)
| | - Jie Jin
- Department of Urology, Peking University First Hospital, Beijing, People’s Republic of China
- Institute of Urology, Peking University, Beijing, People’s Republic of China
- National Urological Cancer Center, Beijing, People’s Republic of China
- * E-mail: (WKH); (JJ)
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Wiwanitit V. Re: Preoperative serum albumin as a prognostic factor in patients with upper urinary tract urothelial carcinoma. Int Braz J Urol 2015; 41:822. [PMID: 26401881 PMCID: PMC4757017 DOI: 10.1590/s1677-5538.ibju.2015.0102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 06/10/2015] [Indexed: 12/02/2022] Open
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Kim M, Moon KC, Choi WS, Jeong CW, Kwak C, Kim HH, Ku JH. Prognostic value of systemic inflammatory responses in patients with upper urinary tract urothelial carcinoma. World J Urol 2015; 33:1439-57. [PMID: 25600022 DOI: 10.1007/s00345-015-1484-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 01/03/2015] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To determine the utility of systemic inflammatory response and develop a model based on serum inflammatory indices to aid prognostication in patients with upper urinary tract urothelial carcinoma (UTUC). METHODS The study population comprised 277 patients with non-metastatic UTUC who underwent nephroureterectomy between 1999 and 2010. Multivariate survival analysis was performed using Cox's proportional hazards model, and a new model was developed to predict recurrence-free (RFS) and disease-specific survival (DSS). The factors considered, in relation to systemic inflammatory responses, were as follows: albumin, white blood cell count, neutrophil count, lymphocyte count, red blood cell count, serum creatinine level, platelet count, prognostic nutritional index, platelet/lymphocyte ratio, neutrophil/lymphocyte ratio (NLR), and derived NLR. RESULTS The final model consisted of bladder cuffing, pathologic T stage, lymphovascular invasion, and derived NLR. The bootstrap-concordance indices of the model were 0.778 [95 confidence interval (CI) 0.730-0.826] for RFS and 0.802 (95 % CI 0.752-0.851) for DSS, respectively, and integrated area under the curve value for time to RFS and DSS for patients was 0.738 and 0.760, respectively. When we generated calibration curves, the nomograms were reasonably calibrated. CONCLUSIONS Derived NLR may be used in combination with conventional staging techniques and other clinicopathological parameters to improve the prediction of survival in patients with UTUC.
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Affiliation(s)
- Myong Kim
- Department of Urology, Seoul National University College of Medicine, Seoul, South Korea
| | - Kyung Chul Moon
- Department of Pathology, Seoul National University College of Medicine, Seoul, South Korea
| | - Woo Suk Choi
- 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. .,Department of Urology, Seoul National University Hospital, 101 Daehak-ro, Jongno-Gu, Seoul, 110-744, South Korea.
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