The impact of preoperative blood-based inflammation markers and tumor size on oncologic outcomes in patients with upper tract urothelial carcinoma

Previous studies have reached diverse conclusions about the influence of tumor size on the oncologic outcomes in patients with upper tract urothelial carcinoma (UTUC). In this study, we retrospectively analyzed the records of 687 patients and evaluated how tumor size affected the prognosis of patients with UTUC after surgery. Clinicopathologic characteristics and oncological outcomes were compared according to tumor size (≤3 cm versus >3 cm). During a median follow-up period of 65 months (range 3–144 months), 225 patients (32.8%) died from UTUC and 228 patients (33.2%) experienced intravesical recurrence (IVR). Patients with a larger tumor size tended to have a significantly higher percentage of being male (p=0.011), tobacco consumption (p=0.036), lack of preoperative ureteroscopy history (p=0.003), renal pelvic location (p<0.001), tumor necrosis (p=0.003), advanced tumor stage (p<0.001), higher tumor grade (p=0.003), and lymph node metastasis (p=0.018). Univariate analysis revealed that a tumor size >3 cm was significantly associated with worse cancer-specific survival (p=0.002) and IVR (p=0.011). However, the influence was not statistically significant after controlling for other factors in the multivariate analysis (hazard ratio [HR] 1.124, p=0.414 and HR 1.196, p=0.219). In conclusion, UTUC patients with a larger tumor present aggressive biological characteristics and tend to have a worse prognosis.

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Impact of perioperative blood transfusion on oncologic outcomes in patients treated with radical nephroureterectomy for upper tract urothelial carcinoma.

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.7_suppl.358 ◽

2015 ◽

Vol 33 (7_suppl) ◽

pp. 358-358

Author(s):

Aditya Bagrodia ◽

Samuel D. Kaffenberger ◽

Michael J Vacchio ◽

Katie S Murray ◽

Andrew G. Winer ◽

...

Keyword(s):

Lymph Node ◽

Blood Transfusion ◽

Urothelial Carcinoma ◽

Upper Tract Urothelial Carcinoma ◽

Oncologic Outcomes ◽

Radical Nephroureterectomy ◽

Upper Tract ◽

T Stage ◽

The Impact ◽

Perioperative Blood Transfusion

358 Background: Patients treated for urothelial carcinoma of the urinary bladder treated with radical cystectomy and pelvic lymph node dissection have worse clinical outcomes if they receive perioperative blood transfusion. We evaluated the impact of perioperative blood transfusion on oncologic outcomes in patients with upper tract urothelial carcinoma (UTUC) treated with radical nephroureterectomy (RNU). Methods: We conducted a single-center, retrospective review of 405 patients treated with RNU for UTUC. Clinicopathologic characteristics were recorded. Hospital charts were reviewed to determine if patients received perioperative blood transfusion. Characteristics were compared between groups based on transfusion status using Chi-square analyses. Survival was assessed using the Kaplan-Meier method. Cox regression analysis addressed cancer-specific mortality (CSM). Results: Median age was 71.4 years (IQR 63.7-76.5) and the majority of patients were male (64%). Median follow up was 43.4 months (IQR 16.7-86.6). CSM occurred in 26.2% of patients. Perioperative transfusion was associated with higher rates of invasive T stage (>/=T2), (62% vs. 47%, p=0.019) and lymph node positive disease (23% vs. 10.3%, p=0.029). Three year disease-specific survival (DSS) was 80% for the entire cohort. DSS was significantly shorter (p=0.003) for patients receiving transfusion (66.3%, 95% CI 53.7%-76.3%) than those who did not (83.3%, 95% CI 78.3%-87.3%). Transfusion was an independent predictor of CSM on multivariable analysis including gender, grade, invasive T stage, nodal status, and transfusion (Table 1). Conclusions: Perioperative blood transfusion may be associated with adverse pathologic and oncologic outcomes in patients undergoing RNU for UTUC. [Table: see text]

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Tumor Necrosis with Adjunction of Preoperative Monocyte-to-Lymphocyte Ratio as a New Risk Stratification Marker Can Independently Predict Poor Outcomes in Upper Tract Urothelial Carcinoma

Journal of Clinical Medicine ◽

10.3390/jcm10132983 ◽

2021 ◽

Vol 10 (13) ◽

pp. 2983

Author(s):

Kun-Che Lin ◽

Hau-Chern Jan ◽

Che-Yuan Hu ◽

Yin-Chien Ou ◽

Yao-Lin Kao ◽

...

Keyword(s):

Urothelial Carcinoma ◽

Tumor Necrosis ◽

Roc Analysis ◽

Upper Tract Urothelial Carcinoma ◽

Postoperative Treatment ◽

Rank Test ◽

Prognostic Impact ◽

Lymphocyte Ratio ◽

Upper Tract ◽

The Impact

Objectives: This study aimed at investigating the prognostic impact of tumor necrosis and preoperative monocyte-to-lymphocyte ratio (MLR) in patients treated with radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC). Methods: A total of 521 patients with UTUC treated with RNU from January 2008 to June 2019 at our institution were enrolled. Histological tumor necrosis was defined as the presence of microscopic coagulative necrosis. The optimal value of MLR was determined as 0.4 by receiver operating characteristic (ROC) analysis based on cancer-specific mortality. The Kaplan–Meier method with log-rank test and Cox proportional hazards regression models were performed to evaluate the impact of tumor necrosis and MLR on overall (OS), cancer-specific (CSS), and recurrence-free survival (RFS). Furthermore, ROC analysis was used to estimate the predictive ability of potential prognostic factors for oncological outcomes. Results: Tumor necrosis was present in 106 patients (20%), which was significantly associated with tumor location, high pathological tumor stage, lymph node metastasis, high tumor grade, lymphovascular invasion, tumor size, and increased monocyte counts. On multivariate analysis, the combination of tumor necrosis and preoperative MLR was an independent prognosticator of OS, CSS, and RFS (all p < 0.05). Moreover, ROC analyses revealed the predictive accuracy of a combination of tumor necrosis and preoperative MLR for OS, CSS, and RFS with the area under the ROC curve of 0.745, 0.810, and 0.782, respectively (all p < 0.001). Conclusions: The combination of tumor necrosis and preoperative MLR can be used as an independent prognosticator in patients with UTUC after RNU. The identification of this combination could help physicians to recognize high-risk patients with unfavorable outcomes and devise more appropriate postoperative treatment plans.

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Trends of lymphadenectomy in upper tract urothelial carcinoma patients treated with radical nephroureterectomy: The impact of surgical technique

European Urology Supplements ◽

10.1016/s1569-9056(17)31211-3 ◽

2017 ◽

Vol 16 (3) ◽

pp. e2021-e2022

Author(s):

M. Moschini ◽

T. Seisen ◽

M. Roupret ◽

P. Colin ◽

A. De La Taille ◽

...

Keyword(s):

Surgical Technique ◽

Urothelial Carcinoma ◽

Upper Tract Urothelial Carcinoma ◽

Radical Nephroureterectomy ◽

Upper Tract ◽

The Impact

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Metabolic Syndrome and Risk of Upper Tract Urothelial Carcinoma: A Case-Control Study From Surveillance, Epidemiology and End Results-Medicare-Linked Database

Frontiers in Oncology ◽

10.3389/fonc.2020.613366 ◽

2021 ◽

Vol 10 ◽

Author(s):

Yi Lu ◽

Wei Zhang ◽

Shujun Fan ◽

Zhen Liang ◽

Zhongjia Li ◽

...

Keyword(s):

Metabolic Syndrome ◽

Urothelial Carcinoma ◽

Tumor Size ◽

Significant Risk ◽

Upper Tract Urothelial Carcinoma ◽

Central Adiposity ◽

Upper Tract ◽

Tumor Stages ◽

Diagnosis Date ◽

End Results

BackgroundMetabolic syndrome (MetS) and its components are associated with increased risks of several cancers. However, the relationship between MetS and upper tract urothelial carcinoma (UTUC) has never been investigated before.MethodsWe identified 3,785 UTUC cases aged over 65 years old within the Surveillance, Epidemiology and End Results-Medicare database between 2007 and 2016. For comparison, non-cancer controls (n = 189,953) were selected from the 5% random sample of individuals residing within regions of SEER registries and matched with cases through diagnosis date and pseudo-diagnosis date. MetS and its components were all defined by using ICD-9-CM codes. Multivariate logistic regression models were conducted to calculate odds ratios (ORs) and 95% confidence intervals (CIs). Time trends for MetS and its components were reported and we also performed dose-response effect analysis to test the concomitant effect of these components. The study was presented following the STROBE reporting checklist.ResultsUTUC risk was associated with metabolic syndrome (NCEP-III: OR: 1.669, 95% CI: 1.550–1.792; IDF: OR: 1.924, 95% CI: 1.676–2.172) and its component factors: elevated waist circumference/central adiposity (OR: 1.872, 95% CI: 1.693–2.055), impaired fasting glucose (OR: 1.306, 95% CI: 1.133–1.480), high blood pressure (OR: 1.295, 95% CI: 1.239–1.353), high triglycerides (OR: 1.280, 95% CI: 1.222–1.341), and low high-density lipoprotein cholesterol (OR: 1.354, 95% CI: 1.118–1.592). Consistent associations could also be observed in the subgroup analyses by tumor stages, grades, and tumor size. Additionally, the rates of MetS increased over time in both UTUC and control cohort (NCEP-III criterion; EAPC: +18.1%, P <0.001; EAPC: +16.1%, P <0.001, respectively). A significantly gradual increase in UTUC rates could be seen as the No. of the MetS components increase (χ² = 37.239, Ptrend = 0.000).ConclusionsAmong people aged over 65, MetS and its components were significant risk factors for UTUC with consistent associations in different tumor stages, grades, and tumor size. Even if a subject who did not meet the criteria for MetS had only one of the components, he (she) still had an elevated risk for UTUC. Strategies to control the epidemic of MetS and its components might contribute to a reduction in the UTUC burden. The findings should be considered tentative until ascertained by more researches.

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