scholarly journals The hemoglobin, albumin, lymphocyte, and platelet (HALP) score as a prognostic marker for patients with upper tract urothelial carcinoma undergoing radical nephroureterectomy: a retrospective study from two centers

Author(s):  
Xiaomin Gao ◽  
Binwei Lin ◽  
Qi Lin ◽  
Tingyu Ye ◽  
Tao Zhou ◽  
...  

The combination of hemoglobin, albumin, lymphocyte, and platelet (HALP) score has been confirmed as an important risk biomarker in several cancers. Hence, we aimed at evaluating the prognostic value of the HALP score in patients with non-metastatic upper tract urothelial carcinoma (UTUC). We retrospectively enrolled 533 of the 640 patients from two centers (315 and 325 patients, respectively) who underwent radical nephroureterectomy (RNU) for UTUC in this study. The cutoff value of HALP was determined using the Youden index by performing receiver operating characteristic (ROC) curve analysis. The relationship between postoperative survival outcomes and preoperative HALP level was assessed using Kaplan-Meier analysis and Cox regression analysis. As a result, the cutoff value of HALP was 28.67 and patients were then divided into HALP<28.67 group and HALP≥28.67 group. Kaplan-Meier analysis and log-rank test revealed that HALP was significantly associated with overall survival (OS) (P<0.001) and progression-free survival (PFS) (P<0.001). Multivariate analysis demonstrated that lower HALP score was an independent risk factor for OS (HR=1.54, 95%CI, 1.14-2.01, P=0.006) and PFS (HR=1.44, 95%CI, 1.07-1.93, P=0.020). Nomograms of OS and PFS incorporated with HALP score were more accurate in predicting prognosis than without. In the subgroup analysis, the HALP score could also stratify patients with respect to survival under different pathologic T stages. Therefore, pretreatment HALP score was an independent prognostic factor of OS and PFS in UTUC patients undergoing RNU.

Author(s):  
Shicong Lai ◽  
Xingbo Long ◽  
Pengjie Wu ◽  
Jianyong Liu ◽  
Samuel Seery ◽  
...  

Abstract Objective To evaluate the role of Ki-67 in predicting subsequent intravesical recurrence following radical nephroureterectomy and to develop a predictive nomogram for upper tract urothelial carcinoma patients. Methods This retrospective analysis involved 489 upper tract urothelial carcinoma patients who underwent radical nephroureterectomy with bladder cuff excision. The data set was randomly split into a training cohort of 293 patients and a validation cohort of 196 patients. Immunohistochemical analysis was used to assess the immunoreactivity of the biomarker Ki-67 in the tumor tissues. A multivariable Cox regression model was utilized to identify independent intravesical recurrence predictors after radical nephroureterectomy before constructing a nomographic model. Predictive accuracy was quantified using time-dependent receiver operating characteristic curve. Decision curve analysis was performed to evaluate the clinical benefit of models. Results With a median follow-up of 54 months, intravesical recurrence developed in 28.2% of this sample (n = 137). Tumor location, multifocality, pathological T stage, surgical approach, bladder cancer history and Ki-67 expression levels were independently associated with intravesical recurrence (all P &lt; 0.05). The full model, which intercalated Ki-67 with traditional clinicopathological parameters, outperformed both the basic model and Xylinas’ model in terms of discriminative capacity (all P &lt; 0.05). Decision-making analysis suggests that the more comprehensive model can also improve patients’ net benefit. Conclusions This new model, which intercalates the Ki-67 biomarker with traditional clinicopathological factors, appears to be more sensitive than nomograms previously tested across mainland Chinese populations. The findings suggest that Ki-67 could be useful for determining risk-stratified surveillance protocols following radical nephroureterectomy and in generating an individualized strategy based around intravesical recurrence predictions.


2021 ◽  
Author(s):  
Tsu-Ming Chien ◽  
Ching-Chia Li ◽  
Yen-Man Lu ◽  
Hsueh-Wei Chang ◽  
Yii-Her Chou ◽  
...  

Abstract Background: Upper tract urothelial carcinoma (UTUC) is a relatively rare type of urothelial carcinoma. Additionally, only few reports have examined the sex differences in patients with UTUC. Therefore, the present study aimed to identify the sex factors affecting renal function in patients with UTUC.Methods: Patients who underwent radical nephroureterectomy for non-metastatic UTUC between 2000 and 2013 were retrospectively reviewed and divided into two groups by sex. The Kaplan–Meier method was applied to evaluate the effects of sex on survival, whereas for the other clinicopathological parameters, hazard ratios were evaluated using the Cox regression model. The analyses were also performed in patients with different chronic kidney disease (CKD) stages.Results: A total of 368 patients were included, 147 men and 221 women. Female patients had a higher rate of anemia, advanced CKD stage, and dialysis. Male patients predominantly had a higher rate of smoking. The Kaplan–Meier analysis revealed no differences between sexes on metastasis-free survival (MFS) and cancer-specific survival. Multivariate analysis confirmed that ureteral tumors, advanced pathological tumor stage, and adjuvant chemotherapy indicated significantly worse survival outcomes in both sexes. However, only female patients with advanced CKD showed poorer MFS. After adjusting for renal function, the analysis found men had worse MFS.Conclusions: The female sex is significantly associated with a higher prevalence of advanced CKD among patients with UTUC in Taiwan. The impact of sex differences on renal function needs to be considered when evaluating survival.


2018 ◽  
Vol 2018 ◽  
pp. 1-7
Author(s):  
Jianzhong Zhang ◽  
Feiya Yang ◽  
Mingshuai Wang ◽  
Yinong Niu ◽  
Weicheng Chen ◽  
...  

This study aimed to compare the oncological and renal outcomes of partial ureterectomy (PU) versus radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC). UTUC patients’ clinical information was reviewed, and progression-free survival (PFS), overall survival (OS), and kidney function were collected. The mean follow-up period was 59 (6–135) months in the RNU group and 34.5 (5–135) months in the PU group. The mean operation time in the PU group was 141 (64–340) min, which is significantly shorter than the RNU group (P<0.01). Regarding kidney function at one year or two years after operation, the PU group had significantly improved mean estimated glomerular filtration rate (eGFR) levels and a remarkably decreased constitution of patients with chronic kidney disease (CKD) III or higher group (P<0.05). There was no significant difference in PFS and OS between the RNU group and the PU group (P>0.05). Multifactor Cox regression analysis indicated that age and the preoperative CKD stages were independent risk factors for poor kidney functions of UTUC patients. Compared to patients in RNU group, patients in PU have no significant difference in survival time but have shorter operation time, shorter hospital stay, and improved kidney functions.


2021 ◽  
Author(s):  
Shicong Lai ◽  
Pengjie Wu ◽  
Shengjie Liu ◽  
Samuel Seery ◽  
Jianyong Liu ◽  
...  

Abstract Objective To assess the characteristics, predictive risk factors, and prognostic effect of secondary bladder cancer (BCa) following radical nephroureterectomy (RNU) in upper tract urothelial carcinoma (UTUC). Methods Using the Surveillance, Epidemiology, and End Results (SEER) database, the authors analyzed clinicopathologic characteristics and survival data from 472 UTUC patients with secondary BCa after RNU between 2004 and 2017. Cox’s proportional hazard regression model was implemented to identify independent predictors associated with post-recurrence outcomes. The threshold for statistical significance was p < 0.05. Results In total, 200 Ta-3N0M0 localized UTUC patients with complete data were finally included. With a median follow-up of 71 months (interquartile ranges [IQR] 36 -103.75 months), 52.5% (n = 105) had died, with 30.5% (n = 61) dying of UTUC. The median time interval from UTUC to BCa was 13.5 months (IQR 6–40.75 months). According to multivariable Cox regression analysis, patients with intravesical recurrence (IVR) located at multiple sites, advanced BCa stage, higher BCa grade, elderly age and a shorter recurrence time, encountered worse cancer-specific survival (CSS) (all p ༜0.05). Conclusions For primary UTUC patients experiencing IVR after radical surgery, advanced age, multiple IVR sites, shorter recurrence time, higher BCa stage, and grade proved to be significant independent prognostic factors of CSS. We ought to pay more attention to IVR prevention as well as to earlier signs which may increase the likelihood of early detection. Having the ability to manage what may be seen as the superficial BCa signs may enable us to improve survival but further research is required.


2019 ◽  
Author(s):  
Huamao Ye ◽  
Xiang Feng ◽  
Yang Wang ◽  
Rui Chen ◽  
Meimian Hua ◽  
...  

Abstract Background: The effect of diagnostic ureteroscopy (DURS) on intravesical recurrence (IVR) after radical nephroureterectomy (RNU) were controversial. To investigate the impact of DURS, we carried out this single-center retrospective study by applying propensity-score matching (PSM) and Cox regression model. Patients and Methods: The data of 160 patients with pTa-pT3 upper tract urothelial carcinoma (UTUC) were analyzed. Eighty-six patients underwent DURS (DURS group) and 74 patients without DURS (control group). The DURS group was further sub-grouped into synchronous DURS group (DURS followed by immediate RNU, n=45) and non-synchronous DURS group (DURS followed by delayed RNU, n=41). Baseline confounders were corrected by PSM. The impact of DURS on IVR was assessed by Kaplan-Meier analysis in PSM cohort and by Cox regression model in the full data set. Results: The median follow-up time was 40.4 months. No difference of the 3-year IVRFS between DURS group and control group (72.6% vs. 65.3%, p=0.263). In subgroup analysis, the 3-year IVR-free survival of non-synchronous DURS group (51.4%) was significantly lower than that of synchronous DURS (78.3%) or control group (72.6%) (p=0.027). Further Cox regression analysis showed that non-synchronous DURS (HR 1.481, 95% CI 1.031-2.127, p=0.034) was independent risk factors for postoperative IVR. Conclusions: Non-synchronous DURS was not recommended for the diagnosis and preoperative evaluation of UTUC, because it could raise the risk of IVR after RNU. For UTUC patients in need of DURS, synchronous DURS could be a safer choice than the non-synchronous DURS in terms of lowering the IVR risk.


2019 ◽  
Vol 37 (7_suppl) ◽  
pp. 452-452
Author(s):  
Hang Xu ◽  
Ping Tan ◽  
Lu Yang ◽  
Qiang Wei

452 Background: Metabolic syndrome (MetS) has been reported to be associated with poor survival outcomes in cancer patients. However, the role of MetS in upper tract urothelial carcinoma (UTUC) has yet to be explored. We aim to investigate the prognostic value of MetS in UTUC after radical nephroureterectomy (RNU). Methods: A total of 644 patients with UTUC after RNU were identified at West China Hospital from May 2003 to December 2016. MetS was defined as the co-existence of three or more of five components (obesity, hypertension, elevated fasting glucose, decreased high-density lipoprotein-cholesterol and hypertriglyceridemia). Logistic and Cox regression analyses was performed to evaluate the associations of MetS with pathological features and survival outcomes. Decision curve analysis was performed to determine the clinical utility of the prediction models. Results: Of 644 patients, 157 (24.4%) had MetS. Over a median follow-up of 39 months, 269 (41.8%) experienced disease recurrence, 233 (36.2%) died and 185 (28.7%) died of UTUC. MetS was independently associated with high-grade disease (odds ratio [OR]: 2.01, P = 0.005), advanced pT stage (≥ pT3, OR: 1.54, P = 0.027) and lymphovascular invasion (OR: 1.71, P = 0.03). Multivariate Cox regression analysis showed that MetS was an independent factor for decreased cancer-specific survival (CSS, HR: 1.38, 95% CI: 1.01-1.89, P = 0.042) but not for RFS (HR: 1.27, 95% CI: 0.97-1.67, P = 0.078) and OS (HR: 1.24, 95% CI: 0.95-1.62, P = 0.121). The estimated c-index of the multivariate models for CSS was 0.763 compared with 0.769 when MetS added. Conclusions: MetS is a negative prognostic factor in UTUC. Further studies of MetS in UTUC are demanded.


2017 ◽  
Vol 12 (3) ◽  
pp. E132-6 ◽  
Author(s):  
Tadatsugu Anno ◽  
Eiji Kikuchi ◽  
Keishiro Fukumoto ◽  
Koichiro Ogihara ◽  
Mototsugu Oya

Introduction: Sarcopenia is a novel concept representing skeletal muscle wasting and has been identified as a prognostic factor for several cancers. The aims of this study were to evaluate the prognostic significance of sarcopenia and the relationship between sarcopenia and poor pathological findings in upper tract urothelial carcinoma (UTUC) patients who underwent radical nephroureterectomy (RNU).Methods: We identified 123 UTUC patients who underwent RNU between 2003 and 2014.We assessed sarcopenia by measuring the area of skeletal muscle at the third lumber vertebra on preoperative computed tomography scans. Sarcopenia was classified based on a sex-specific consensus definition. We investigated whether sarcopenia predicts clinical outcomes such as cancer death and poor pathological findings at RNU.Results: A total of 40.7% of patients (n=50) had sarcopenia. In a multivariate Cox regression analysis, sarcopenia was not associated with cancer-specific survival (CSS), and lymphovascular invasion (LVI) (hazard ratio 5.88; p=0.002) was the only independent risk factor for CSS. A multivariate logistic regression analysis showed that sarcopenia independently correlated with the LVI status (odds ratio 2.36; p=0.025). LVI was positive in 27 out of 50 (54%) and 25 out of 73 (34%) patients with and without sarcopenia, respectively (p=0.029).Conclusions: Preoperative sarcopenia predicted the LVI status, which was a strong prognostic factor for UTUC patients after RNU.


2017 ◽  
Vol 35 (6_suppl) ◽  
pp. 305-305
Author(s):  
Ross Erik Krasnow ◽  
Thomas Seisen ◽  
Joaquim Bellmunt ◽  
Morgan Roupret ◽  
Jeffrey J. Leow ◽  
...  

305 Background: There is limited evidence supporting the use of adjuvant chemotherapy (AC) after radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC). Against this backdrop, we hypothesized that such treatment is associated with an overall survival (OS) benefit in patients with locally advanced and/or positive regional lymph node disease. Methods: Within the National Cancer Data Base (2004-2012), we identified 3,253 individuals who received AC or observation after RNU for pT3/T4 and/or pN+ UTUC. Inverse probability of treatment weighting (IPTW)-adjusted Kaplan-Meier curves and Cox regression analyses were used to compare OS of patients in the two treatment groups. Additionally, we performed exploratory analyses of treatment effect according to age, gender, Charlson comorbidity index, pathological stage (pT3/T4N0, pT3/T4Nx and pTanyN+) and surgical margin status. Results: Overall, 762 (23.42%) and 2,491 (76.58%) patients with pT3/T4 and/or pN+ UTUC received AC and observation after RNU, respectively. IPTW-adjusted Kaplan-Meier curves showed that median OS was significantly longer for AC vs. observation (47.41 [IQR, 19.88-112.39] vs. 35.78 [IQR, 14.09-99.22] months; P< 0.001). The 5-year IPTW-adjusted rates of OS for AC vs. observation were 43.90% vs. 35.85%, respectively. In IPTW-adjusted Cox regression analysis, AC was associated with a significant OS benefit (HR = 0.77; 95% CI = [0.68-0.88]; P< 0.001). This benefit was consistent across all subgroups examined (all P< 0.05) and no significant heterogeneity of treatment effect was observed (all Pinteraction> 0.05). The 3-month conditional landmark IPTW-adjusted analysis demonstrated little impact of immortal time bias (HR = 0.79; 95% CI = [0.70-0.91]; P = 0.001). Conclusions: We report an OS benefit in patients who received AC vs. observation after RNU for pT3/T4 and/or pN+ UTUC. Although our results are limited by the usual biases related to the observational study design, we believe that the present findings should be considered when advising post-RNU management of advanced UTUC, pending level I evidence.


2021 ◽  
Vol 10 (13) ◽  
pp. 2983
Author(s):  
Kun-Che Lin ◽  
Hau-Chern Jan ◽  
Che-Yuan Hu ◽  
Yin-Chien Ou ◽  
Yao-Lin Kao ◽  
...  

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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