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KMID : 1001020230210020174
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Journal of Urologic Oncology
2023 Volume.21 No. 2 p.174 ~ p.180
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The Predictive Value of the Preoperative Systemic Inflammatory Response Indices in Non-Organ-Confined Disease in Upper Urinary Tract Urothelial Carcinoma
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Choi Sung-Kyung
Gwak Chan-Hoon
Suh Jun-Gyo
Lim Bum-Jin
Song Che-Ryn
You Dal-San
Jeong In-Gab
Hong Jun-Hyuk
Hong Bum-Sik
Kim Choung-Soo
Ahn Han-Jong
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Abstract
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Purpose : This study aims to evaluate the systemic inflammatory response indices (SII) for the prediction of the non-organ-confined (non-OC) disease in upper urinary tract urothelial carcinoma (UTUC) patients.
Materials and Methods : From March 2010 to March 2020, patients who underwent radical nephroureterectomy (RNU) in a single tertiary center were retrospectively reviewed. Tumor location, multifocality, hydronephrosis on preoperative imaging, and preoperative SII, including C-reactive protein-to-albumin ratio (CAR), neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio (PLR) were used for analysis. Non-OC defined by locally advanced (pT3-4) or node-positive disease (pN1-2) in pathologic examination. Multivariable logistic regression was used for determining independent predictive markers of non-OC disease. Factors associated with locally advanced (pT3-4), and node-positive (pN1-2) disease were also analyzed.
Results : Overall, 711 UTUC patients who underwent RNU, without neoadjuvant chemotherapy, were analyzed. The average age was 68.6±9.9 years and 507 patients were male. Non-OC disease was 36.8% (262 of 711); specifically, 35.9% (255 of 711) was locally advanced and 7.2% (51 of 771) was node-positive disease. Multivariable analysis demonstrated hydronephrosis (odds ratio [OR], 1.46; 95%confidence interval [CI], 1.06-2.01; p=0.02), high PLR (OR, 1.45; 95% CI, 1.05-2.01; p=0.03), and high CAR (OR, 2.56; 95% CI, 1.79-3.66; p<0.01) were independent predictive markers non-OC disease. Hydronephrosis (p=0.01), high PLR (p=0.02), and high CAR (p<0.01) were predictive markers for locally advanced disease, and multifocal tumor (p<0.01) and high CAR (p<0.01) were predictive markers for node-positive disease.
Conclusions : CAR is a novel important factor for predicting any subtype of non-OC disease among SII. Large scale, multicenter studies should validate the clinical role of CAR.
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KEYWORD
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Transitional cell carcinoma, C-reactive protein, Albumins, Nephroureterectomy
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