Predictors of survival in patients with disease recurrence after radical nephroureterectomy

Abstract

contributed equally to this work. Objectives• To evaluate the prognostic value of the Bajorin criteria in a multi-institutional cohort of patients with disease recurrence after radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC).• To investigate whether clinical, pathological and/or biological factors at time of disease recurrence are also associated with cancer-specific outcomes in these patients. Patients and Methods• We identified 242 patients with disease recurrence after RNU for UTUC from 11 centres.• With regard to the Bajorin criteria, patients were categorized into three groups based on two risk factors: Karnofsky performance status <80% and the presence of visceral metastasis.• Assessed variables included pathological characteristics, time to disease recurrence, age-adjusted Charlson comorbidity index (ACCI), American Society of Anesthesiologists (ASA) score, and laboratory tests at time of disease recurrence. Results• Overall, 185 patients died from their disease; the median survival was 9 months. The survival rates at 1 year were 53, 33, and 39% for patients with no (n = 18), one (n = 109) and two (n = 115) risk factors, respectively, with no significant difference between the groups. • In univariable analyses, higher pT-stage, tumour necrosis, non-administered salvage chemotherapy, higher ACCI score, higher ASA score, lower albumin level and higher white blood cell count were significantly associated with a shorter time to cancer-specific mortality. Conclusions• We confirmed the poor yet variable outcomes of patients with disease recurrence after RNU.• While the Bajorin criteria seem to have limited prognostic value in this specific cohort, we found several other clinical variables to be associated with worse cancer-specific mortality.• If validated, these factors should be taken into consideration for clinical trial design.

Is preoperative serum lactate dehydrogenase useful in predicting the outcomes of patients with upper tract urothelial carcinoma?

“…However, the results of our cohort suggested that high serum LDH level was not associated with overall CSS, OS, RFS, or MFS in UTUC patients, which was consistent with the results reported by Kluth et al . Also, subgroup analysis in this study showed that serum LDH level could not affect survival outcomes of patients with the low‐grade disease or high‐grade UTUC.…”

“…Sheth et al also suggested white blood cells were not a prognostic predictor in high‐grade patients, while our cohort found higher white blood cells to be associated with worse CSS and RFS, which was in line with Kluth et al reported higher white blood cells were correlated with a higher after disease recurrence . Recent studies also figured out that white blood cells were associated with worse CSS in patients with bladder cancer in univariate analysis …”

“…In our cohort, we also found albumin, globulin, and HBDH were not associated with prognosis of UTUC patients, while higher alkaline phosphatase was found to be associated with worse CSS and OS in all patients and higher globulin was associated with poor CSS and RFS in cases with localized disease separately. In contrast, Kluth et al reported lower serum albumin level contributed to higher mortality after disease recurrence and Sheth et al found lower albumin was associated with worse RFS and OS without adjusting the impact of other confounder biomarkers . Moreover, they did not exclude patients with liver diseases which could affect albumin levels and other biochemical indexes such as globulin, aspartate aminotransferase, and bilirubin .…”

Performance status as a significant prognostic predictor in patients with urothelial carcinoma of the bladder who underwent radical cystectomy

“…Psychosocial parameters, such as comorbidity and PS, are useful indices for characterizing patients with respect to their general health and functional capabilities when determining therapeutic options and predicting outcome. In addition, the usefulness of these parameters as prognostic predictors has been reported in several types of malignant tumor . For example, Robbins et al .…”

“…Therefore, the decision to undergo RC should consider the general health status of the patient as well as parameters directly associated with disease‐specific characteristics. Several studies have shown the significant impact of factors reflecting general health status, such as comorbidity and PS indices, on the prognosis of various types of malignant tumor . Thus, assessment of general health status has become important when treating cancer patients.…”