Preoperative predictive factors focused on inflammation-, nutrition-, and muscle-status in patients with upper urinary tract urothelial carcinoma undergoing nephroureterectomy

Itami, Yoshitaka; Miyake, Makito; Tatsumi, Yoshihiro; Gotoh, Daisuke; Morizawa, Yosuke; Ohnishi, Kenta; Nakai, Yasushi; Inoue, Takeshi; Anai, Satoshi; Tanaka, Nobumichi; Shimada, Kaoru; Hirao, Shuya; Fujimoto, Kiyohide

doi:10.1007/s10147-018-01381-y

Cited by 36 publications

(35 citation statements)

References 36 publications

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“…Recent studies have shown that inflammation and immune responses play a role in cancer development [7–9]. The systemic inflammatory response (SIR) can substantially influence UC progression [10–12]. A series of hematological parameters, reflecting the immune status of cancer patients, have been widely explored as prognostic markers in recent years [13–15].…”

Section: Introductionmentioning

confidence: 99%

“…Neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), and platelet-to-lymphocyte ratio (PLR) are non-invasive and cost-effective prognostic indicators for solid tumors [16–19]. Recent retrospective studies have reported inconsistent findings regarding the prognostic impact of PLR in UC [11, 12, 20–32]. For example, some studies reported a positive association between a high PLR and poor survival in UC [24, 29], whereas others did not [20] or even showed the opposite trend [12, 30].…”

Section: Introductionmentioning

confidence: 99%

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Prognostic significance of platelet-to-lymphocyte ratio in urothelial carcinoma patients: a meta-analysis

et al. 2019

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Background: The prognostic value of pre-treatment platelet-to-lymphocyte ratio (PLR) in patients with urothelial carcinoma (UC) remains controversial. Therefore, this meta-analysis aimed to identify the prognostic impact of PLR on UC. Methods: The PubMed, Embase, Web of Science, and Cochrane Library databases were systematically searched. Hazard ratios (HRs) with 95% confidence intervals (CIs) were used to summarize the correlations between PLR and overall survival (OS), progression-free survival (PFS), disease-free survival (DFS), and cancer-specific survival (CSS). Odds ratios (ORs) with 95% CIs were used to measure the association between PLR and tumor clinicopathological factors. Results: The meta-analysis included 15 studies published from 2015 to 2019 with a total of 5354 patients. Overall, a high PLR was correlated to poorer PFS (HR = 1.81, 95% CI 1.28-2.56, p = 0.001) and DFS (HR = 1.09, 95% CI 1.31-2.16, p < 0.001) but not poor OS (HR = 1.23, 95% CI 0.95-1.59, p = 0.124) or CSS (HR = 1.000, 95% CI 0.998-1.002, p = 0.919) in UC. In addition, an elevated PLR was correlated with patient age > 65 years (OR = 1.72, 95% CI 1.25-2.38, p = 0.001) and hypertension (OR = 1.48, 95% CI 1.01-2.18, p = 0.046). However, no significant association was observed between PLR and sex (OR = 0.79, 95% CI 0.56-1.14, p = 0.206) or diabetes (OR = 1.29, 95% CI 0.77-2.15, p = 0.333). Conclusions: Our results demonstrated a significant correlation between elevated PLR and poor prognosis in UC. The prognostic role of PLR may help guide the management and prognostication of UC patients.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Prognostic significance of platelet-to-lymphocyte ratio in urothelial carcinoma patients: a meta-analysis

et al. 2019

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“…This seems predominantly because clinicians consider that not all patients benefit from systemic chemotherapy and it can cause toxicities which can delay RNU. Several prognostic factors at baseline have been identified to support decision making in the pursuit of personalized care [8][9][10][11][12][13], including radiographic variables, inflammatory markers, nutritional indices, and molecular markers. Some studies analyzed the relationship of hydronephrosis at baseline to poor outcomes [10][11][12][13].…”

Section: Introductionmentioning

confidence: 99%

Down-Grading of Ipsilateral Hydronephrosis by Neoadjuvant Chemotherapy Correlates with Favorable Oncological Outcomes in Patients Undergoing Radical Nephroureterectomy for Ureteral Carcinoma

et al. 2019

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Few studies have analyzed the details of neoadjuvant chemotherapy (NAC)-induced changes in patients with upper tract urothelial carcinoma. This study aimed to describe the impact of down-grading ipsilateral hydronephrosis by NAC for ureteral carcinoma. An observational study was conducted in 32 patients with cT1-3N0M0 ureteral carcinoma treated with NAC and radical nephroureterectomy. Hydronephrosis was classified into five grades based on computed tomography findings. We focused on the differences between the baseline and post-NAC status of ipsilateral hydronephrosis, radiographic tumor response, and blood markers. Down-grading, no change, and up-grading was observed in 10 (31%), 21 (66%), and 1 (3%) patients, respectively. In univariate analysis, locally advanced disease (cT3), severe hydronephrosis (grade 3/4) at baseline, no change/up-grading of hydronephrosis after NAC, and pathological lymphovascular involvement were identified as potential prognostic factors of progression-free and cancer-specific survival after radical nephroureterectomy. Locally advanced disease (cT3) at baseline and no change/up-grading of hydronephrosis by NAC were independently associated with poor progression-free survival. Notably, none of the patients with NAC-induced down-grading of hydronephrosis died of ureteral carcinoma during the follow-up. We reported the prognostic impact of down-grading of ipsilateral hydronephrosis, which could serve as a useful aid or clinical marker for decision-making.

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“…Several biomarkers based on the TLC, such as NLR and PLR, were proven to be indexes for the immune status and serve as prognostic predictors for UTUC. 11,25,26 As a reliable indicator of the status of host nutrition and systematic inflammation, serum albumin can be influenced not only by the production of proinflammatory cytokines, 27 such as interleukin-6 and tumor necrosis factor-alpha, but also by body fluid retention and damage to hepatocytes. 28,29 Previous studies revealed that hypoalbuminemia was associated with immune deficiency.…”

Section: Discussionmentioning

confidence: 99%

“…9,10 Recently, several biomarkers, such as serum sodium, hemoglobin, C-reactive protein (CRP), albumin, albumin to globulin ratio (AGR), plasma fibrinogen, neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), lymphocyte to monocyte ratio (LMR), body mass index (BMI), sarcopenia and prognostic nutritional index (PNI), have been reported to be independent prognostic factors in many human malignancies, including UTUC. 11,12 The controlling nutritional status (CONUT) score, a new index calculated from three peripheral blood parameters (total lymphocyte count [TLC], serum albumin concentration and total cholesterol concentration [TCC]), was originally reported as an early screening tool to detect a poor nutritional status in 2005 (Table 1). 13 The CONUT score was proposed as a comprehensive index that could assess the immune response status and long-term nutritional effect of the host.…”

Section: Introductionmentioning

confidence: 99%

<p>High Preoperative Controlling Nutritional Status Score Predicts a Poor Prognosis in Patients with Localized Upper Tract Urothelial Cancer: A Propensity Score Matching Study in a Large Chinese Center</p>

Bao¹,

Li²,

Guan³

et al. 2020

CMAR

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The aim of this study was to elucidate the prognostic value of the preoperative controlling nutritional status (CONUT) score, a new index based on the total lymphocyte count, serum albumin concentration and total cholesterol concentration, in patients with localized upper tract urothelial cancer (UTUC) after radical nephroureterectomy (RNU) using propensity score matching (PSM) analysis. Methods: We retrospectively reviewed 908 consecutive patients with localized UTUC who underwent RNU between 1999 and 2015. Patients were divided into two groups according to the optimal cutoff value of the preoperative CONUT score. Relationships between the CONUT score with clinicopathological characteristics, overall survival (OS), cancer-specific survival (CSS), and disease-free survival (DFS) were analyzed before and after 1:1 PSM. Results: A high preoperative CONUT score was significantly correlated with older age, low body mass index (BMI), poor American Statistical Association (ASA) score, advanced pathological T stage, and tumor squamous or glandular differentiation (all p<0.05). Kaplan-Meier curves showed poor OS, CSS, and DFS for patients with a high CONUT score before and after PSM (all p<0.001). Furthermore, multivariate analyses revealed that a high preoperative CONUT score was an independent risk factor for poor DFS (hazard ratio [HR] 1.418, 95% confidence interval [CI] 1.132-1.776, p=0.002) before PSM and an independent risk factor for poor DFS (HR 1.333, 95% CI 1.010-1.760, p=0.042) and OS (HR 1.459, 95% CI 1.010-2.107, p=0.044) after PSM. Conclusion: A high preoperative CONUT score is an independent prognostic factor for poor outcomes in patients with localized UTUC after RNU.

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Preoperative predictive factors focused on inflammation-, nutrition-, and muscle-status in patients with upper urinary tract urothelial carcinoma undergoing nephroureterectomy

Cited by 36 publications

References 36 publications

Prognostic significance of platelet-to-lymphocyte ratio in urothelial carcinoma patients: a meta-analysis

Prognostic significance of platelet-to-lymphocyte ratio in urothelial carcinoma patients: a meta-analysis

Down-Grading of Ipsilateral Hydronephrosis by Neoadjuvant Chemotherapy Correlates with Favorable Oncological Outcomes in Patients Undergoing Radical Nephroureterectomy for Ureteral Carcinoma

<p>High Preoperative Controlling Nutritional Status Score Predicts a Poor Prognosis in Patients with Localized Upper Tract Urothelial Cancer: A Propensity Score Matching Study in a Large Chinese Center</p>

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