Significance of multiple preoperative laboratory abnormalities as prognostic indicators in patients with urothelial carcinoma of the upper urinary tract following radical nephroureterectomy.
BACKGROUND
The aim of this study was to investigate the prognostic significance of multiple preoperative laboratory abnormalities in upper urinary tract urothelial carcinoma (UUTUC) patients.


METHODS
This study included a total of 135 consecutive patients with clinically localized UUTUC who underwent radical nephroureterectomy (RNU). The impact of several preoperative blood-based markers in addition to conventional clinical factors on extravesical recurrence-free survival (eRFS) in these patients was retrospectively evaluated.


RESULTS
Despite the lack of a significant correlation between conventional clinical factors and any of the postoperative pathologic parameters, preoperative laboratory abnormalities were shown to have a significant impact on some pathological factors reflecting an aggressive phenotype as follows-C-reactive protein (CRP) level on pathological stage, De Ritis (aspartate transaminase/alanine transaminase) ratio on nodal involvement, and neutrophil-lymphocyte ratio (NLR) on pathological stage. During the observation period of this study (median 36.1 months), extravesical disease recurrence was detected in 44 (32.6%) of the 135 patients with a 5-year eRFS rate of 62.1%. Of several factors examined, the CRP level, De Ritis ratio, and NRL were significantly correlated with eRFS on univariate analysis. Of these significant factors, the De Ritis ratio and NRL were identified as independent predictors of eRFS on multivariate analysis. Moreover, there were significant differences in eRFS according to the positive numbers of these two independent risk factors.


CONCLUSIONS
These findings suggest that it is important to consider laboratory abnormalities, particularly the De Ritis ratio and NLR, to predict disease recurrence following RNU in patients with clinically localized UUTUC.
['Nishikawa|Masatomo|M|', 'Miyake|Hideaki|H|', 'Kurahashi|Toshifumi|T|', 'Fujisawa|Masato|M|']
D000368:Aged D000369:Aged, 80 and over D015415:Biomarkers D002097:C-Reactive Protein D005260:Female D006801:Humans D007958:Leukocyte Count D008297:Male D008875:Middle Aged D015999:Multivariate Analysis D000074682:Nephroureterectomy D009504:Neutrophils D057234:Preoperative Period D011379:Prognosis D012189:Retrospective Studies D012307:Risk Factors D014571:Urologic Neoplasms D019459:Urothelium
Laboratory abnormalities Radical nephroureterectomy Upper urinary tract urothelial carcinoma Prognosis