Presentation Authors: Yoshitaka Itami*, Makito Miyake, Shunta Hori, Yosuke Morizawa, Kota Iida, Kenta Ohnishi, Takuya Owari, Yasushi Nakai, Nobumichi Tanaka, Shuya Hirao, Kiyohide Fujimoto, Kashihara, Nara, Japan
Introduction: The prognosis of upper urinary tract urothelial carcinoma (UTUC) has been reported as postoperative pathological factors such as pathological T stage and tumor grade. However, the potential prognostic preoperative factors are still limited in UTUC. The present study evaluated the clinical relevance of an integrative preoperative assessment of inflammation-, nutrition-, and muscle-based markers for patients with UTUC undergoing curative nephroureterectomy (NUx).
Methods: The study enrolled 125 patients and the preoperative variables assessed included age, body mass index, neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), serum fibrinogen level (Fib), modified Glasgow prognostic score, serum albumin level (Alb), prognostic nutritional index (PNI), skeletal muscle index (SMI), psoas muscle index (PMI), and peak expiratory flow (PEF). PNI was calculated as 10 Ã— Alb (g/dL) + 0.005 Ã— total lymphocyte count (per mm3). The correlations among the variables and their prognostic values after NUx were evaluated.
Results: Age was not significantly correlated with the inflammation markers, but older age was associated with low Alb, PNI, SMI, PMI, and PEF values. There was a significant inverse correlation between PNI and age, NLR, MLR, and PLR. Fib was positively correlated with two inflammation markers, NLR and PLR, but was negatively correlated with SMI (Figure). Disease-specific survival was independently predicted by preoperative ipsilateral hydronephrosis and low PNI. Overall survival was independently associated with high Fib and low PNI (Table).
Conclusions: The preoperative inflammation-, nutrition-, and muscle-based markers would be useful risk assessment tools for UTUC. Low baseline PNI, the presence of hydronephrosis, and high Fib were representative prognostic factors among several studied markers.