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Prognostic value of systemic inflammatory responses in patients with upper urinary tract urothelial carcinoma

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Abstract

Purpose

To determine the utility of systemic inflammatory response and develop a model based on serum inflammatory indices to aid prognostication in patients with upper urinary tract urothelial carcinoma (UTUC).

Methods

The study population comprised 277 patients with non-metastatic UTUC who underwent nephroureterectomy between 1999 and 2010. Multivariate survival analysis was performed using Cox’s proportional hazards model, and a new model was developed to predict recurrence-free (RFS) and disease-specific survival (DSS). The factors considered, in relation to systemic inflammatory responses, were as follows: albumin, white blood cell count, neutrophil count, lymphocyte count, red blood cell count, serum creatinine level, platelet count, prognostic nutritional index, platelet/lymphocyte ratio, neutrophil/lymphocyte ratio (NLR), and derived NLR.

Results

The final model consisted of bladder cuffing, pathologic T stage, lymphovascular invasion, and derived NLR. The bootstrap-concordance indices of the model were 0.778 [95 confidence interval (CI) 0.730–0.826] for RFS and 0.802 (95 % CI 0.752–0.851) for DSS, respectively, and integrated area under the curve value for time to RFS and DSS for patients was 0.738 and 0.760, respectively. When we generated calibration curves, the nomograms were reasonably calibrated.

Conclusions

Derived NLR may be used in combination with conventional staging techniques and other clinicopathological parameters to improve the prediction of survival in patients with UTUC.

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Conflict of interest

The authors have no financial conflict of interests.

Ethical standard

The protocol of this study was approved by the Institutional Review Board of our institutions (Approval No. H1311-069-533). The need for informed consent was waived by the Institutional Review Board because of the retrospective design with minimal risk of harm to subjects. All personal identifiers were removed, and data were analyzed anonymously.

Author information

Authors and Affiliations

  1. Department of Urology, Seoul National University College of Medicine, Seoul, South Korea

    Myong Kim, Woo Suk Choi, Chang Wook Jeong, Cheol Kwak, Hyeon Hoe Kim & Ja Hyeon Ku

  2. Department of Pathology, Seoul National University College of Medicine, Seoul, South Korea

    Kyung Chul Moon

  3. Department of Urology, Seoul National University Hospital, 101 Daehak-ro, Jongno-Gu, Seoul, 110-744, South Korea

    Ja Hyeon Ku

Authors
  1. Myong Kim
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  2. Kyung Chul Moon
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  3. Woo Suk Choi
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  4. Chang Wook Jeong
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  5. Cheol Kwak
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  6. Hyeon Hoe Kim
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Corresponding author

Correspondence to Ja Hyeon Ku.

Appendices

Appendix 1

See Table 4.

Table 4 Systemic inflammation-based prognostic scores
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Appendix 2

See Table 5.

Table 5 Comparison of clinicopathologic parameters between the groups divided by derived neutrophil/lymphocyte ratio (NLR)
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Appendix 3

See Fig. 4.

Fig. 4
figure 4

Time-dependent receiver operating characteristics curve analysis of the nomogram. Curve plots the area under the curve over time. Recurrence-free survival for the nomogram excluding (a) and including (b) derived NLR. Integrated area under the curve value was 0.718 (a) and 0.738 (b), respectively. Disease-specific survival for the nomogram excluding (c) and including (d) derived NLR. Integrated area under the curve value was 0.745 (a) and 0.760 (b), respectively

Full size image

Appendix 4

See Fig. 5.

Fig. 5
figure 5

Body mass index according to systemic inflammation-based prognostic scores. a Prognostic Nutrition Index. b Platelet:lymphocyte ratio. c Neutrophil:lymphocyte ratio. d Derived neutrophil:lymphocyte ratio (all p < 0.05)

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Appendix 5

See Table 6.

Table 6 Cox proportional hazard regression analysis of disease-free survival in high-grade subgroup
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Appendix 6

See Table 7.

Table 7 Cox proportional hazard regression analysis of disease-specific survival in high-grade subgroup
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Kim, M., Moon, K.C., Choi, W.S. et al. Prognostic value of systemic inflammatory responses in patients with upper urinary tract urothelial carcinoma. World J Urol 33, 1439–1457 (2015). https://doi.org/10.1007/s00345-015-1484-9

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  • DOI: https://doi.org/10.1007/s00345-015-1484-9

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