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

  • Yoshitaka Itami
  • Makito MiyakeEmail author
  • Yoshihiro Tatsumi
  • Daisuke Gotoh
  • Shunta Hori
  • Yousuke Morizawa
  • Kota Iida
  • Kenta Ohnishi
  • Yasushi Nakai
  • Takeshi Inoue
  • Satoshi Anai
  • Nobumichi Tanaka
  • Keiji Shimada
  • Shuya Hirao
  • Kiyohide Fujimoto
Original Article

Abstract

Objective

The present study evaluated the clinical relevance of an integrative preoperative assessment of inflammation-, nutrition-, and muscle-based markers for patients with upper urinary tract urothelial carcinoma (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), C-reactive protein (CRP), 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). The correlations among the variables and their prognostic values after NUx were evaluated.

Results

Five inflammation markers (NLR, MLR, PLR, Fib and CRP) were positively correlated. Fib was positively correlated with NLR, PLR and CRP, but inversely correlated with SMI. PNI was inversely correlated with age and the four inflammation markers (p < 0.001). Age was not significantly correlated with the inflammation markers, but older age was associated with lower Alb, PNI, SMI, PMI, and PEF. Disease-specific survival was independently predicted by preoperative ipsilateral hydronephrosis and low PNI. Overall survival was independently associated with high Fib and low PNI.

Conclusion

The preoperative inflammation-, nutrition-, and muscle-based markers would be useful risk assessment tools for UTUC.

Keywords

Upper urinary tract urothelial carcinoma Preoperative prognostic factor Nephroureterectomy Inflammation Nutrition Sarcopenia 

Abbreviations

UTUC

Upper urinary tract urothelial carcinoma

NUx

Nephroureterectomy

BMI

Body mass index

CRP

C-reactive protein

NLR

Neutrophil-to-lymphocyte ratio

MLR

Monocyte-to-lymphocyte ratio

PLR

Platelet-to-lymphocyte ratio

Fib

Serum fibrinogen level

GPS

Glasgow prognostic score

mGPS

Modified Glasgow prognostic score

Alb

Serum albumin level

PNI

Prognostic nutritional index

SMI

Skeletal muscle index

PMI

Psoas muscle index

PEF

Peak expiratory flow

DSS

Disease-specific survival

OS

Overall survival

HR

Hazard ratio

CI

Confidence interval

Notes

Compliance with ethical standards

Conflict of interest

We declare that we have no conflicts of interest.

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Copyright information

© Japan Society of Clinical Oncology 2019

Authors and Affiliations

  • Yoshitaka Itami
    • 1
    • 3
  • Makito Miyake
    • 1
    Email author
  • Yoshihiro Tatsumi
    • 1
  • Daisuke Gotoh
    • 1
  • Shunta Hori
    • 1
  • Yousuke Morizawa
    • 1
  • Kota Iida
    • 1
  • Kenta Ohnishi
    • 1
  • Yasushi Nakai
    • 1
  • Takeshi Inoue
    • 1
  • Satoshi Anai
    • 1
  • Nobumichi Tanaka
    • 1
  • Keiji Shimada
    • 2
  • Shuya Hirao
    • 3
  • Kiyohide Fujimoto
    • 1
  1. 1.Department of UrologyNara Medical UniversityKashiharaJapan
  2. 2.Department of PathologyNara City HospitalNaraJapan
  3. 3.Department of UrologyHirao HospitalKashiharaJapan

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