Can serum cytokeratin 19 fragments predict postoperative early progression in patients with upper urinary tract urothelial carcinoma?

Abstract

557 Background: Current guidelines do not yet provide recommendations for any serum tumor markers in patients with upper tract urothelial carcinoma (UTUC) who received nephroureterectomy (NU). The criteria for adjuvant chemotherapy is also controversial. Previous studies have shown that serum cytokeratin levels (sCK) were correlated with depth of tumor invasion and metastases in patients with bladder cancer. We found that preoperative sCK was correlated with cancer specific survival(CSS) after NU. In this study we evaluated whether postoperative sCK (poCK) could predict early progression in patients who received NU. Methods: 160 patients with UTUC underwent NU from December 2003 to 2014 at our institution. The median age at diagnosis was 73 years (41-89). poCK19 had been measured in 112 patients within 8 weeks after NU. Patients were divided into two groups, a high-group and a low-group based on poCK19 levels (a cut-off value of 3.5 ng/mL). CSS and progression-free survival (PFS) were measured by Kaplan–Meier curves and log–rank test. Multivariate analysis was carried out using the Cox hazards model. Results: Of 112 patients ≤pT1 was 39 (34%), pT2 in 26 (23%), pT3 in 40 (35%), and pT4 in 7 (8%). The 5-year (5y) CSS rate was 86% and the 5yPFS rate was 60%. There were 24 (21%) patients in the high-group and 88 (79%) in the low-group. During the median follow-up period of 34.0 (1-152) months, 39 patients (35%) died. The 5yCSS rate of the high-group was 51%, which is significantly lower than the low-group (86%) (p<0.001). The 1yPFS of the high-group was 66%, which was significantly lower than that of the low-group (86%) (p<0.001). On univariate analysis, positive margin (HR4.0, p<0.001) and poCK19 (HR3.9, p<0.001) were the significant factors for 1yPFS. On multivariate analysis, poCK19 (HR5.3 95%CI (1.8-15.7), p=0.002) and positive margin (HR 4.6 95%CI (1.1-18.9), p=0.032) were also independent factors for 1yPFS. Conclusions: Our study suggests that postoperative sCK19 could predict early progression in patients with UTUC who received NU. Adjuvant chemotherapy might be indicated for patients with high postoperative sCK19 levels independent of pathological findings.