Abstract
PurposeThe accurate selection of patients who are most likely to benefit from neoadjuvant chemotherapy is an important challenge in oncology. Serum AGR has been found to be associated with oncological outcomes in various malignancies. We assessed the association of pre-therapy serum albumin-to-globulin ratio (AGR) with pathologic response and oncological outcomes in patients treated with neoadjuvant platin-based chemotherapy followed by radical nephroureterectomy (RNU) for clinically non-metastatic UTUC.MethodsWe retrospectively included all clinically non-metastatic patients from a multicentric database who had neoadjuvant platin-based chemotherapy and RNU for UTUC. After assessing the pretreatment AGR cut‐off value, we found 1.42 to have the maximum Youden index value. The overall population was therefore divided into two AGR groups using this cut‐off (low, < 1.42 vs high, ≥ 1.42). A logistic regression was performed to measure the association with pathologic response after NAC. Univariable and multivariable Cox regression analyses tested the association of AGR with OS and RFS.ResultsOf 172 patients, 58 (34%) patients had an AGR < 1.42. Median follow-up was 26 (IQR 11–56) months. In logistic regression, low AGR was not associated with pathologic response. On univariable analyses, pre-therapy serum AGR was neither associated with OS HR 1.15 (95% CI 0.77–1.74; p = 0.47) nor RFS HR 1.48 (95% CI 0.98–1.22; p = 0.06). These results remained true regardless of the response to NAC.ConclusionPre-therapy low serum AGR before NAC followed by RNU for clinically high-risk UTUC was not associated with pathological response or long-term oncological outcomes. Biomarkers that can complement clinical factors in UTUC are needed as clinical staging and risk stratification are still suboptimal leading to both over and under treatment despite the availability of effective therapies.
Highlights
Upper Tract Urothelial Carcinoma (UTUC) is a rare disease which represents only 5% of urothelial carcinoma, and has generally a worse prognosis compared to bladder cancer [1]
We performed a retrospective analysis of patient treated with NAC followed by radical nephroureterectomy (RNU) for UTUC from an multicenter database arising from international cooperation
There was no difference in the Kaplan–Meier analysis according to the serum albumin-to-globulin ratio (AGR) for Recurrence-free survival (RFS) [HR 1.33, 95% CI 0.77–2.31; p = 0.30] (Fig. 1a)
Summary
Upper Tract Urothelial Carcinoma (UTUC) is a rare disease which represents only 5% of urothelial carcinoma, and has generally a worse prognosis compared to bladder cancer [1]. The local or systemic immune response in cancer-related inflammation is associated with an increased production of these inflammatory mediators. The combination of these proteins as a ratio can help to assess the systemic inflammatory response and the patient nutritional status [25]. In UTUC, abnormal serum preoperative AGR has been found to be associated with adverse pathologic features, survival, and poorer outcomes in patients treated with RNU [21, 22].
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