Abstract
PurposeTo investigate the prognostic value of preoperative pre-albumin and albumin level in patients with localized upper tract urothelial carcinoma (UTUC) undergoing radical nephroureterectomy.Methods and MaterialsBetween January 2003 and June 2013, we evaluated data on 425 patients with nonmetastatic UTUC (Ta-4N0/+M0) who underwent radical nephroureterectomy at our institution. Low pre-albumin level was defined as <20 mg/dl, while hypoalbuminemia was defined as albumin <35 g/L. The associations of preoperative low pre-albumin level and hypoalbuminemia with clinical and pathologic variables were assessed. Univariable and multivariable analyses using the Cox regression model were performed to determine prognostic factors that were associated with cancer specific survival (CSS) and overall survival (OS). The Harrell concordance index with variables only or combined pre-albumin data were used to evaluate the prognostic accuracy.ResultsCompared with patients with high pre-albumin level, patients with low pre-albumin level were more likely to have older age, higher tumor stage, higher rate of diabetes, regional lymph node metastasis and lymphovascular invasion. Meanwhile, hypoalbuminemia was only associated with diabetes. Multivariate analysis identified decreased preoperative pre-albumin level as an independent prognostic factor for CSS (HR 1.85, 95% CI 1.14-3.00, p=0.013) and OS (HR 1.73, 95% CI 1.12-2.70, p=0.015), but not preoperative hypoalbuminemia. The estimated c-index of the multivariate model for CSS and OS increased from 0.771 and 0.760 without pre-albumin to 0.775 and 0.765 when pre-albumin added.ConclusionsLow preoperative pre-albumin level but not preoperative hypoalbuminemia is a negative independent prognostic factor for survival outcome in patients with UTUC undergoing radical nephroureterectomy.
Highlights
Upper tract urothelial carcinoma (UTUC) is an uncommon but aggressive malignant disease that accounts for only 5% to 10% of all urothelial carcinomas [1]
Multivariate analysis identified decreased preoperative pre-albumin level as an independent prognostic factor for cancer specific survival (CSS) (HR 1.85, 95% confidence interval (CI) 1.143.00, p=0.013) and overall survival (OS) (HR 1.73, 95% CI 1.12-2.70, p=0.015), but not preoperative hypoalbuminemia
Lymphadenectomy was done in 93 patients (21.8%) who presented with clinically enlarged lymph nodes. 86 patients received adjuvant chemotherapy (AC) in this study
Summary
Upper tract urothelial carcinoma (UTUC) is an uncommon but aggressive malignant disease that accounts for only 5% to 10% of all urothelial carcinomas [1]. The natural history and oncogenicity of UTUC appear to be rather different from that of urothelial carcinomas of the bladder. Around 50% of UTUCs are muscular invasive at diagnosis compared to only 15% of urothelial carcinomas of the bladder [2, 3]. Pathological T stage, tumor grade, lymph node metastasis, distant metastasis, lymphovascular invasion (LVI) are well established pathological prognostic factors in patients with UTUC [1, 6,7]. Patient age www.impactjournals.com/oncotarget and tumor multifocality are independent predictors of patient survival [1, 8]. The potential prognostic preoperative factors are still limited in UTUC. The nutritional status of patients with cancer is an important parameter affecting survival outcomes [9, 10]
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