Prognostic scores based on the preoperative plasma fibrinogen and serum albumin level as a prognostic factor in patients with upper urinary tract urothelial carcinoma.

Jianfeng Cui,Yaofeng Zhu,Xigao Liu,Pengxiang Chen,Hongda Zhao,Wenbo Wang,Shiyu Wang,Ning Zhang,Meng Yu,Dongqing Zhang,Jian Du,Shouzhen Chen,Kejia Zhu,Benkang Shi

doi:10.18632/oncotarget.16483

Abstract

This study is to clarify the prognostic value of preoperative plasma fibrinogen and serum albumin level, as known as FA score, in a cohort of Chinese patients with upper urinary tract urothelial carcinoma (UTUC). We retrospectively evaluated clinicopathological data on 169 patients who underwent surgery between 2006 and 2013. The FA score was calculated based on cutoff values of 3.53g/L for fibrinogen and 43.56 g/L for albumin. Overall survival and cancer specific survival was assessed using the Kaplan-Meier method and the equivalences of the curves were tested by log-rank tests. The Cox proportional hazards regression model was applied in univariate and multivariate analyses. In univariate analysis, tumor size, tumor grade, pathological T stage and FA score were significantly associated with overall survival and cancer specific survival, and multivariate Cox proportional hazards regression analysis identified FA score (score 1: HR=3.486, 95%CI 1.358-8.948, p=0.009; HR=3.485, 95%CI 1.363-8.913, p=0.009, respectively; score 2: HR=5.509, 95%CI 2.144-14.158, p<0.001; HR=5.521, 95%CI 2.074-14.697, p=0.001, respectively) was an independent predictor for overall survival and cancer specific survival. The evaluation of preoperative FA score can be regarded as an independent prognostic factor for predicting overall survival and cancer specific survival in UTUC. The fibrinogen and albumin levels are low cost and easy accessibility in clinical practice.

Highlights

Urothelial carcinomas (UCs) have become the fourth most common cancer, upper urinary tract urothelial cell carcinomas (UTUCs) are relatively uncommon but aggressive malignant disease [1, 2]
This study is to clarify the prognostic value of preoperative plasma fibrinogen and serum albumin level, as known as FA score, in a cohort of Chinese patients with upper urinary tract urothelial carcinoma (UTUC)
The clinicopathologic characteristics of 169 patients are shown in Table 1. 107 (63.3%) were male and 62 (36.7%) were female, and mean (SD) age of the study cohort was 65.66 (9.98). 38 (22.5%) patients had the history of smoking and 15 (8.9%) patients had the history of bladder cancer

Summary

Introduction

Urothelial carcinomas (UCs) have become the fourth most common cancer, upper urinary tract urothelial cell carcinomas (UTUCs) are relatively uncommon (only about 5-10% of UCs) but aggressive malignant disease [1, 2]. According to the latest published reports [1, 5] on UTUC, pathological T stage and tumor grade are regarded as prognostic indicators of great importance, and several other prognostic parameters, such as tumor size and lymph node involvement, were suggested to predict prognosis in UTUC. Reports on the preoperative prognostic factors are still limited in UTUC. Some groups illuminated certain prognostic indexes or models to predict the clinical outcome of UTUC [6, 7]. Several studies show that preoperative plasma fibrinogen which plays a vital part in clot formation, independently predicts prognosis in various human cancers [9,10,11]. Hypoproteinemia reflects SIR and has been reported as an important predictor of clinical outcomes in various types of cancer [8, 12, 13]. Serum albumin level has been regarded as a crucial parameter of malnutrition

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