Risk stratification model, including preoperative serum C-reactive protein and estimated glomerular filtration rate levels, in patients with upper urinary tract urothelial carcinoma undergoing radical nephroureterectomy.

Abstract

To investigate the prognostic indicators, including clinicopathological and preoperative hematological factors, in patients undergoing radical nephroureterectomy (RNU) for upper urinary tract urothelial carcinoma (UTUC), and to develop a prognostic factor-based risk stratification model. The clinicopathological data and preoperative parameters were collected from 345 UTUC patients treated with RNU without neoadjuvant therapy, retrospectively. The prognostic values of preoperative hematological parameters and clinicopathological factors were evaluated. Then, a risk stratification model was developed to predict poor survival after RNU using the regression coefficients of multivariate analysis. In multivariate analysis, high serum C-reactive protein (CRP) levels (≥0.5 mg/dl), low estimated glomerular filtration rate (eGFR) levels (<50 ml/min/1.73 m(2)), Eastern Cooperative Oncology Group Performance status ≥1, number of tumor foci >1, tumor grade (G3), positive LN, and positive surgical margin were independent factors predicting poor cancer-specific survival (CSS). Patients were stratified into three groups, and the risk stratification model revealed significant differences in CSS between the three subgroups. The 5-year CSS in patients at low, intermediate, and high risk was 92.7, 75.4, and 31.5 %, respectively. This study indicates that preoperative hematological markers, such as low eGFR and high CRP levels predict a poor survival in patients with UTUC. Our risk stratification model may provide physicians with useful prognostic information for identifying patients who may be candidates for multimodal treatment.