C-reactive Protein is a Strong Prognostic Factor for Overall Survival in Clinically Node-positive Patients with Upper Tract Urothelial Carcinoma

Abstract

Background There is sparse evidence regarding optimal management and prognosticators for oncologic outcomes in patients with clinical node positive (cN+) upper tract urothelial carcinoma (UTUC). Methods We retrospectively analyzed the data from 105 UTUC patients with cN1-2M0 between June 2010 and June 2022 at multiple institutions affiliated with our university. At the time of diagnosis, all patients received standard-of-care treatment including radical nephroureterectomy (RNU), chemotherapy, and/or palliative care. We employed a Cox regression model to analyze the prognostic importance of various factors on overall survival (OS). Results Of 105 patients, 54 (51%) underwent RNU, while 51 (49%) did not. RNU was likely to be selected in younger and healthy patients, resulting in better median OS in patients who underwent RNU than in those who did not (42 months vs. 15 months, p < 0.001). Multivariable analysis among the entire cohort revealed that low G8 score (≤ 14) (hazard ratio [HR]: 2.20, 95% confidence interval [CI]: 1.15–4.23), elevated pretreatment C-reactive protein (CRP) (HR: 3.28, 95%CI: 1.59–6.76), and failure to perform RNU (HR: 2.27, 95%CI: 1.11–4.76) were independent prognostic factors for worse OS. In the subgroup analyses of cohorts who underwent RNU and those who did not, elevated pretreatment CRP was the only common independent prognostic factor for worse OS in cN + UTUC patients. Conclusions RNU seems to be a reasonable treatment option in cN + UTUC patients where applicable. Elevated pretreatment CRP appears to be a strong prognosticator of worse OS and may be helpful in optimizing candidate selection for intensified treatment in this setting.