Chronic kidney disease and positive surgical margins as prognosticators for upper urinary tract urothelial carcinoma patients undergoing radical nephroureterectomy

Abstract

Chronic kidney disease (CKD) is a common condition among elderly patients and has been reported to be a biomarker for the presence of malignant disease. In addition, unfavorable outcomes for patients with upper tract urothelial carcinoma (UTUC) undergoing radical nephroureterectomy can be due to independent clinical factors. Therefore, the present study analyzed the clinicopathological data of patients with UTUC, who underwent radical nephroureterectomy at our institution, to clarify whether preoperative CKD and other factors are independent predictors of the shorter disease-specific and/or recurrence-free survival time of these patients. A retrospective review of 187 patients who underwent radical nephroureterectomy was conducted, and patients were followed for at least 3 months postoperatively. The clinicopathological factors that are thought to have potentially significant roles in the progression and metastasis of malignant tumors and for disease-specific and recurrence-free survival were evaluated. Positive surgical margins and an estimation of the glomerular filtration rate (eGFR) of <60 were independent factors for the shorter disease-specific survival time in multivariate analysis with Cox's proportional hazards model [hazard ratio (HR), 2.401: 95% confidence interval (CI), 1.044-5.255; and HR, 2.371: 95% CI, 1.024-5.898, respectively]. Another multivariate analysis also revealed that positive surgical margins (HR, 4.477; 95% CI, 2.042-9.469), and preoperative eGFR <60 (HR, 2.362; 95% CI, 1.067-5.592) were independent factors for the worse recurrence-free survival rate in all patients. Patients with UTUC who had eGFR <60 as well as positive surgical margins had significantly shorter time to disease-specific mortality and extraurothelial recurrence. The present study demonstrated that patients with UTUC undergoing radical nephroureterectomy who have CKD as well as positive surgical margins should be carefully followed up postoperatively.

Prognostic significance of platelet-to-lymphocyte ratio in urothelial carcinoma patients: a meta-analysis

“…The major characteristics of the 15 eligible studies are presented in Table 1. These studies were published from 2015 to 2019 and were conducted in six countries including China (n = 5) [21, 22, 25, 27, 32], Korea (n = 4) [20, 26, 29, 31], Japan (n = 3) [11, 12, 30], Austria (n = 1) [24], Poland (n = 1) [28], and Turkey (n = 1) [23]. The sample sizes ranged from 113 to 1551, with a median value of 186.…”

“…Eight studies [12, 20, 22–25, 29, 30] investigated the prognostic value of PLR in UTUC while seven studies focused on BC [11, 21, 26–28, 31, 32]. Regarding the prognostic role of PLR in UC, nine studies reported OS [11, 12, 21, 24–26, 28, 31, 32], seven studies reported PFS [22–25, 27, 29, 30], six studies reported DFS [20, 22, 23, 27, 29, 30], and five studies provided data on CSS [11, 20, 26, 28, 31]. All studies had NOS scores ≥ 6.

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“…Subgroup analysis showed that PLR was associated with worse OS in patients receiving radical nephroureterectomy (RNU) (HR = 2.13, 95% CI 1.48–3.07, p < 0.001; Table 2), although this subgroup included only two studies. Seven studies [22–25, 27, 29, 30] reported the impact of PLR on PFS. The pooled HR and corresponding 95% CI were 1.81 and 1.28–2.56, respectively (p = 0.001) (Table 2, Fig.…”

“…Subgroup analysis showed that PLR remained a significant indicator for PFS irrespective of sample size and tumor type. Six studies [20, 22, 23, 27, 29, 30] evaluated DFS. The pooled HR was 1.09 (95% CI 1.31–2.16, p < 0.001) (Table 2, Fig.…”

“…Recent retrospective studies have reported inconsistent findings regarding the prognostic impact of PLR in UC [11, 12, 20–32]. For example, some studies reported a positive association between a high PLR and poor survival in UC [24, 29], whereas others did not [20] or even showed the opposite trend [12, 30]. Therefore, the present meta-analysis aimed to estimate the prognostic role of PLR for different survival outcomes in UC.…”