Elevated serum α-hydroxybutyrate dehydrogenase is an independent risk factor for survival outcomes in UTUC patients after radical nephroureterectomy

Abstract

Background To determine the prognostic value of α-hydroxybutyrate dehydrogenase (α-HBDH) on survival outcomes in upper tract urothelial carcinoma (UTUC) patients after radical nephroureterectomy (RNU). Methods Data from 544 UTUC patients who underwent RNU at West China Hospital from May 2003 to June 2019 were retrospectively acquired and analysed. Overall survival (OS), cancer-specific survival (CSS) and metastasis free survival (MFS) were the endpoints of interest. The cut-off value of α-HBDH was calculated by receiver operating characteristic. Kaplan-Meier curves were used to estimate patients’ survival and Cox proportional hazard model was used for risk assessment. Results Overall, 407 and 137 patients were divided into the α-HBDH-low group and α-HBDH -high group at the cutoff value of 161 U/L. Patients in the α-HBDH-high group showed significantly worse OS (p = 0.003), CSS (p = 0.025) and MFS (p = 0.031) than those in the α-HBDH-low group. However, serum α-HBDH level was not an independent predictor for OS, CSS or MFS in the multivariate Cox regression (all p > 0.05). The subsequent subgroup analysis about the pathological tumor stage suggested that higher serum α-HBDH value was significantly associated with better OS and CSS in localized UTUC patients (T ≤ 2) (HR 2.127, 95%CI 1.313–3.445; HR 1.846, 95%CI 1.030–3.308), but not in locally advanced UTUC patients (T > 2) (all p > 0.05). Conclusion The preoperative value of α-HBDH is an independent risk factor for survival outcomes in localized UTUC patients who underwent RNU.