Preoperative predictive factors focused on inflammation-, nutrition-, and muscle-status in patients with upper urinary tract urothelial carcinoma undergoing nephroureterectomy

• Published in: International journal of clinical oncology Vol. 24; no. 5; pp. 533 - 545
• Main Authors: Itami, Yoshitaka, Miyake, Makito, Tatsumi, Yoshihiro, Gotoh, Daisuke, Hori, Shunta, Morizawa, Yousuke, Iida, Kota, Ohnishi, Kenta, Nakai, Yasushi, Inoue, Takeshi, Anai, Satoshi, Tanaka, Nobumichi, Shimada, Keiji, Hirao, Shuya, Fujimoto, Kiyohide
• Format: Journal Article
• Language: English
• Published: Singapore Springer Singapore 01-05-2019; Springer Nature B.V
• Subjects: Age; Bladder cancer; Body mass index; C-reactive protein; Cancer Research; Fibrinogen; Inflammation; Lymphocytes; Medicine; Medicine & Public Health; Monocytes; Nutrition; Oncology; Original Article; Psoas muscle; Risk assessment; Sarcopenia; Skeletal muscle; Surgical Oncology; Urinary tract; Urogenital system; Urothelial carcinoma; Upper urinary tract urothelial carcinoma; Sarcopenia; Nephroureterectomy; Preoperative prognostic factor; Inflammation; Nutrition
• ISSN: 1341-9625; 1437-7772
• DOI: 10.1007/s10147-018-01381-y

Objective
The present study evaluated the clinical relevance of an integrative preoperative assessment of inflammation-, nutrition-, and muscle-based markers for patients with upper urinary tract urothelial carcinoma (UTUC) undergoing curative nephroureterectomy (NUx).
Methods
The study enrolled 125 patients and the preoperative variables assessed included age, body mass index, neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), serum fibrinogen level (Fib), C-reactive protein (CRP), modified Glasgow prognostic score, serum albumin level (Alb), prognostic nutritional index (PNI), skeletal muscle index (SMI), psoas muscle index (PMI), and peak expiratory flow (PEF). The correlations among the variables and their prognostic values after NUx were evaluated.
Results
Five inflammation markers (NLR, MLR, PLR, Fib and CRP) were positively correlated. Fib was positively correlated with NLR, PLR and CRP, but inversely correlated with SMI. PNI was inversely correlated with age and the four inflammation markers (
p
 < 0.001). Age was not significantly correlated with the inflammation markers, but older age was associated with lower Alb, PNI, SMI, PMI, and PEF. Disease-specific survival was independently predicted by preoperative ipsilateral hydronephrosis and low PNI. Overall survival was independently associated with high Fib and low PNI.
Conclusion
The preoperative inflammation-, nutrition-, and muscle-based markers would be useful risk assessment tools for UTUC.