新發炎相關的生物標記對於上泌尿道泌尿上皮癌的預測分析

李一宏、林益聖、歐宴泉、許兆畬、童敏哲

童綜合醫院外科部泌尿科

Influence of Novel Inflammatory Biomarkers on Prediction for Patients with Upper Tract Urothelial Carcinoma

Yi-Hong Li, Yi-Sheng Lin, Yen-Chuan Ou, Chao-Yu Shu, Min-Che Tung

Division of Urology, Department of Surgery,

Tungs' Taichung MetroHarborHospital, Taichung, Taiwan

Introduction:

In present studies, more research reported benefits of neoadjuvant chemotherapy on survival outcomes and pathological downstaging for upper tract urothelial carcinoma(UTUC). Some patients could also benefit from cisplatin based regimen free from radical nephroureterectomy related inadequate renal function. Otherwise, accumulating data revealed the significant role of inflammatory biomarkers to predict survival outcome in UTUC. We aimed to evaluate the preoperative blood test on prediction for tumor stage of UTUC.

Materials and Methods:

Patients who received radical nephroureterectomy with pathologic report were reviewed in a retrospective cohort with Ta,Tis, T1-T4 UTUC. The laboratory data was enrolled within 1 week before the operation. The possible confounding factors containing previous or concurrent malignancy(containing urinary bladder urothelial carcinoma), cirrhosis, immunocompromised, hematopoietic disease or active infection were excluded.

Results:

A total of 67 patients were identified and included. Five inflammatory biomarkers containing platelet-to-lymphocyte ratio(PLR), neutrophil-to lymphocyte ratio(NLR), monocyte-to-lymphocyte ratio(MLR), systemic inflammation index(SII) and systemic inflammatory response index(SIRI) were evaluated. The T stage was classified into 1,2,3 and 4. Ordinal logistic regression showed only PLR with correlation to advanced stage(OR, 1.005; P=0.047; 95% CI, 1.000-1.010). Univariate logistic regression revealed that PLR was significantly related to UTUC ≥T2 stage(OR, 3.879; P=0.035; 95% CI, 1.099-13.686). In multivariate analysis, PLR was also the only independent predictor of ≥T2 stage(OR, 8.736; P=0.023; 95% CI, 1.346-56.685).

Conclusion:

Compared with other studies to assess the relationship between novel inflammatory biomarkers and survival outcome, this is the first study for evaluation about pathologic T stage on UTUC. In summary, PLR was noted to be an independent predictor of muscle invasive UTUC in our study. It may alter our treatment protocol in some patients.