多重焦點性腫瘤併有升高的系統性發炎反應指數可作為上泌尿道上皮癌的獨立預測因子
詹皓程 胡哲源 楊文宏 歐建慧
國立成功大學附設醫院 泌尿部
Multifocal tumors synchronous with elevated systemic inflammation-response index (SIRI) as an indepenfent factor for predicting worse outcomes in upper tract urothelial carcinoma after radical nephroureterectomy
Hau-Chern Jan, Che-Yuan Hu, Wen-Horng Yang, Chien-Hui Ou.
Department of Urology, National Cheng Kung University Hospital, Tainan, Taiwan
Abstract
Purpose
To evaluate the prognostic value of tumor multifocality and preoperative systemic inflammation-response index (SIRI) on oncologic outcomes in patients with upper tract urothelial carcinomas (UTUC) after radical nephroureterectomy (RNU)
Methods and materials
We reviewed the medical records of 515 patients with UTUC treated with RNU between 2007 and 2018. Clinicopathological data were collected retrospectively for analysis. ROC analyses determined the optimal cut-off value of preoperative SIRI as 1.36 according to cancer-specific death. According to tumor multifocality and SIRI, Kaplan-Meier analyses were applied to evaluate overall, cancer-specific (CSS) and progression-free survival (PFS). Univariate and multivariate analyses with Cox regression methods were performed to calculate hazard ratios (HRs) for OS, CSS, and PFS.
Results
Of the 515 patients, 139 (27%) were multifocal tumors and 274 (53%) had high-level SIRI (> 1.36). Kaplan-Meier analysis showed multifocal tumors with high-level SIRI significantly had worse OS, CSS, and PFS (all P < 0.05). Notably, concurrence of multifocal tumors and high-level SIRI independently predicted adverse outcome (hazard ratio = 6.433, P < 0.001 for OS, hazard ratio = 6.445, P < 0.001 for CSS, and hazard ratio = 2.847, P < 0.001 for PFS, respectively) in multivariate Cox proportional hazards models. Otherwise, combined use of tumor multifocality and SIRI was also significantly predictive of inferior survivals in UTUC patients with muscle-invasive or non-organ-confined disease (all P < 0.05).
Conclusions
Multifocal tumors combined with high-level SIRI (>1.36) has been demonstrated to be an independent prognostic factor and enable to predict an unfavorable outcome in UTUC patients treated with RNU. Therefore, the clinical utilization of tumor multifocality and preoperative SIRI is a feasible and useful way to assess survivals and help physicians make appropriate treatment plans for high-risk UTUCs.