血液細胞相關之發炎指標對上尿路上皮癌預後之重要性
葉信志1,2,3、吳文正1,2,3、李經家1,2,3、黃俊農2、柯宏龍2,3、李威明2,3,4、李香瑩1,2,3
1高雄市立大同醫院 泌尿科；2高雄醫學大學附設中和紀念醫院 泌尿科；3高雄醫學大學 醫學研究所；4衛生福利部屏東醫院 泌尿科
The prognostic significance of inflammation-associated blood cell markers in patients with upper tract urothelial carcinoma
Hsin-Chih Yeh1,2,3, Wen-Jeng Wu1,2,3, Ching-Chia Li1,2,3, Chun-Nung Huang2, Hung-Lung Ke2,3, Wei-Ming Li2,3,4, Hsiang-Ying Lee1,2,3
1Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan; 2Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; 3Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; 4Department of Urology, Ministry of Health and Welfare Pingtung Hospital, Pingtung, Taiwan
Purpose: Inflammation-related parameters based on blood cells, including white blood cell (WBC) count, neutrophil-lymphocyte ratio, platelet count, and red cell distribution width (RDW), have been shown to be associated with prognosis in many cancers. We aimed to evaluate these inflammation-associated markers simultaneously in upper tract urothelial carcinoma (UTUC).
Materials and Methods: A total of 195 patients with UTUC who received radical nephroureterectomy between 2005 and 2010 were included retrospectively as the derivation cohort to investigate the impact of inflammation markers on overall survival (OS) and cancer-specific survival (CSS). In turn, another independent set of 225 patients were used for validation. Finally, we performed survival analysis in the combined cohort consisting of 420 UTUC patients.
Results: The predictive value of RDW and WBC count on outcome was replicable in different cohorts. Multivariate analysis showed high RDW was independently associated with poor OS (P < 0.001), and WBC count was a significant prognosticator for both OS and CSS (both P < 0.001). In subgroup analysis, we found the prognostic significance of RDW for OS was limited in organ-confined disease (≤pT2 without pN+). More importantly, a clear survival difference can be demonstrated by combining RDW and WBC count with other known prognostic factors in the risk stratification model.
Conclusion: RDW and WBC count have the advantage of their common accessibility and are useful markers to predict outcome of UTUC in the preoperative setting. RDW and WBC count could provide additional prognostic value and help physicians identify patients at high risk for mortality and formulate individualized treatment strategy.