術前腎功能及嗜中性球對淋巴球比率對上泌尿道泌尿上皮癌病人於接受根除性腎臟輸尿管切除手術後膀胱內腫瘤復發的影響
鄭琮翰、詹皓程、胡哲源、楊文宏、歐建慧
國立成功大學醫學院附設醫院 泌尿部
The impact of preoperative renal function and neutrophil to lymphocyte ratio on intra-vesical recurrence in patients with upper tract urothelial carcinomas (UTUC) after radical nephroureterectomy (RNU)
Tsung-Han Cheng, Hau-Chern Jan, Che-Yuan Hu, Wen-Horng Yang, Chien-Hui Ou
Department of Urology, National Cheng Kung University Hospital, Tainan, Taiwan
Purpose: To evaluate the influence of preoperative renal function and neutrophil to lymphocyte ratio(NLR) on intra-vesical recurrence (IVR) in patients with upper tract urothelial carcinomas (UTUC) after radical nephroureterectomy (RNU).
Materials and Methods: We reviewed the medical records of 476 patients with UTUC treated with RNU between January 2005 and December 2017. Clinicopathological data were collected retrospectively for analysis. Furthermore, according to preoperative renal function (non-ESRD, including eGFR ≥ 60% and < 60%, and ESRD) and NLR (> 3 and ≤ 3), Kaplan-Meier analyses were performed to evaluate IVR.
Results: Of the 476 patients, 194 (41%) were non-ESRD with eGFR ≥ 60%, 200 (42%) non-ESRD with eGFR < 60%, and 82 (17%) ESRD. Also, NLR > and ≤ 3 were 273 (57%) and 203 (43%), respectively. Renal function was significantly associated with NLR and other parameters, such as age, hypertension or diabetes mellitus, hydronephrosis, previous bladder cancer (BC) history, concomitant BC, tumor location, multifocality, pathological tumor stage, and tumor grade. Kaplan-Meier analysis showed ESRD significantly had a more advanced IVR compared to non-ESRD. Moreover, high NLR had a trend of higher risk of IVR than low NLR. After further stratifying patients based on preoperative renal function and NLR, ESRD had a more advanced IVR than non-ESRD regardless of NLR; when presence of high NLR, non-ESRD with eGFR < 60% significantly had a higher IVR than eGFR ≥ 60%. In addition, subgroup analyses showed there were similar results in patients without previous BC history, concomitant BC or muscle-invasive disease.
Conclusions: Preoperative high NLR (>3) with poor renal function is a significant factor associated with IVR in UTUC patients after RNU. We should provide more careful follow-up and postoperative intra-vesical therapy to avoid bladder recurrence for patients with preoperative elevated NLR and poor renal function.