|کد مقاله||کد نشریه||سال انتشار||مقاله انگلیسی||ترجمه فارسی||نسخه تمام متن|
|6193914||1259331||2016||8 صفحه PDF||سفارش دهید||دانلود رایگان|
- Preoperative risk stratification of high-grade UTUC can delineate neoadjuvant chemotherapy use.
- Elevated alkaline phosphatase (ALP) and low albumin levels best correlate with poor prognosis.
- A preoperative prognostic model is improved with addition of a combined ALP and albumin score.
IntroductionThe role of preoperative serum-based markers in predicting survival outcomes of patients has been reported for several cancer types; however, their association with upper tract urothelial carcinoma (UTUC) prognosis is unclear. We evaluated the role of systemic serum-based markers in predicting adverse pathological features and survival outcomes in patients surgically treated for high-grade (HG) UTUC.MethodsWe retrospectively reviewed all patients undergoing surgery for HG UTUC between June 2006 and July 2013 at our institution. Comprehensive clinicopathologic data and preoperative serum-based markers including hemoglobin, white blood cell count, platelet count, serum albumin, calcium, and liver function tests were recorded. Associations of serum markers with pathologic features and recurrence-free survival (RFS) were determined by logistic and Cox regression analyses, respectively. The concordance index for the oncologic outcomes model was determined.ResultsIn total, 101 patients were identified with a median follow-up of 18.5 months (range: 1-74Â mo). In all, 60% of patients had pT2 or less and 11% had nodal metastases. Preoperative elevated alkaline phosphatase (ALP) (â¥116Â IU/l) was associated with multiple adverse pathologic features including advanced T stage, lymphovascular invasion, and histologic necrosis. On univariate analysis, serum markers independently associated with RFS included hemoglobinâ¤12.9 (hazards ratio [HR] = 2.51; 95% CI: 1.17-5.36, P = 0.018), albuminâ¤4Â g/dl (HR = 4.4; 95% CI: 2.04-9.30; P<0.0001), ALPâ¥116Â U/l (HR = 13.3; 95% CI: 5.3-33.52, P<0.0001), alanine transaminaseâ¥27 (HR = 2.63, 95% CI: 1.11-6.21, P = 0.028), serum aspartate transaminaseâ¥20 (HR = 2.21, 95% CI: 1.04-4.69, P = 0.038), and corrected calciumâ¥9.3 (HR = 2.45, 95% CI: 1.01-5.93, P = 0.047). The 2 strongest predictors, albumin and ALP, were combined to form an AA score (range: 0-2), which improved the baseline preoperative clinical model concordance index for prediction of RFS from 0.626 to 0.799.ConclusionIn HG UTUC, elevated preoperative ALP was associated with adverse pathologic features. Additionally, elevated ALP and low albumin were independently associated with worse RFS and overall survival. These serum-based markers are often measured in the preoperative workup of UTUC, and thus they can be included in future prognostic models to risk stratify patients.
Journal: Urologic Oncology: Seminars and Original Investigations - Volume 34, Issue 9, September 2016, Pages 418.e9-418.e16