Prognostic factors for overall survival in clinical node-positive patients with upper tract urothelial carcinoma
Taishiro Sasahara
Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
Department of Urology, Machida Municipal Hospital, Tokyo, Japan
Search for more papers by this authorCorresponding Author
Takafumi Yanagisawa
Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
Correspondence
Takafumi Yanagisawa M.D., Ph.D., Department of Urology, The Jikei University School of Medicine, 3-19-18, Nishi-shimbashi, Minato-ku, Tokyo 105-8471, Japan.
Email: [email protected]
Search for more papers by this authorShingo Sugaya
Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
Department of Urology, Machida Municipal Hospital, Tokyo, Japan
Search for more papers by this authorAkira Hisakane
Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
Search for more papers by this authorKeigo Sakanaka
Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
Search for more papers by this authorShuhei Hara
Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
Search for more papers by this authorTakashi Otsuka
Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
Search for more papers by this authorShigeaki Takamizawa
Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
Search for more papers by this authorYuji Yata
Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
Search for more papers by this authorYusuke Takahashi
Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
Search for more papers by this authorYuki Takiguchi
Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
Search for more papers by this authorKeiichiro Mori
Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
Search for more papers by this authorShunsuke Tsuzuki
Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
Search for more papers by this authorShoji Kimura
Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
Search for more papers by this authorJun Miki
Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
Search for more papers by this authorTakahiro Kimura
Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
Search for more papers by this authorTaishiro Sasahara
Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
Department of Urology, Machida Municipal Hospital, Tokyo, Japan
Search for more papers by this authorCorresponding Author
Takafumi Yanagisawa
Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
Correspondence
Takafumi Yanagisawa M.D., Ph.D., Department of Urology, The Jikei University School of Medicine, 3-19-18, Nishi-shimbashi, Minato-ku, Tokyo 105-8471, Japan.
Email: [email protected]
Search for more papers by this authorShingo Sugaya
Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
Department of Urology, Machida Municipal Hospital, Tokyo, Japan
Search for more papers by this authorAkira Hisakane
Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
Search for more papers by this authorKeigo Sakanaka
Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
Search for more papers by this authorShuhei Hara
Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
Search for more papers by this authorTakashi Otsuka
Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
Search for more papers by this authorShigeaki Takamizawa
Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
Search for more papers by this authorYuji Yata
Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
Search for more papers by this authorYusuke Takahashi
Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
Search for more papers by this authorYuki Takiguchi
Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
Search for more papers by this authorKeiichiro Mori
Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
Search for more papers by this authorShunsuke Tsuzuki
Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
Search for more papers by this authorShoji Kimura
Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
Search for more papers by this authorJun Miki
Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
Search for more papers by this authorTakahiro Kimura
Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
Search for more papers by this authorAbstract
Background
There is sparse evidence regarding optimal management and prognosticators for oncologic outcomes in patients with clinical node-positive (cN+) upper tract urothelial carcinoma (UTUC).
Methods
We retrospectively analyzed the data from 105 UTUC patients with cN1-2M0 between June 2010 and June 2022 at multiple institutions affiliated with our university. At the time of diagnosis, all patients received standard-of-care treatment including radical nephroureterectomy (RNU), chemotherapy, and/or palliative care. We employed a Cox regression model to analyze the prognostic importance of various factors on overall survival (OS).
Results
Of 105 patients, 54 (51%) underwent RNU, while 51 (49%) did not. RNU was likely to be selected in patients with younger and higher G8 score, resulting in better median OS in patients who underwent RNU than in those who did not (42 months vs. 15 months, p < 0.001). Multivariable analysis among the entire cohort revealed that low G8 score (≤14) (hazard ratio [HR]: 2.07, 95% confidence interval [CI]: 1.08–3.99), elevated pretreatment C-reactive protein (CRP) (HR: 3.35, 95%CI: 1.63–6.90), and failure to perform RNU (HR: 2.16, 95%CI: 1.06–4.42) were independent prognostic factors for worse OS. In the subgroup analyses of cohorts who did not undergo RNU, elevated pretreatment CRP was the only independent prognostic factor for worse OS in cN+ UTUC patients.
Conclusions
RNU seems to be a reasonable treatment option in cN+ UTUC patients where applicable. Elevated pretreatment CRP appears to be a reliable prognosticator of worse OS and may be helpful in optimizing candidate selection for intensified treatment in this setting.
CONFLICT OF INTEREST STATEMENT
Takahiro Kimura is a paid consultant/advisor for Astellas, Bayer, Janssen, and Sanofi. The other authors declare no conflicts of interest associated with this manuscript.
Open Research
DATA AVAILABILITY STATEMENT
NA.
Supporting Information
| Filename | Description |
|---|---|
| iju15380-sup-0001-Supinfo.docxWord 2007 document , 101.7 KB | Tables S1–S2 Figures S1–S2 |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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