Kuroda Kenji, Tasaki Shinsuke, Asakuma Junichi, Horiguchi Akio, Ito Keiichi
Department of Urology, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan.
Mol Clin Oncol. 2021 May;14(5):102. doi: 10.3892/mco.2021.2264. Epub 2021 Mar 13.
It has been previously indicated that preoperative plasma fibrinogen levels can correlate with cancer progression and be used as a useful predictor of lymph node metastasis or its premetastatic status such as lymphovascular invasion (LVI). In the present study, how preoperative plasma fibrinogen levels, considered in conjunction with other clinicopathological factors, can predict the presence of LVI and prognosisin patients with upper urinary tract urothelial carcinoma (UTUC) was examined. Medical records of 145 patients with UTUC who underwent radical nephroureterectomy (RNU) were retrospectively reviewed. The current study evaluated systemic inflammatory response markers including levels of plasma fibrinogen and other clinicopathological factors in orderto determine independent predictors of LVI and prognosis. The Cox proportional hazards model indicated that positive surgical margins and LVI were independent factors for poor cancer-specific survival (CSS) rates and extraurothelial recurrence-free survival (ERFS) rates. In addition, positive cytology, the presence of hydronephrosis and plasma fibrinogen levels were significant preoperative predictors of LVI. Furthermore, patients exhibiting two or more of higher fibrinogen levels (≥400 mg/dl), positive urine cytology and the presence of hydronephrosis were indicated to exhibit worse CSS or ERFS rates compared with patients exhibiting only one of the aforementioned factors or those with none of the three aforementioned factors in the multivariate analysis of the Cox proportional hazards model. In conclusion, hyperfibrinogenemia can be an independent predictor of the presence of LVI, and stratifying preoperative risk using fibrinogen levels, urine cytology and hydronephrosis can serve as the basis for selecting candidates for additional therapy before and/or after RNU in patients with UTUC.
先前已有研究表明，术前血浆纤维蛋白原水平与癌症进展相关，可作为淋巴结转移或其转移前状态（如淋巴管侵犯，LVI）的有效预测指标。在本研究中，我们探讨了术前血浆纤维蛋白原水平与其他临床病理因素相结合时，如何预测上尿路尿路上皮癌（UTUC）患者LVI的存在及预后。我们回顾性分析了145例行根治性肾输尿管切除术（RNU）的UTUC患者的病历。本研究评估了包括血浆纤维蛋白原水平在内的全身炎症反应标志物及其他临床病理因素，以确定LVI和预后的独立预测指标。Cox比例风险模型表明，手术切缘阳性和LVI是癌症特异性生存率（CSS）和非尿路上皮复发生存率（ERFS）较差的独立因素。此外，阳性细胞学检查、肾积水的存在和血浆纤维蛋白原水平是LVI的重要术前预测指标。此外，在Cox比例风险模型的多变量分析中，与仅表现出上述因素之一或无上述三个因素的患者相比，表现出两种或更多高纤维蛋白原水平（≥400mg/dl）、阳性尿细胞学检查和肾积水的患者，其CSS或ERFS较差。总之，高纤维蛋白原血症可能是LVI存在的独立预测指标，利用纤维蛋白原水平、尿细胞学检查和肾积水对术前风险进行分层，可为UTUC患者在RNU术前和/或术后选择额外治疗的候选者提供依据。
