Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of the Geriatric Medicine, Chinese Academy of Medical Sciences, No. 1 DaHua Road, Dong Dan, Beijing, 100730, People's Republic of China.
Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China.
Eur J Med Res. 2023 Oct 28;28(1):469. doi: 10.1186/s40001-023-01295-0.
Oxidative stress plays an important role in the occurrence and development of malignancy. However, the relationship between oxidative stress and upper urinary tract urothelial carcinoma (UTUC) prognosis remains elusive. This study aimed to evaluate the prognostic value of systematic oxidative stress indices as a predictor of patient outcomes in UTUC after radical nephroureterectomy.
Clinical data for 483 patients with UTUC who underwent radical nephroureterectomy were analyzed. Patients were categorized according to an optimal value of systematic oxidative stress indices (SOSIs), including fibrinogen (Fib), gamma-glutamyl transpeptidase (γ-GGT), creatinine (CRE), lactate dehydrogenase (LDH) and albumin (ALB). Kaplan-Meier analyses were used to investigate associations of SOSIs with overall survival (OS) and progression-free survival (PFS). Moreover, associations between SOSIs and OS and PFS were assessed with univariate and multivariate analyses.
High values of Fib, γ-GGT, CRE, and LDH, and low values of ALB were associated with reduced OS. SOSIs status correlated with age, tumor site, surgical approach, hydronephrosis, tumor size, T stage, and lymph node status. The Kaplan-Meier survival analysis showed a significant discriminatory ability for death and progression risks in the two groups based on SOSIs. Multivariate Cox proportional hazards models showed that SOSIs were an independent prognostic indicator for OS (p = 0.007) and PFS (p = 0.021). SOSIs and clinical variables were selected to establish a nomogram for OS. The 1-, 3-, and 5-year AUC values were 0.77, 0.78, and 0.81, respectively. Calibration curves of the nomogram showed high consistencies between the predicted and observed survival probability. Decision curve analysis curves showed that the nomogram could well predict the 1-year, 3-year, and 5-year OS.
SOSIs are an independent unfavorable predictor of OS and PFS in patients diagnosed with UTUC undergoing RNU. Therefore, incorporating SOSIs into currently available clinical parameters may improve clinical decision-making.
氧化应激在恶性肿瘤的发生和发展中起着重要作用。然而，氧化应激与上尿路上皮癌（UTUC）预后之间的关系仍不清楚。本研究旨在评估系统性氧化应激指标作为预测接受根治性肾输尿管切除术的 UTUC 患者预后的指标的预后价值。
分析了 483 例接受根治性肾输尿管切除术的 UTUC 患者的临床资料。根据系统性氧化应激指标（SOSIs）的最佳值，将患者分为不同组别，包括纤维蛋白原（Fib）、γ-谷氨酰转肽酶（γ-GGT）、肌酐（CRE）、乳酸脱氢酶（LDH）和白蛋白（ALB）。Kaplan-Meier 分析用于研究 SOSIs 与总生存（OS）和无进展生存（PFS）之间的关系。此外，还通过单变量和多变量分析评估了 SOSIs 与 OS 和 PFS 的关系。
高 Fib、γ-GGT、CRE 和 LDH 值以及低 ALB 值与 OS 降低相关。SOSIs 状态与年龄、肿瘤部位、手术方式、肾积水、肿瘤大小、T 分期和淋巴结状态有关。Kaplan-Meier 生存分析显示，基于 SOSIs 的两组之间对死亡和进展风险具有显著的区分能力。多变量 Cox 比例风险模型显示，SOSIs 是 OS（p=0.007）和 PFS（p=0.021）的独立预后指标。SOSIs 和临床变量被选入 OS 列线图模型。1、3 和 5 年 AUC 值分别为 0.77、0.78 和 0.81。列线图的校准曲线显示了预测和观察生存率之间的高度一致性。决策曲线分析曲线显示，该列线图可以很好地预测 1 年、3 年和 5 年 OS。
SOSIs 是接受 RNU 的 UTUC 患者 OS 和 PFS 的独立不利预测指标。因此，将 SOSIs 纳入现有的临床参数中可能会改善临床决策。
