Gwak Chan Hoon, Suh Jungyo, Lim Bumjin, Song Cheryn, You Dalsan, Jeong In Gab, Hong Jun Hyuk, Hong Bumsik, Ahn Hanjong
Department of Urology, Asan Medical Center, Ulsan University College of Medicine, Seoul, South Korea.
Department of Urology, Asan Medical Center, Ulsan University College of Medicine, Seoul, South Korea.
Urol Oncol. 2024 Feb;42(2):30.e17-30.e23. doi: 10.1016/j.urolonc.2023.10.011. Epub 2023 Dec 9.
This study aimed to evaluate the prognostic impact of the preoperative C-reactive protein to albumin ratio (CAR) on progression-free survival (PFS) and cancer-specific survival (CSS) in patients with upper urinary tract urothelial carcinoma (UTUC) undergoing radical nephroureterectomy (RNU).
A retrospective analysis was conducted using data from a single-center nephroureterectomy registry between January 2011 and December 2017. Participants were categorized into high and low CAR groups based on the optimal CAR cut-off value determined using the Youden index. The primary endpoint was PFS, the time from RNU to metastasis or disease recurrence. The secondary endpoint was CSS, the time from RNU to UTUC-related death. Median PFS and CSS were compared between the high and low CAR groups using Kaplan-Meier analysis and log-rank test. Multivariable Cox proportional hazard regression analysis was performed to assess the prognostic significance of CAR, adjusting for known prognostic factors.
We included 491 patients with UTUC in the analysis. The optimal CAR cut-off value was determined to be 0.036, which resulted in classifying 49.3% (242/491) of patients into the high CAR group. The high CAR group had older patients (69.8 vs. 67.4, p-value = 0.01), advanced T and N stages (p-value<0.001), high-grade tumor (p-value = 0.03), and a higher incidence of preoperative hydronephrosis (p-value < 0.01) than the low CAR group. The high CAR group demonstrated significantly inferior median PFS (78.3 vs. 100.3 months, p-value < 0.01) and CSS (73.2 vs. 96.1 months, p-value < 0.01) than the low CAR group. Moreover, high CAR independently increased the risk of disease progression (hazard ratio [HR]: 1.80, 95% confidence interval [CI]: 1.23-2.64, p < 0.01) and UTUC-related mortality (HR: 1.79, 95% CI: 1.15, p < 0.01).
Pre-operative CAR is independently associated with poor PFS and CSS in patients with UTUC undergoing RNU. Moreover, CAR may be an independent UTUC prognostic factor, offering a cost-effective and minimally invasive marker. However, further validation through large-scale, multi-center studies is necessary to confirm these findings and determine the optimal CAR cut-off value.
本研究旨在评估术前C反应蛋白与白蛋白比值（CAR）对上尿路尿路上皮癌（UTUC）患者行根治性肾输尿管切除术（RNU）后的无进展生存期（PFS）和癌症特异性生存期（CSS）的预后影响。
使用2011年1月至2017年12月单中心肾输尿管切除术登记处的数据进行回顾性分析。根据使用约登指数确定的最佳CAR临界值，将参与者分为高CAR组和低CAR组。主要终点是PFS，即从RNU到转移或疾病复发的时间。次要终点是CSS，即从RNU到UTUC相关死亡的时间。使用Kaplan-Meier分析和对数秩检验比较高CAR组和低CAR组的中位PFS和CSS。进行多变量Cox比例风险回归分析，以评估CAR的预后意义，并对已知的预后因素进行调整。
我们纳入了491例UTUC患者进行分析。确定最佳CAR临界值为0.036，这导致49.3%（242/491）的患者被归类为高CAR组。高CAR组患者年龄较大（69.8岁对67.4岁，p值 = 0.01），T和N分期较晚（p值<0.001），肿瘤分级较高（p值 = 0.03），术前肾积水发生率较高（p值<0.01），均高于低CAR组。高CAR组的中位PFS（78.3个月对100.3个月，p值<0.01）和CSS（73.2个月对96.1个月，p值<0.01）明显低于低CAR组。此外，高CAR独立增加疾病进展风险（风险比[HR]：1.80，95%置信区间[CI]：1.23 - 2.64，p < 0.01）和UTUC相关死亡率（HR：1.79，95% CI：1.15，p < 0.01）。
术前CAR与行RNU的UTUC患者的不良PFS和CSS独立相关。此外，CAR可能是一个独立的UTUC预后因素，提供了一种经济有效且微创的标志物。然而，需要通过大规模、多中心研究进行进一步验证，以证实这些发现并确定最佳CAR临界值。
