Zheng Lei, Ye Jianjun, Wang Qihao, Wu Qiyou, Chen Kai, Wei Qiang, Bao Yige
Department of Urology and Institute of Urology, West China Hospital, Sichuan University, Chengdu, China; West China School of Medicine, Sichuan University, Chengdu, China; Department of Urology, People's Hospital of Tibet Autonomous Region, Lhasa, China.
Department of Urology and Institute of Urology, West China Hospital, Sichuan University, Chengdu, China; West China School of Medicine, Sichuan University, Chengdu, China.
Clin Genitourin Cancer. 2025 Aug;23(4):102352. doi: 10.1016/j.clgc.2025.102352. Epub 2025 Apr 15.
The aim of this study was to determine the impact of the preoperative creatinine-cystatin C ratio (CCR) on the survival prognosis of patients following radical nephrectomy (RNU) for upper tract urothelial carcinoma (UTUC).
The retrospective analysis was conducted on UTUC patients who underwent radical nephrectomy (RNU) at West China Hospital between January 2009 and December 2019. The endpoint of the study was cancer-specific survival (CSS). Kaplan-Meier curves were used to estimate survival, and Cox proportional hazards modelling was used to assess risk. Nomograms were developed to predict CSS at 3 and 5 years of age, and the predictive power was assessed.
A critical CCR of 59.61 µmol/mg was demonstrated to affect 504 patients with UTUC who had undergone RNU. A correlation was identified between a lower preoperative CCR and a considerably worse CSS. In patients with UTUC, CCR was identified as an independent risk factor for CSS, particularly in patients with locally advanced UTUC (pT ≥ 3) (HR: 1.84, 95% CI: 1.14, 2.97). Moreover, the CCR-based nomogram exhibited robust predictive capacity, with areas under the curve for the 3- and 5-year CSS reaching 0.823 and 0.793, respectively.
Preoperative CCR is an independent predictor of CSS in UTUC patients receiving RNU treatment. As such, it should be viewed as a potentially useful customized tool in therapeutic decision-making.
本研究旨在确定术前肌酐-胱抑素C比值（CCR）对上尿路尿路上皮癌（UTUC）患者根治性肾切除术（RNU）后生存预后的影响。
对2009年1月至2019年12月在四川大学华西医院接受根治性肾切除术（RNU）的UTUC患者进行回顾性分析。研究的终点是癌症特异性生存（CSS）。采用Kaplan-Meier曲线估计生存率，采用Cox比例风险模型评估风险。绘制列线图以预测3岁和5岁时的CSS，并评估预测能力。
504例接受RNU的UTUC患者的临界CCR为59.61µmol/mg。术前CCR较低与CSS明显较差之间存在相关性。在UTUC患者中，CCR被确定为CSS的独立危险因素，尤其是在局部晚期UTUC（pT≥3）患者中（HR：1.84，95%CI：1.14，2.97）。此外，基于CCR的列线图显示出强大的预测能力，3年和5年CSS的曲线下面积分别达到0.823和0.793。
术前CCR是接受RNU治疗的UTUC患者CSS的独立预测因子。因此，它应被视为治疗决策中潜在有用的定制工具。
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