Prognostic significance of inflammation-based prognostic scoring in patients with upper urinary tract urothelial carcinoma

Suyama, Taisuke; Kanbe, Shigeki; Maegawa, Masanobu; Shimizu, Hirofumi; Nakajima, Koichi

doi:10.1590/S1677-5538.IBJU.2018.0251

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Original Article • IBJUInt. braz j urol 45 (3) • May-Jun 2019 • https://doi.org/10.1590/S1677-5538.IBJU.2018.0251 copy

Prognostic significance of inflammation-based prognostic scoring in patients with upper urinary tract urothelial carcinoma

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objectives:

To investigate whether Glasgow Prognostic Score has prognostic significance in patients with upper urinary urothelial carcinoma.

Patients and methods:

We retrospectively reviewed the clinical records of 74 patients with upper urinary urothelial carcinoma. We set the cut-off value for C-reactive protein as 1.0mg/dL, and 3.5mg/dL for albumin as Glasgow Prognostic Score. Their blood data including albumin and C-reactive protein for Glasgow Prognostic Score and cytokeratin 19 fragment 21-1 as a tumor marker were measured before starting treatment. The patients were stratified into three groups with Glasgow Prognostic Score: The Group-1, albumin ≥3.5g/dL and C-reactive protein < 1.0mg/dL; Group-2, albumin < 3.5g/dL or C-reactive protein ≥1.0mg/dL; Group-3, albumin < 3.5g/dL and C-reactive protein ≥1.0mg/dL.

Results:

The median follow-up for all patients was 26.9 months (range: 10.9-91.1 months), during which 37 (50%) patients died. There was a significant difference in the estimated survival rate among the 3 groups stratified by Glasgow Prognostic Score. The estimated survival rate in the Group-1 was significantly higher than those in Groups 2 and 3.

In the univariate analysis C-reactive protein, serum cytokeratin 19 fragment 21-1 and Glasgow Prognostic Score were significant predictors of overall survival. On the multivariate analysis, serum cytokeratin 19 fragment 21-1 and Glasgow Prognostic Score were independently associated with shorter overall survival.

Conclusion:

Our review suggests Glasgow Prognostic Score may play as a prognostic predictor for upper urinary urothelial carcinoma.

Keywords:
C-Reactive Protein; Keratin-19; Biomarkers; Urinary Tract

	All cases N = 74	Overall Death N = 37	Alive N = 37	P values
Age, years	71.7±9.2	72.6±8.4	70.8±9.9	0.39 ¹⁾ 1) unpaired t test,
Male	43 (58.0)	20 (54.1)	23 (62.2)	0.63 ²⁾ 2) Fisher's exact test,
BMI, kg/m²	21.2±2.6	21.3±3.2	21.2±2.0	0.76 ¹⁾ 1) unpaired t test,
Albumin, g/dL	3.98±0.45	3.98±0.50	3.99±0.41	0.86 ¹⁾ 1) unpaired t test,
WBC, /μL	7368±2330	7828±2437	6907±02153	0.089 ¹⁾ 1) unpaired t test,
Platelet, x10³/μL	218±68	227±78	210±55	0.280 ¹⁾ 1) unpaired t test,
NLR	4.77 [3.59-6.10]	4.82 [2.70-7.39]	4.74 [3.74-5.43]	0.717 ³⁾ 3) Mann-Whitney test. BMI indicates body mass index; GPS, Glasgow prognostic score (1: Albumin ≥3.5 g/dL and CRP <1.0 mg/dL, 2: Albumin <3.5 g/dL or CRP ≥1.0 mg/dL, 3: Albumin <3.5 g/dL and CRP ≥1.0 mg/dL).
CRP, mg/dL	0.20 [0.10-0.70]	0.50 [0.10-1.00]	0.10 [0.10-0.30]	0.002 ³⁾ 3) Mann-Whitney test. BMI indicates body mass index; GPS, Glasgow prognostic score (1: Albumin ≥3.5 g/dL and CRP <1.0 mg/dL, 2: Albumin <3.5 g/dL or CRP ≥1.0 mg/dL, 3: Albumin <3.5 g/dL and CRP ≥1.0 mg/dL).
GPS, 1/2/3	55/15/4	22/11/4	33/4/0	0.003 ³⁾ 3) Mann-Whitney test. BMI indicates body mass index; GPS, Glasgow prognostic score (1: Albumin ≥3.5 g/dL and CRP <1.0 mg/dL, 2: Albumin <3.5 g/dL or CRP ≥1.0 mg/dL, 3: Albumin <3.5 g/dL and CRP ≥1.0 mg/dL).
CYFRA, ng/mL	5.97 [1.75-12.27]	6.13 [3.50-30.67]	2.30 [1.50-6.13]	<0.001 ³⁾ 3) Mann-Whitney test. BMI indicates body mass index; GPS, Glasgow prognostic score (1: Albumin ≥3.5 g/dL and CRP <1.0 mg/dL, 2: Albumin <3.5 g/dL or CRP ≥1.0 mg/dL, 3: Albumin <3.5 g/dL and CRP ≥1.0 mg/dL).
Follow-up, month	26.9 [10.9-91.1]	16.0 [8.8-50.3]	50.7 [22.7-97.0]	0.005 ³⁾ 3) Mann-Whitney test. BMI indicates body mass index; GPS, Glasgow prognostic score (1: Albumin ≥3.5 g/dL and CRP <1.0 mg/dL, 2: Albumin <3.5 g/dL or CRP ≥1.0 mg/dL, 3: Albumin <3.5 g/dL and CRP ≥1.0 mg/dL).

Variables	Univariable Analysis		Multivariable Analysis
Variables	HR (95%CI)	P values	HR (95%CI)	P values
Age ≥70 years	2.02 (1.03 – 3.97)	0.04	1.76 (0.86 – 3.58)	0.12
Male	0.85 (0.45 - 1.64)	0.63	1.14 (0.58 - 2.24)	0.71
Albumin <3.5 g/dL	1.91 (0.78 - 4.64)	0.15	NA
CRP ≥1.0 mg/dL	3.26 (1.64 - 6.48)	0.001	NA
CYFRA ≥6.0 mg/dL^* * The median value in all patients.	2.01 (1.02 – 3.96)	<0.001	2.07 (1.05 – 4.08)	0.03
GPS	2.54 (1.55 – 4.14)	<0.001	2.28 (1.33 – 3.91)	0.003
Group 1	reference (1.00)		reference (1.00)
Group 2	2.82 (0.88 - 9.06)	0.08	3.14 (0.88 - 11.16)	0.07
Group 3	6.68 (2.24 - 19.93)	0.001	6.18 (1.85 - 20.60)	0.003

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[1] Correspondence address: Taisuke Suyama, MD Department of Genitourinary, Sanaikai General Hospital (IMS) 3-7-17 Hikonari Misato, Saitama 341-0003, Japan Fax: +81 48 958-6835 E-mail: tsuyama-jua@umin.ac.jp