Cargando…
Tumor Necrosis with Adjunction of Preoperative Monocyte-to-Lymphocyte Ratio as a New Risk Stratification Marker Can Independently Predict Poor Outcomes in Upper Tract Urothelial Carcinoma
Objectives: This study aimed at investigating the prognostic impact of tumor necrosis and preoperative monocyte-to-lymphocyte ratio (MLR) in patients treated with radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC). Methods: A total of 521 patients with UTUC treated with RNU...
Autores principales: | , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2021
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8267944/ https://www.ncbi.nlm.nih.gov/pubmed/34279467 http://dx.doi.org/10.3390/jcm10132983 |
_version_ | 1783720255695093760 |
---|---|
author | Lin, Kun-Che Jan, Hau-Chern Hu, Che-Yuan Ou, Yin-Chien Kao, Yao-Lin Yang, Wen-Horng Ou, Chien-Hui |
author_facet | Lin, Kun-Che Jan, Hau-Chern Hu, Che-Yuan Ou, Yin-Chien Kao, Yao-Lin Yang, Wen-Horng Ou, Chien-Hui |
author_sort | Lin, Kun-Che |
collection | PubMed |
description | Objectives: This study aimed at investigating the prognostic impact of tumor necrosis and preoperative monocyte-to-lymphocyte ratio (MLR) in patients treated with radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC). Methods: A total of 521 patients with UTUC treated with RNU from January 2008 to June 2019 at our institution were enrolled. Histological tumor necrosis was defined as the presence of microscopic coagulative necrosis. The optimal value of MLR was determined as 0.4 by receiver operating characteristic (ROC) analysis based on cancer-specific mortality. The Kaplan–Meier method with log-rank test and Cox proportional hazards regression models were performed to evaluate the impact of tumor necrosis and MLR on overall (OS), cancer-specific (CSS), and recurrence-free survival (RFS). Furthermore, ROC analysis was used to estimate the predictive ability of potential prognostic factors for oncological outcomes. Results: Tumor necrosis was present in 106 patients (20%), which was significantly associated with tumor location, high pathological tumor stage, lymph node metastasis, high tumor grade, lymphovascular invasion, tumor size, and increased monocyte counts. On multivariate analysis, the combination of tumor necrosis and preoperative MLR was an independent prognosticator of OS, CSS, and RFS (all p < 0.05). Moreover, ROC analyses revealed the predictive accuracy of a combination of tumor necrosis and preoperative MLR for OS, CSS, and RFS with the area under the ROC curve of 0.745, 0.810, and 0.782, respectively (all p < 0.001). Conclusions: The combination of tumor necrosis and preoperative MLR can be used as an independent prognosticator in patients with UTUC after RNU. The identification of this combination could help physicians to recognize high-risk patients with unfavorable outcomes and devise more appropriate postoperative treatment plans. |
format | Online Article Text |
id | pubmed-8267944 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-82679442021-07-10 Tumor Necrosis with Adjunction of Preoperative Monocyte-to-Lymphocyte Ratio as a New Risk Stratification Marker Can Independently Predict Poor Outcomes in Upper Tract Urothelial Carcinoma Lin, Kun-Che Jan, Hau-Chern Hu, Che-Yuan Ou, Yin-Chien Kao, Yao-Lin Yang, Wen-Horng Ou, Chien-Hui J Clin Med Article Objectives: This study aimed at investigating the prognostic impact of tumor necrosis and preoperative monocyte-to-lymphocyte ratio (MLR) in patients treated with radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC). Methods: A total of 521 patients with UTUC treated with RNU from January 2008 to June 2019 at our institution were enrolled. Histological tumor necrosis was defined as the presence of microscopic coagulative necrosis. The optimal value of MLR was determined as 0.4 by receiver operating characteristic (ROC) analysis based on cancer-specific mortality. The Kaplan–Meier method with log-rank test and Cox proportional hazards regression models were performed to evaluate the impact of tumor necrosis and MLR on overall (OS), cancer-specific (CSS), and recurrence-free survival (RFS). Furthermore, ROC analysis was used to estimate the predictive ability of potential prognostic factors for oncological outcomes. Results: Tumor necrosis was present in 106 patients (20%), which was significantly associated with tumor location, high pathological tumor stage, lymph node metastasis, high tumor grade, lymphovascular invasion, tumor size, and increased monocyte counts. On multivariate analysis, the combination of tumor necrosis and preoperative MLR was an independent prognosticator of OS, CSS, and RFS (all p < 0.05). Moreover, ROC analyses revealed the predictive accuracy of a combination of tumor necrosis and preoperative MLR for OS, CSS, and RFS with the area under the ROC curve of 0.745, 0.810, and 0.782, respectively (all p < 0.001). Conclusions: The combination of tumor necrosis and preoperative MLR can be used as an independent prognosticator in patients with UTUC after RNU. The identification of this combination could help physicians to recognize high-risk patients with unfavorable outcomes and devise more appropriate postoperative treatment plans. MDPI 2021-07-03 /pmc/articles/PMC8267944/ /pubmed/34279467 http://dx.doi.org/10.3390/jcm10132983 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Article Lin, Kun-Che Jan, Hau-Chern Hu, Che-Yuan Ou, Yin-Chien Kao, Yao-Lin Yang, Wen-Horng Ou, Chien-Hui Tumor Necrosis with Adjunction of Preoperative Monocyte-to-Lymphocyte Ratio as a New Risk Stratification Marker Can Independently Predict Poor Outcomes in Upper Tract Urothelial Carcinoma |
title | Tumor Necrosis with Adjunction of Preoperative Monocyte-to-Lymphocyte Ratio as a New Risk Stratification Marker Can Independently Predict Poor Outcomes in Upper Tract Urothelial Carcinoma |
title_full | Tumor Necrosis with Adjunction of Preoperative Monocyte-to-Lymphocyte Ratio as a New Risk Stratification Marker Can Independently Predict Poor Outcomes in Upper Tract Urothelial Carcinoma |
title_fullStr | Tumor Necrosis with Adjunction of Preoperative Monocyte-to-Lymphocyte Ratio as a New Risk Stratification Marker Can Independently Predict Poor Outcomes in Upper Tract Urothelial Carcinoma |
title_full_unstemmed | Tumor Necrosis with Adjunction of Preoperative Monocyte-to-Lymphocyte Ratio as a New Risk Stratification Marker Can Independently Predict Poor Outcomes in Upper Tract Urothelial Carcinoma |
title_short | Tumor Necrosis with Adjunction of Preoperative Monocyte-to-Lymphocyte Ratio as a New Risk Stratification Marker Can Independently Predict Poor Outcomes in Upper Tract Urothelial Carcinoma |
title_sort | tumor necrosis with adjunction of preoperative monocyte-to-lymphocyte ratio as a new risk stratification marker can independently predict poor outcomes in upper tract urothelial carcinoma |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8267944/ https://www.ncbi.nlm.nih.gov/pubmed/34279467 http://dx.doi.org/10.3390/jcm10132983 |
work_keys_str_mv | AT linkunche tumornecrosiswithadjunctionofpreoperativemonocytetolymphocyteratioasanewriskstratificationmarkercanindependentlypredictpooroutcomesinuppertracturothelialcarcinoma AT janhauchern tumornecrosiswithadjunctionofpreoperativemonocytetolymphocyteratioasanewriskstratificationmarkercanindependentlypredictpooroutcomesinuppertracturothelialcarcinoma AT hucheyuan tumornecrosiswithadjunctionofpreoperativemonocytetolymphocyteratioasanewriskstratificationmarkercanindependentlypredictpooroutcomesinuppertracturothelialcarcinoma AT ouyinchien tumornecrosiswithadjunctionofpreoperativemonocytetolymphocyteratioasanewriskstratificationmarkercanindependentlypredictpooroutcomesinuppertracturothelialcarcinoma AT kaoyaolin tumornecrosiswithadjunctionofpreoperativemonocytetolymphocyteratioasanewriskstratificationmarkercanindependentlypredictpooroutcomesinuppertracturothelialcarcinoma AT yangwenhorng tumornecrosiswithadjunctionofpreoperativemonocytetolymphocyteratioasanewriskstratificationmarkercanindependentlypredictpooroutcomesinuppertracturothelialcarcinoma AT ouchienhui tumornecrosiswithadjunctionofpreoperativemonocytetolymphocyteratioasanewriskstratificationmarkercanindependentlypredictpooroutcomesinuppertracturothelialcarcinoma |