title: Preoperative prognostic factors after radical nephroureterectomy in patients with upper urinary tract urothelial carcinoma.
abstract: OBJECTIVE
  To evaluate the clinical significance of preoperative biomarkers such as laboratory data, Eastern Cooperative Oncology Group Performance Status (ECOG PS) and clinicopathological factors in patients undergoing radical nephroureterectomy for upper urinary tract urothelial carcinoma.
  
  
  METHODS
  Between 1995 and 2011, a total of 99 patients treated at our institution for upper urinary tract urothelial carcinoma were enrolled in this study. The prognostic significance of various preoperative data and clinicopathological factors were analyzed. Univariate and multivariate analyses were performed using the Kaplan-Meier method with the log-rank test and a Cox proportional hazards regression model.
  
  
  RESULTS
  Median patient age was 73 years (range 44-86 years), and the median follow-up period after radical nephroureterectomy was 37.9 months (range 6.6-171.4 months). The 5-year intravesical recurrence-free survival and cancer-specific survival estimates were 47.1 and 70.0 %, respectively. On multivariate analysis, concomitant bladder carcinoma was an independent predictor of intravesical recurrence (hazard ratio 3.689; P = 0.002), and infiltration (hazard ratio 14.842; P = 0.002), preoperative serum creatinine level (hazard ratio 9.992; P = 0.005), preoperative serum hemoglobin level (hazard ratio 6.370; P = 0.018) and ECOG PS (hazard ratio 4.326; P = 0.037) were associated with worse cancer-specific survival. This study is limited by biases associated with its retrospective design.
  
  
  CONCLUSIONS
  This study indicates that not only clinicopathological factors, but also preoperative biomarkers, such as serum creatinine and hemoglobin levels and ECOG PS, predict a poor survival in patients with upper urinary tract urothelial carcinoma.
authors.affiliation: Faculty of Medicine, Tottori University, Yonago, Japan. morizane@med.tottori-u.ac.jp
authors.forename: Shuichi
authors.initials: S
authors.lastname: Morizane
authors.forename: Hideto
authors.initials: H
authors.lastname: Iwamoto
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Masago
authors.forename: Akihisa
authors.initials: A
authors.lastname: Yao
authors.forename: Tadahiro
authors.initials: T
authors.lastname: Isoyama
authors.forename: Takehiro
authors.initials: T
authors.lastname: Sejima
authors.forename: Atsushi
authors.initials: A
authors.lastname: Takenaka
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000097:blood*; D002277:Carcinoma / Q000473:pathology / Q000601:surgery*; D003404:Creatinine / Q000097:blood*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006454:Hemoglobins / Q000378:metabolism*; D006801:Humans; D053208:Kaplan-Meier Estimate; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009392:Nephrectomy; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014513:Ureter / Q000601:surgery; D014516:Ureteral Neoplasms / Q000473:pathology / Q000601:surgery*; D001749:Urinary Bladder Neoplasms / Q000150:complications*; D019459:Urothelium
chemical_list: D014408:Biomarkers, Tumor; D006454:Hemoglobins; D003404:Creatinine