title: Risk group stratification based on preoperative factors to predict survival after nephroureterectomy in patients with upper urinary tract urothelial carcinoma.
abstract: BACKGROUND
  After radical nephroureterectomy (RNU), substantial numbers of patients with upper urinary tract urothelial carcinoma (UUT-UC) are ineligible for adjuvant chemotherapy owing to diminished renal function. Accurate preoperative prediction of survival is considered important because neoadjuvant chemotherapy may be as effective for high-risk UUT-UC as for muscle-invasive bladder cancer. We performed risk group stratification to predict survival based on specific preoperative factors.
  
  
  METHODS
  We enrolled 536 UUT-UC patients treated with RNU in this retrospective cohort study and assessed preoperative clinical and laboratory variables influencing disease-specific survival.
  
  
  RESULTS
  The median follow-up was 40.9 months. Using univariate analysis, tumor location; number of tumors; hydronephrosis; clinical T stage; clinical N category; voided urine cytology; neoadjuvant chemotherapy; hemoglobin; white blood cell (WBC) counts; and C-reactive protein had a significant influence on disease-specific survival (P < 0.05). Multivariate analysis revealed that clinical T stage, voided urine cytology, and WBC were independent predictors (P = 0.041, P = 0.020, and P = 0.017, respectively). We divided patients into three risk groups based on the number of the three independent predictors: 0, low risk; 1, intermediate risk; 2 and 3, high risk. Significant differences in disease-specific survival were found among these risk groups (P ≤ 0.0047).
  
  
  CONCLUSIONS
  Our results suggest that risk group stratification based on preoperative clinical T stage, voided urine cytology, and WBC counts may be useful for selection of UUT-UC patients for neoadjuvant chemotherapy. Prospective studies with larger numbers of patients and a longer follow-up period are needed to confirm our results.
authors.affiliation: Department of Urology, Graduate School of Medicine, Yamaguchi University, Ube, Yamaguchi, Japan, shigerus@yamaguchi-u.ac.jp.
authors.forename: Shigeru
authors.initials: S
authors.lastname: Sakano
authors.forename: Hideyasu
authors.initials: H
authors.lastname: Matsuyama
authors.forename: Yoriaki
authors.initials: Y
authors.lastname: Kamiryo
authors.forename: Shigeaki
authors.initials: S
authors.lastname: Hayashida
authors.forename: Norio
authors.initials: N
authors.lastname: Yamamoto
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Kaneda
authors.forename: Takahito
authors.initials: T
authors.lastname: Nasu
authors.forename: Osamu
authors.initials: O
authors.lastname: Hashimoto
authors.forename: Keiji
authors.initials: K
authors.lastname: Joko
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Baba
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Shimabukuro
authors.forename: Akinobu
authors.initials: A
authors.lastname: Suga
authors.forename: Mitsutaka
authors.initials: M
authors.lastname: Yamamoto
authors.forename: Akihiko
authors.initials: A
authors.lastname: Aoki
authors.forename: Kimio
authors.initials: K
authors.lastname: Takai
authors.forename: Satoru
authors.initials: S
authors.lastname: Yoshihiro
authors.forename: Masafumi
authors.initials: M
authors.lastname: Matsumura
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000378:metabolism*; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000401:mortality*; D011300:Preoperative Care; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D014571:Urologic Neoplasms / Q000378:metabolism* / Q000401:mortality* / Q000628:therapy
chemical_list: D014408:Biomarkers, Tumor