title: Risk stratification model, including preoperative serum C-reactive protein and estimated glomerular filtration rate levels, in patients with upper urinary tract urothelial carcinoma undergoing radical nephroureterectomy.
abstract: OBJECTIVE
  To investigate the prognostic indicators, including clinicopathological and preoperative hematological factors, in patients undergoing radical nephroureterectomy (RNU) for upper urinary tract urothelial carcinoma (UTUC), and to develop a prognostic factor-based risk stratification model.
  
  
  METHODS
  The clinicopathological data and preoperative parameters were collected from 345 UTUC patients treated with RNU without neoadjuvant therapy, retrospectively. The prognostic values of preoperative hematological parameters and clinicopathological factors were evaluated. Then, a risk stratification model was developed to predict poor survival after RNU using the regression coefficients of multivariate analysis.
  
  
  RESULTS
  In multivariate analysis, high serum C-reactive protein (CRP) levels (≥0.5 mg/dl), low estimated glomerular filtration rate (eGFR) levels (<50 ml/min/1.73 m(2)), Eastern Cooperative Oncology Group Performance status ≥1, number of tumor foci >1, tumor grade (G3), positive LN, and positive surgical margin were independent factors predicting poor cancer-specific survival (CSS). Patients were stratified into three groups, and the risk stratification model revealed significant differences in CSS between the three subgroups. The 5-year CSS in patients at low, intermediate, and high risk was 92.7, 75.4, and 31.5 %, respectively.
  
  
  CONCLUSIONS
  This study indicates that preoperative hematological markers, such as low eGFR and high CRP levels predict a poor survival in patients with UTUC. Our risk stratification model may provide physicians with useful prognostic information for identifying patients who may be candidates for multimodal treatment.
authors.affiliation: Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, 86 Nishi-cho, Yonago, Tottori, 683-8504, Japan.
authors.forename: Shuichi
authors.initials: S
authors.lastname: Morizane
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Yumioka
authors.forename: Noriya
authors.initials: N
authors.lastname: Yamaguchi
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Masago
authors.forename: Masashi
authors.initials: M
authors.lastname: Honda
authors.forename: Takehiro
authors.initials: T
authors.lastname: Sejima
authors.forename: Atsushi
authors.initials: A
authors.lastname: Takenaka
mesh_terms: D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism*; D002295:Carcinoma, Transitional Cell / Q000097:blood* / Q000503:physiopathology / Q000601:surgery; D015653:Cystectomy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D008297:Male; D009392:Nephrectomy; D057234:Preoperative Period; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D013997:Time Factors; D014513:Ureter / Q000601:surgery*; D014571:Urologic Neoplasms / Q000097:blood* / Q000503:physiopathology / Q000601:surgery
chemical_list: D014408:Biomarkers, Tumor; D002097:C-Reactive Protein