Hs-CRP,a Potential Prognostic Marker And Recurrence Indicator For Patients With Upper Urinary Tract Urothelial Carcinoma (UUT-UC): A Retrospective Analysis

Background:To explore the predictive value of the preoperative levels of inflammatory markers for the postoperative survival and recurrence in patients with upper urinary tract urothelial carcinoma(UUT-UC).Methods:A total of 103 patients with UUT-UC who underwent radical nephro-ureterectomy with bladder cuff excision at the First Affiliated Hospital of Soochow University between 2007-2015 were selected.After excluding all patients with a history of neoadjuvant chemotherapy,muscle-invasive bladder cancer or metastasis,70 patients with complete serum data and without symptoms of infection were enrolled for the study.The relationship between three inflammatory indicators—hs-CRP,LMR and NLR—and postoperative prognosis,in terms of progression free survival(PFS),overall survival(OS)and tumor recurrence was retrospectively analyzed.Results:The mean age of the patients was 66.1±10.1 years,male to female patient ratio was 39/31,and median follow-up duration was 43(3-130)months.The 3-year PFS and OS were 55.7%and 64.3%respectively.Univariate analysis showed that hs-CRP,NLR,LMR,gender,tumor stage and positive surgery margin were significantly associated with both 3-year PFS(p<0.0001,p=0.0015,p<0.0001,p=0.019,p=0.0024 and p<0.0001 respectively).Hs-CRP,NLR,LMR,gender,age,tumor stage,and positive surgery margin were also statistically significant with 3-year OS(p<0.0001,p=0.0015,p<0.0001,p=0.043,p=0.020,p=0.0005 and p<0.0001 respectively).Multivariate analysis showed that while hs-CRP and LMR were independent prognostic factors for 3-year PFS(p=0.002 and p=0.005),hs-CRP and NLR were predictive of 3-year OS(p<0.0001 and p=0.049).In addition,the patients with high preoperative levels of hs-CRP(≥6.13 mg/L)suffered a higher postoperative recurrence compared to patients with low hs-CRP(81.5%vs 20.9%,p<0.0001).Interestingly,some of these high-risk patients who showed a decrease in postoperative hs-CRP levels were free from tumor relapse(p=0.032),while low-risk patients with an increase in postoperative hs-CRP levels always relapsed(p=0.302).Despite a lack of statistical difference in the pre-and postoperative levels of hs-CRP in the low-risk patients,the postoperative change in hs-CRP is predictive of UUT-UC outcome(p=0.033).Conclusion:Preoperative hs-CRP is not only a prognostic marker but also an indicator of tumor relapse for UUT-UC,thereby underscoring its clinical utility.