Prognostic Value Of Peripheral Inflammation Index To Predict Stage And Grade In Patients With Upper Urinary Tract Carcinoma

Purpose:Pretreatment inflammation indexes are associated with oncologic outcomes in many malignancies. We evaluated the predictive association between the pretreatment inflammation index and muscle invasion^ pathological stage and histological grade in upper tract urothelial carcinoma.Methods:We evaluated clinical data from97 patients who were treated surgically for upper tract urothelial carcinoma in urological department of Shandong Provincial Hospital from January 2012 to June 2015 retrospectively. Patients demographics and pretreatment prognostic scores (WBC count、neutrophil count、lymphocyte count、 neutrophil-to-lymphocyte ratio) were recorded. We used descriptive analyses to evaluate the demographics characteristics, and the spearmancorrelational analyses were conducted to evaluate the association between variables and muscle invasion pathological stage and histological grade in upper tract urothelial carcinoma by SPSS 19.0 version. We used chi-square test orFisher exact test to compare the inter-group difference and there was significantly difference if P<0.05.Results:A total of 97 patients were enrolled in our study,55 male patients (56.7% of the patients) and 42 female patients (43.3%). The age of the patients was from 38 to 87ys old. The average age was 66.37ys, and the median patient age was 67ys.49 patients (50.5%) took blood urine as the only compliant. There were 20 patients (20.6%) had lower back/abdominal pain.10 patients (10.3%) had both of blood urine and lower back/abdominal pain. The other 18 patients (18.6%)were asymptomatic. The positive rate of B ultrasound inspection was 61.4%, by contrast, the positive rate of CT was 88.1%. The number of pelvis carcinoma and ureteral carcinoma were 38 and 59.2 patients was diagnosed with UTUC complicating with bladder carcinoma.45 cases had left UTUCs and 52 cases had right UTUCs. Non-muscle-invasive UTUCs was recorded in 28(28.8%), including 1(1%) TO and 27(27.8%) T1. There were 69 muscle invasive UTUCs. T2/T3/T4 stages were presented in 14(14.4%)/46(47.4%)/9(9.3%) patients. N0/Nx/N1/N2 stages were presented in 82(84.5%)/2(2.1%)/12(12.4%)/1(1%) patients. There were 2 patients (2.1%) presented in stage M1 which were both of peritoneal metastasis. We used spearman correlation analysis by SPSS19.0 to analyze the correlation between the muscle-invasion tumor stage、grade and other clinical variables. The correlation analysis showed that pretreatment NLR is correlated with muscle invasion、pathological stage and histological grade. The chi-square test or Fisher exact test showed that the muscle invasion pT stage had significant correlation with Neutrophil count、Lymphocyte count、NLR and Albumin level.Conclusion:The pretreatment NLR is a balance index between inflammation and anti-inflammation reaction in our bodies. Our study showed that the derived NLR was significantly correlated with tumor muscle invasion pathological stage in upper tract urothelial carcinoma. Pretreatment elevated NLR indicated higher stage and muscle invasion of the tumor. The Pretreatment NLR level could be a reference indicator to predict the stage and muscle invasion of UTUCs before surgery. Elevated NLR indicated higher stage and muscle invasion. Although there weren’t other evidence to diagnose higher stage UTUCs, we should take radical nephroureterectomy. The patients with elevatedNLR had a poorer outcome. And a close follow-up was required. The NLR may be a simple, cost-effective and easily measured marker for upper tract urothelial carcinoma to help clinician have a decision and prognosis.