EUF Vol. 1 No. 1

54 96

Priority Focus – Urothelial Cancer
Editorial by Brant Inman and Kae Jack Tay on pp. 64–65 of this issue
Impact of Combined Use of Blood-based Inflammatory Markers
on Patients with Upper Tract Urothelial Carcinoma Following
Radical Nephroureterectomy: Proposal of a Cumulative Marker
Score as a Novel Predictive Tool for Prognosis
Nobuyuki Tanaka Eiji Kikuchi Kent Kanao Kazuhiro Matsumoto Suguru Shirotake
Yasumasa Miyazaki Hiroaki Kobayashi Gou Kaneko Masayuki Hagiwara
Hiroki Ide Jun Obata Katsura Hoshino Nozomi Hayakawa Takeo Kosaka
Satoshi Hara Ken Nakagawa Masahiro Jinzaki Mototsugu Oya
a Department of Urology, Keio University School of Medicine, Tokyo, Japan; bDepartment of Urology, Saiseikai Central Hospital, Tokyo, Japan; c Department of
Urology, Kyosai Tachikawa Hospital, Tokyo, Japan; dDepartment of Urology, Kawasaki City Hospital, Tokyo, Japan; e Department of Urology, Ichikawa
General Hospital, Tokyo Dental College, Ichikawa, Japan; f Department of Urology, Inagi City Hospital, Tokyo, Japan; g Department of Urology, Irumagawa
Hospital, Saitama, Japan; h Department of Diagnostic Radiology, Keio University School of Medicine, Tokyo, Japan
available at
journal homepage:
Article info
Article history:
Accepted February 4, 2015
Associate Editor:
Gianluca Giannarini
Keywords:
Urothelial carcinoma
Upper urinary tract
C-reactive protein
Neutrophil-to-lymphocyte ratio
Fibrinogen
Outcome
Prognosis
Marker score
Abstract
Background: Previous studies showed the prognostic impact of preoperative levels of neutrophil-to-
lymphocyte ratio (NLR), plasma fibrinogen, and serum C-reactive protein (CRP) in surgically treated
upper tract urothelial carcinoma; however, few papers have discussed the proper use of these indices.
Objective: To investigatewhether combinations of these threemarkers, as a cumulativemarker score
(CMS), improve the accuracy of prognostic models following radical nephroureterectomy (RNU).
Design, setting, and participants: A total of 394 patients from multiple institutions were included.
Median follow-up was 30 mo.
Intervention: All patients underwent RNU without neoadjuvant chemotherapy.
Outcome measurements and statistical analysis: Associated outcomes were assessed using mul-
tivariate analysis. The CMS was defined as the number of elevated levels of preoperative NLR,
plasma fibrinogen, and serum CRP.
Results and limitations: Multivariate analyses revealed that an increasing CMS was independently
associated with high rates of disease recurrence, cancer-specific mortality, and all-cause mortality
following RNU. Addition of the CMS to a model that included standard clinicopathologic predictors
significantly improved predictive accuracy by 2.7% for disease recurrence, 3.9% for cancer-specific
mortality, and 4.0% for all-cause mortality, which were the highest among other prognostic models
using each marker alone or combinations of two. The study is limited by its retrospective nature.
Conclusions: Although the use of each inflammatory marker alone may be as predictive as
clinicopathologic indices for prognosis, combinations like CMS can provide more accurate prog-
nostic models following RNU.
Patient summary: Elevation of blood-based inflammatory markers may be useful for predicting
prognosis because of their low cost and accessibility. Among blood-based indices, we examined
the efficacy of preoperative neutrophil-to-lymphocyte ratio, plasma fibrinogen, and serumC-reactive
protein levels. Although use of each marker alone provides additional prognostic information,
the combination of all three markers would be more predictive than any single marker or combina-
tions of two.
# 2015 European Association of Urology. Published by Elsevier B.V. This is an open access article
under the CC BY-NC-ND license ).
* Corresponding author. Department of Urology, Keio University School of Medicine, 35 Shinanomachi,
Shinjuku-ku, Tokyo 160-8582, Japan. Tel. +81 3 5363 3825; Fax: +81 3 3225 1985.
E-mail address: (E. Kikuchi).
2405-4569/# 2015 European Association of Urology. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license
.