Prognostic Value Of Preoperative Plasma Fibrinogen Level And Neutrophil-lymphocyte Ratio(F-NLR) In Patients With Upper Tract Urothelial Carcinoma

Background and objectiveIn the latest global cancer statistics,tumors of urinary system have become the fourth most common human cancers,of which upper urinary tract urothelial carcinomas(UTUC)are relatively uncommon(5%to 10%of urothelial carcinoma)but are one of the poorer prognosis cancers.Patients with concurrent bladder cancer(BCa)account for 17%of the patients with upper urinary tract cancer.Recent literatures show that tumor T stage and pathological grade are considered to be a very important prognostic indicator of UTUC,and other prognostic parameters such as tumor size and lymph node metastasis can also be used as a predictor of the prognosis of UTUC.Some studies show that preoperative plasma fibrinogen level plays a vital role in thrombosis,and it can independently predict the prognosis of various human cancers.Meanwhile,many studies have shown that neutrophil-lymphocyte ratio(NLR)is related to the development of multiple types of cancers such as lung cancer,breast cancer,prostate cancer,colon cancer,bladder cancer,kidney cancer and so on.Other studies have revealed that NLR could be valuable i n early diagnosis,prognosis and postoperative monitoring of tumors.Thus,the purpose of this study was to incorporate both markers into what we called as the F-NLR(fibrinogen and neutrophil-lymphocyte ratio)score.To our knowledge,the value of F-NLR score has not used to detect in patients with UTUC.We decided to clarify the prognostic value of preoperative F-NLR score in a cohort of Chinese patients with UTUC.MethodsThis retrospective analysis included UTUC patients who were hospitalized in Department of Urology,Qilu Hospital,Shandong University from January 2006 to December 2013.A total of 180 patients underwent radical nephrectomy or renal ureteral segmental resection.Patients with following condition were excluded from this study:1.No data on preoperative plasma fibrinogen level;2.No data on neutrophils and lymphocyte level information;3.patients with autoimmune diseases,patients with chronic unexplained chronic inflammation;4.patients with hematological diseases;5.Patients with other systemic cancer were unable to determine whether associated with this disease or patients receiving neoadjuvant chemotherapy and radiation therapy;6.postoperative pathological types returned to show other types of cancer,that is,patients who were not urothelial carcinoma;7.distant metastasis;8.patients' followup were lost.OS was defined as the time from surgery to death from all causes.Cancer-specific survival(CSS)was defined as the time from surgery to cancer related death.The best cutoff value level of the fibrinogen and neutrophil-lymphocyte ratio level was determined by applying receiver operating curve(ROC)analysis which divide the F-NLR score.In OS and CSS analyses,the Kaplan-Meier method was used to evaluate the survival rates in different groups and the equivalences of the survival curves were tested by log-rank test.Cox proportional hazards regression model was applied in univariate and multivariate analyses.ResultsDuring the follow-up period,71(42%)patients died of all causes and 63(37.3%)died of cancer-specific causes,with a median OS of 47 months.In univariate analysis,no survival difference was found in gender,age,history of smoking and lymphatic vascular invasion.Tumor size(<4cm or>4cm),tumor grade(G1-2 or G3),pathological T stage(pTa/T1 or pT2-4)and preoperative F-NLR score(score 0 or score 1/2)were significantly associated with OS and CSS.Multivariate Cox proportional hazards regression analysis using tumor size,tumor grade,tumor stage and preoperative F-NLR score as covariates revealed that F-NLR score was.an independent predictor for OS and CSS.The Kaplan-Meier survival analysis showed that preoperative F-NLR score was significantly associated with OS and CSS,The higher F-NLR score predicted shorter OS(P<0.001)and shorter CSS(P<0.001).ConclusionThe present study shows the evaluation of preoperative F-NLR score can be regarded as an independent prognostic factor for predicting OS and CSS of patients with UTUC.Therefore,the combination of plasma fibrinogen level and neutrophil-lymphocyte ratio(F-NLR)should be included in the prognostic indicators,which helps to evaluate the prognosis of UTUC patients and to monitor the effect of postoperative treatment regularly.