Prognostic value of preoperative systemic inflammation markers in localized upper tract urothelial cell carcinoma: a large, multicenter cohort analysis

Background The aim of this study was to investigate the prognostic value of preoperative systemic inflammation markers in upper tract urothelial carcinoma (UTUC). Methods A total of 1137 patients who underwent radical nephroureterectomy with bladder cuff excision at 9 institutions from 2004 to 2015, were retrospectively reviewed. The Glasgow Prognostic Score (GPS), modified GPS (mGPS), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) for each patient were calculated. Univariable and multivariable analysis was performed using the Cox proportional hazards regression model. Cut-off values for NLR and PLR were calculated using a receiver operating characteristic curve. Results The median follow-up period was 39.1 (interquartile range: 18.3-63.8) months. Univariable analysis revealed that GPS, mGPS, PLR, and NLR (all, P=0.001) were significantly associated with both recurrence-free survival (RFS) and cancer-specific survival (CSS). Multivariable analysis revealed that GPS (P=0.001), PLR (hazards ratio [HR] =1.32; 95% CI: 1.08-1.62, P=0.007 and HR =1.87; 95% CI: 1.21-2.92, P=0.005), NLR (HR =1.38; 95% CI: 1.12-1.69, P=0.003 and HR =1.70; 95% CI: 1.10-2.62, P=0.017) were significantly associated with RFS and CSS. Conclusions Our results suggest that preoperative systemic inflammation markers such as GPS, PLR, and NLR are independent prognostic factors in patients with UTUC after surgery.