Prognostic value of systemic inflammatory responses in patients with upper urinary tract urothelial carcinoma.

PURPOSE: To determine the utility of systemic inflammatory response and develop a model based on serum inflammatory indices to aid prognostication in patients with upper urinary tract urothelial carcinoma (UTUC). METHODS: The study population comprised 277 patients with non-metastatic UTUC who underwent nephroureterectomy between 1999 and 2010. Multivariate survival analysis was performed using Cox's proportional hazards model, and a new model was developed to predict recurrence-free (RFS) and disease-specific survival (DSS). The factors considered, in relation to systemic inflammatory responses, were as follows: albumin, white blood cell count, neutrophil count, lymphocyte count, red blood cell count, serum creatinine level, platelet count, prognostic nutritional index, platelet/lymphocyte ratio, neutrophil/lymphocyte ratio (NLR), and derived NLR. RESULTS: The final model consisted of bladder cuffing, pathologic T stage, lymphovascular invasion, and derived NLR. The bootstrap-concordance indices of the model were 0.778 [95 confidence interval (CI) 0.730-0.826] for RFS and 0.802 (95 % CI 0.752-0.851) for DSS, respectively, and integrated area under the curve value for time to RFS and DSS for patients was 0.738 and 0.760, respectively. When we generated calibration curves, the nomograms were reasonably calibrated. CONCLUSIONS: Derived NLR may be used in combination with conventional staging techniques and other clinicopathological parameters to improve the prediction of survival in patients with UTUC.