(UroToday.com) The 37th Annual European Association of Urology Congress held in Amsterdam, the Netherlands between July 1st, and 4th 2022 was host to an abstract session regarding new insights into the management of upper tract urothelial cancer (UTUC). Dr. Ithaar Derweesh presented results from the ROBUUST (ROBotic surgery for Upper Tract Urothelial Cancer study) registry evaluating creatinine to hemoglobin ration elevations as a novel preoperative marker for worsened survival outcomes in UTUC.
Dr. Derweesh began by noting that UTUC remains a disease space with an evolving management paradigm and limited prognostic biomarkers. To this end, the authors sought to determine the utility of Creatinine:Hemoglobin (Cr:Hgb) ratio as a prognostic marker of survival outcomes in UTUC.
The authors conducted a multi-institutional retrospective cohort analysis using the ROBUUST registry to evaluate whether an elevated Cr:Hgb ratio >0.15 was associated with adverse oncologic outcomes. A cutoff level of 0.15 was chosen based on the upper limit of normal for creatinine and the lower limit of normal for hemoglobin. The primary outcome was all-cause mortality/overall survival. The secondary outcomes were:
- Cancer-specific mortality/cancer-specific survival
- Recurrence-free survival
- Predictors of overall mortality, cancer-specific mortality, and recurrence-free survival
- Using multivariable cox proportional hazards modeling
- 5-year overall, cancer-specific, and recurrence-free survivals
- Using Kaplan-Meier analysis
The cohort included 829 patients undergoing a radical nephroureterectomy, of whom 85 (10.3%) had elevated Hgb:Cr ratios >0.15. Patients with elevated Hgb:Cr ratios had increased risks of advanced disease stages (p=0.016) and high-grade tumors (89.4% versus 72.8%, p<0.001).
On multivariable analysis, elevated Cr:Hgb ratio >0.15 was associated with worsened:
- All-cause mortality (HR: 2.49, p=0.003)
- Cancer-specific mortality (HR: 3.64, p<0.001)
- Recurrence (HR: 1.27, p=0.001)
Other predictors of increased/worsened all-cause mortality included:
- Increasing age (HR: 1.04, p=0.002)
- Lympho-vascular invasion (HR: 4.61, p<0.001)
- Higher stage (HR: 3.82, p<0.001)
Other predictors of increased/worsened cancer-specific mortality included:
- Increasing age (HR: 1.04, p=0.030)
- Lymph-vascular invasion
Kaplan-Meier analysis demonstrated that patients with elevated Cr:Hgb ratios >0.15 had significantly worse 5-year:
- Overall survival (78% versus 65%, p=0.002)
- Cancer-specific survival (86% versus 74%, p<0.001)
- Recurrence-free survival (53% versus 22%, p=0.004)
Dr. Derweesh concluded that baseline elevated Cr: Hgb ratio >0.15 may predict adverse survival outcomes in UTUC patients undergoing nephroureterectomy, serving as a pre-operative marker to risk stratify such patients and guide patient counseling and management.
Presented by: Ithaar H. Derweesh, MD, Professor of Urology and Radiology, Department of Urology, University of California in San Diego, San Diego, CA
Written by: Rashid Sayyid, MD, MSc – Society of Urologic Oncology (SUO) Clinical Fellow at The University of Toronto, @rksayyid on Twitter during the 2022 European Association of Urology (EAU) Annual Hybrid Meeting, Amsterdam, NL, Fri, July 1 – Mon, July 4, 2022.