Creatinine-Cystatin C Ratio as a Promising Prognostic Biomarker in Patients With UTUC After Radical Nephroureterectomy.

PURPOSE: The aim of this study was to determine the impact of the preoperative creatinine-cystatin C ratio (CCR) on the survival prognosis of patients following radical nephrectomy (RNU) for upper tract urothelial carcinoma (UTUC).

METHODS

The retrospective analysis was conducted on UTUC patients who underwent radical nephrectomy (RNU) at West China Hospital between January 2009 and December 2019. The endpoint of the study was cancer-specific survival (CSS). Kaplan-Meier curves were used to estimate survival, and Cox proportional hazards modelling was used to assess risk. Nomograms were developed to predict CSS at 3 and 5 years of age, and the predictive power was assessed.

RESULTS

A critical CCR of 59.61 µmol/mg was demonstrated to affect 504 patients with UTUC who had undergone RNU. A correlation was identified between a lower preoperative CCR and a considerably worse CSS. In patients with UTUC, CCR was identified as an independent risk factor for CSS, particularly in patients with locally advanced UTUC (pT ≥ 3) (HR: 1.84, 95% CI: 1.14, 2.97). Moreover, the CCR-based nomogram exhibited robust predictive capacity, with areas under the curve for the 3- and 5-year CSS reaching 0.823 and 0.793, respectively.

CONCLUSION

Preoperative CCR is an independent predictor of CSS in UTUC patients receiving RNU treatment. As such, it should be viewed as a potentially useful customized tool in therapeutic decision-making.