Combined fibrinogen concentration and neutrophil-to-lymphocyte ratio, an integrative model of the inflammatory response and coagulation cascades, for predicting prognosis in patients with upper tract urothelial carcinoma

Yangqing Zheng; Chen Chen; Chaoyue Lu; Yongxing Bao; Weishi Zhang; Haote Liang; Tingyu Ye; Zhixian Yu; Yeping Li; Lina Zhou; Deguan Yu; Binwei Lin

doi:10.17305/bb.2024.11039

Authors

Yangqing Zheng Department of Hematology, The Third Clinical Institute Affiliated to Wenzhou Medical University (Wenzhou People’s Hospital), China https://orcid.org/0000-0002-3415-6885
Chen Chen Department of Pharmacy, The Third Clinical Institute Affiliated to Wenzhou Medical University (Wenzhou People’s Hospital), China
Chaoyue Lu Department of Urology, Changhai Hospital, Navy Medical University, Shanghai, China https://orcid.org/0000-0002-7219-0646
Yongxing Bao The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China https://orcid.org/0009-0007-2079-0029
Weishi Zhang Department of Urology, Longgang People’s Hospital, Wenzhou, Zhejiang, China
Haote Liang Department of Urology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
Tingyu Ye Department of Urology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
Zhixian Yu Department of Urology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China https://orcid.org/0000-0002-1226-7891
Yeping Li Department of Urology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
Lina Zhou Department of Nephrology, The Third Clinical Institute Affiliated to Wenzhou Medical University (Wenzhou People’s Hospital), Wenzhou, Zhejiang, China
Deguan Yu Department of Pharmacy, The Third Clinical Institute Affiliated to Wenzhou Medical University (Wenzhou People’s Hospital), Wenzhou, Zhejiang, China
Binwei Lin Department of Urology, Rui’an People’s Hospital, The Third Affiliated Hospital of the Wenzhou Medical University, Wenzhou, Zhejiang, China

DOI:

https://doi.org/10.17305/bb.2024.11039

Keywords:

Upper tract urothelial carcinoma, prognosis, neutrophil-to-lymphocyte ratio, fibrinogen, biomarker

Abstract

Inflammation and coagulation cascades are closely correlated with cancer occurrence and progression. This study investigated the prognostic value of the combination of plasma fibrinogen level and neutrophil-to-lymphocyte ratio (F-NLR) in patients with upper tract urothelial carcinoma (UTUC). The predictive ability of the F-NLR for overall survival (OS), cancer-specific survival (CSS), and progression-free survival (PFS) was initially established and then further validated in patients who underwent radical nephroureterectomy (RNU) for UTUC. As a result, patients were divided into three groups following the establishment of cut-off values for the neutrophil-to-lymphocyte ratio (NLR) (≥2.53 vs <2.53) and fibrinogen (≥4.55 vs <4.55) through receiver operating characteristic (ROC) curve analysis: F-NLR score 0 (low fibrinogen and low NLR), 2 (high fibrinogen and high NLR), or 1 (remaining patients). The F-NLR score was then identified as an independent risk factor for OS, CSS, and PFS (all P value <0.05) by multivariate regression analysis in both the training and validation cohorts. In addition, F-NLR-based nomograms for OS, CSS, and PFS were developed and evaluated using the concordance index (C-index) and calibration curves. The integration of the F-NLR into existing nomograms improved predictive accuracy compared to the use of nomograms without the F-NLR score. This suggests that the addition of F-NLR is beneficial for enhancing the accuracy of prognosis prediction in patients with UTUC. The F-NLR score may serve as a powerful predictor for patients with UTUC.