Prognostic value of AIB1 and EIF5A2 in intravesical recurrence after surgery for upper tract urothelial carcinoma
Authors Huang Y, Wei J, Fang Y, Chen Z, Cen J, Feng Z, Lu J, Liang Y, Luo J, Chen W
Received 26 August 2018
Accepted for publication 16 November 2018
Published 14 December 2018 Volume 2018:10 Pages 6997—7011
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 3
Editor who approved publication: Dr Ahmet Emre Eskazan
Yong Huang,1,2,* Jinhuan Wei,1,* Yong Fang,1,* Zhenhua Chen,1,* Junjie Cen,1,* Zihao Feng,1 Jun Lu,1 Yanping Liang,1 Junhang Luo,1 Wei Chen1
1Department of Urology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China; 2Department of Emergency, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
*These authors contributed equally to this work
Objectives: The aim of this study was to investigate the prognostic effect of amplified in AIB1 and EIF5A2 expression on postoperative intravesical recurrence for upper urinary tract urothelial carcinoma (UTUC) and improve postoperative risk stratification and prediction of intravesical chemotherapy benefit.
Materials and methods: We evaluated immunohistochemical expression of AIB1 and EIF5A2 in 109 UTUC patients to determine the predictive significance in intravesical recurrence. A prognostic model was developed based on univariate and multivariate analyses.
Results: Intravesical recurrence occurred in 18 out of the 109 (16.5%) patients during the follow-up period. Significant associations of high expression of AIB1 and EIF5A2 with shortened bladder recurrence interval (median: 24 months vs 46 months, P=0.021; 28 months vs 39 months, P=0.002) were demonstrated. In different subsets of UTUC patients, high expression of AIB1 was a prognostic indicator in high grade (P=0.006) and pT2–4 (P=0.007), and high expression of EIF5A2 for high grade (P=0.014), pT2–4 (P=0.002) and pN0 (P=0.009). Moreover, in multivariate analysis, AIB1 and EIF5A2 expression (P=0.034 and 0.022, respectively) together with pN stage (P=0.009) provided significant independent predictors for intravesical recurrence after surgery for UTUC. Surgical approach with radical nephroureterectomy (RNU) was an informative factor toward good oncologic outcomes for intravesical recurrence (P=0.056). Based on a prognostic model with these factors, patients with UTUC were classified into the low-risk group and the high-risk group. In a subset analysis, the patients in the high-risk group were found to have a favorable response to intravesical chemotherapy (P=0.047). A nomogram based on the multivariate analysis was developed to predict intravesical recurrence accurately and guide postoperative intravesical instillations. The concordance index (c-index) of this model was 0.806.
Conclusion: High expression of AIB1 and EIF5A2 were independent predictors for intravesical recurrence after RNU and might be able to predict which patients benefit from postoperative intravesical chemotherapy.
Keywords: AIB1, EIF5A2, intravesical recurrence, prognosis, nomogram, upper tract urothelial carcinoma
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