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The Significance of Preoperative Serum Sodium and Hemoglobin in Outcomes of Upper Tract Urothelial Carcinoma: Multi-Center Analysis Between China and the United States

Authors Fang D, Singla N, Bao Z, Jafri SM, Su X, Cao Z, Xiong G, Zhang L, Woldu S, Hutchinson R, Sagalowsky A, Lotan Y, Li X, Raman JD, Margulis V, Zhou L

Received 27 June 2020

Accepted for publication 8 September 2020

Published 8 October 2020 Volume 2020:12 Pages 9825—9836


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 3

Editor who approved publication: Dr Eileen O'Reilly

Dong Fang,1,* Nirmish Singla,2,* Zhengqing Bao,1,3,* Syed M Jafri,4 Xiaohong Su,1 Zhenpeng Cao,1 Gengyan Xiong,1 Lei Zhang,1 Solomon Woldu,2 Ryan Hutchinson,2 Arthur Sagalowsky,2 Yair Lotan,2 Xuesong Li,1 Jay D Raman,4 Vitaly Margulis,2 Liqun Zhou1

1Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, People’s Republic of China; 2Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA; 3Department of Urology, Beijing Jishuitan Hospital, The Fourth Medical College of Peking University, Beijing, People’s Republic of China; 4Division of Urology, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA

*These authors contributed equally to this work

Correspondence: Liqun Zhou
Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, No. 8 Xishiku Street, Xicheng District, Beijing 100034, People’s Republic of China
Tel +86-10-83575006
Fax +86-10-66551726

Purpose: To analyze the effect of preoperative serum sodium and hemoglobin on oncologic outcomes in upper tract urothelial carcinoma (UTUC) based on a multi-center cohort from China and the United States (U.S.).
Methods: We retrospectively reviewed the records of 775 patients with UTUC treated surgically at tertiary care medical facilities in China or the US from 1998 to 2015. We analyzed associations of preoperative serum sodium and hemoglobin with clinicopathological characteristics, overall survival (OS), cancer-specific survival (CSS) and intravesical recurrence free survival (IVRFS).
Results: The US patients had comparatively lower serum sodium and similar hemoglobin at baseline. Preoperative low serum sodium value was associated with tumor multifocality, lymph node metastasis (LNM) and lymphovascular invasion (LVI); preoperative anemia was associated with advanced age, tumor multifocality, high tumor grade and LVI. Preoperative low serum sodium was an independent predictor of worse OS in the entire cohort; preoperative anemia was an independent predictor of worse OS and CSS in the US cohort alone, Chinese cohort alone and the combined cohort. We developed a predictive nomogram for OS which exhibited better prognostic value when it included the values of sodium and anemia, and successfully validated it in different cohorts.
Conclusion: Preoperative low serum sodium and anemia could be informative in predicting worse pathologic and survival outcomes in different UTUC patient ethnic groups.

Keywords: upper tract urothelial carcinoma, serum sodium, anemia, survival, China, the United States

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