Abstract
OBJECTIVE: The objective of this study is to assess the predictive significance of lactate dehydrogenase-to-albumin ratio (LAR) in patients with upper tract urothelial carcinoma (UTUC) who have undergone radical nephroureterectomy (RNU). MATERIALS AND METHODS: We performed a retrospective analysis on patients with UTUC at West China Hospital, covering the period from May 2003 to June 2019. The optimal cut point of LAR was determined using the X-Tile program. Relevant statistical methods included the utilization of Kaplan-Meier curves for survival estimation and the application of Cox proportional hazard model for risk evaluation. A nomogram was constructed to predict the 3-year and 5-year CSS and the predictive performance was also evaluated. RESULTS: A cohort of 577 patients with UTUC who underwent RNU were included in the study, and the threshold value of LAR was 5.07. LAR ≥ 5.07 was associated with worse CSS [hazard ratio (HR) = 1.72; 95% confidence interval (95%CI): 1.18-2.50; P = 0.005] in fully adjusted Cox regression analysis. In addition, the nomogram utilizing the LAR exhibited excellent prognostic performance in predicting CSS, with time-dependent areas under the curve (tAUC) values of 0.814 and 0.781 for 3-year and 5-year CSS, respectively. CONCLUSION: Preoperative LAR could be regarded as a valuable individualized tool for clinical decision-making, as it independently predicts CSS in UTUC patients undergoing RNU.