Prognostic Impact of Preoperative Plasma Levels of Urokinase Plasminogen Activator Proteins on Disease Outcomes after Radical Cystectomy

被引:7
作者
不详
机构
[1] Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna
[2] Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg
[3] Department of Urology, University Hospital Zurich, Zurich
[4] Department of Urology, King Fahad Specialist Hospital, Dammam
[5] Research Center for Evidence Based Medicine, Tabriz University of Medical Sciences, Tabriz
[6] Institute for Urology and Reproductive Health, Sechenov University, Moscow
[7] Department of Urology, The Jikei University School of Medicine, Tokyo
[8] Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, QC
[9] Men's Health and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran
[10] Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama
[11] Department of Urology, University of Texas Southwestern, Dallas, TX
[12] Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY
[13] Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman
[14] Karl Landsteiner Institute of Urology and Andrology, Vienna
[15] European Association of Urology Research Foundation, Arnhem
基金
美国国家卫生研究院;
关键词
biomarkers; plasminogen activator inhibitor 1; receptors; urinary bladder neoplasms; urokinase plasminogen activator; urokinase-type plasminogen activator;
D O I
10.1097/JU.0000000000001936
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Purpose: We sought to validate the association of plasma levels of urokinase-type plasminogen activator (uPA), its soluble receptor (SuPAR) and its inhibitor (PAI-one) with oncologic outcomes in a large cohort of patients treated with radical cystectomy (RC) for urothelial carcinoma of the bladder (UCB). Materials and Methods: We collected preoperative blood samples from 1,036 consecutive patients treated with RC for UCB. Plasma specimens were assessed for levels of uPA, SuPAR and PAI-one. Retrospective logistic and Cox regression analyses were performed to assess their correlation with clinical outcomes. The additional clinical net benefit provided by the biomarkers was evaluated using decision curve analysis. Results: Preoperative plasma uPA, SuPAR and PAI-one levels were significantly elevated in patients harboring adverse pathological features. Higher levels of all biomarkers were independently associated with an increased risk of lymph node metastasis; uPA levels were also independently associated with ≥pT3 disease. Preoperative uPA and SuPAR were independently associated with recurrence-free and cancer-specific survival. The addition of these biomarkers to standard pre-treatment and post-treatment models improved the discriminatory power for prediction of lymph node metastasis, ≥pT3 disease, and recurrence-free and cancer-specific survival by a prognostically significant margin. Conclusions: We confirmed that elevated preoperative plasma levels of uPA, SuPAR and PAI-one are associated with features of aggressive disease and worse survival outcomes in patients treated with RC for UCB. These biomarkers hold potential in identifying patients who are likely to benefit from intensified/multimodal therapy. They also demonstrated the ability to improve the discriminatory power of predictive/prognostic models, thus refining personalized clinical decision-making. Copyright © 2021 American Urological Association Education and Research, Inc.
引用
收藏
页码:1122 / 1122
页数:1
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