Elevated creatinine-to-hemoglobin ratio is a novel preoperative marker for worsened survival outcomes in upper tract urothelial carcinoma: analysis from the ROBUUST registry
Recommended Citation
Meagher MF, Cerrato C, Nguyen MV, Autorino R, Mehrazin R, Eun D, Margulis V, Uzzo R, Porter J, Sundaram C, Abdollah F, Mottrie A, Minervini A, Antonelli A, Cerruto MA, Ferro M, Djaladat H, Wu Z, Ghoreifi A, Hakimi K, Saitta C, Saidian A, Walia A, Pandolfo SD, Tellini R, Veccia A, Mazzone E, Rha K, Gonzalgo M, and Derweesh IH. Elevated creatinine-to-hemoglobin ratio is a novel preoperative marker for worsened survival outcomes in upper tract urothelial carcinoma: analysis from the ROBUUST registry. Minerva Urol Nephrol 2025;77(6):795-802.
Document Type
Article
Publication Date
12-1-2025
Publication Title
Minerva Urol Nephrol
Keywords
Humans, Female, Male, Aged, Retrospective Studies, Middle Aged, Creatinine, Carcinoma, Transitional Cell, Registries, Hemoglobins, Kidney Neoplasms, Ureteral Neoplasms, Nephroureterectomy, Robotic Surgical Procedures, Survival Rate, Biomarkers, Tumor, Prognosis, Preoperative Period, Kaplan-Meier Estimate
Abstract
BACKGROUND: To determine the utility of creatinine-to-hemoglobin (Cr:Hgb) ratio, as a predictor of survival outcomes in upper tract urothelial carcinoma (UTUC).
METHODS: We performed a multi-institutional retrospective analysis of UTUC-patients who underwent robotic radical nephrouretectomy utilizing the ROBUUST (ROBotic surgery for Upper Tract Urothelial Cancer Study) registry. Patients were divided into elevated Cr:Hgb ratio (>0.15, based on upper-limit of normal for creatinine and lower-limit of normal for hemoglobin) vs. non-elevated Cr:Hgb ratio (≤0.15). Primary outcome was all cause mortality (ACM)/overall survival (OS). Secondary outcomes were cancer-specific mortality (CSM) / survival (CSS) and recurrence-free survival (RFS). Cox proportional hazards (MVA) was used to elucidate predictive factors for ACM, CSM, and RFS. Kaplan-Meier analysis (KMA) was performed to analyze 5-year OS, CSS, and RFS.
RESULTS: Overall, 829 patients were analyzed (744 non-elevated / 85 elevated Cr:Hgb). Elevated Cr:Hgb patients had more frequently advanced-stage (P=0.016) and high-grade tumors (P< 0.001) at time of surgery. MVA demonstrated increasing-age (HR=1.04, P=0.002), elevated Cr:Hgb (HR=2.49, P=0.003), lympho-vascular invasion (HR=4.61, P< 0.001), and higher-stage (HR=3.82, P< 0.001) to be associated with worsened ACM. Increasing-age (HR=1.04, P=0.030), elevated Cr:Hgb (HR=3.64, P< 0.001), and lympho-vascular invasion (HR=4.52, P< 0.001) were independently associated with worsened CSM. Elevated Cr:Hgb (HR=1.27, P=0.001) was independently associated with worsened recurrence. For elevated vs. non-elevated Cr:Hgb patients, KMA revealed significantly worse 5-year OS (78% vs. 65%, P=0.002), CSS (86% vs. 74%, P< 0.001), and RFS (53% vs. 22%, P=0.004).
CONCLUSIONS: Baseline elevated Cr:Hgb predicted worsened survival outcomes in UTUC patients and may serve a pre-operative marker to stratify oncologic risk and guide counseling and management.
Medical Subject Headings
Humans; Female; Male; Aged; Retrospective Studies; Middle Aged; Creatinine; Carcinoma, Transitional Cell; Registries; Hemoglobins; Kidney Neoplasms; Ureteral Neoplasms; Nephroureterectomy; Robotic Surgical Procedures; Survival Rate; Biomarkers, Tumor; Prognosis; Preoperative Period; Kaplan-Meier Estimate
PubMed ID
41410659
Volume
77
Issue
6
First Page
795
Last Page
802
