PD15-06: Elevated Hemoglobin:Creatinine Ratio Is a Novel Preoperative Marker for Worsened Survival Outcomes in Upper Tract Urothelial Carcinoma: Analysis from the ROBUUST registry

Margaret Meagher*, San Diego, CA, Riccardo Autorino, Richmond, VA, Reza Mehrazin, New York, NY, Daniel Eun, Philadelphia, PA, Vitaly Margulis, Dallas, TX, Robert Uzzo, Philadelphia, PA, James Porter, Seattle, WA, Chandru Sundaram, Indianapolis, IN, Firas Abdollah, Detroit, MI, Alexandre Mottrie, Aalst, Belgium, Andrea Minervini, Florence, Italy, Matteo Ferro, Milan, Italy, Hooman Dialadat, Los Angeles, CA, Zhenjie Wu, Shanghai, China, People's Republic of, Kevin Hakimi, Ava Saidian, Arman Walia, San Diego, CA, Riccardo Tellini, Philadelphia, PA, Alessandro Veccia, Richmond, VA, Koon Rha, Seoul, Korea, Republic of, Mark Gonzalgo, Miami, FL, Ithaar Derweesh, San Diego, CA

Introduction: Upper Tract Urothelial Carcinoma (UTUC) is a neoplasm whose management paradigm is in flux. We sought to determine the utility of a novel ratio, Creatinine:Hemoglobin ratio, as a predictor of survival outcomes in UTUC.

Methods: We performed a multi-institutional retrospective analysis utilizing the ROBUUST (ROBotic surgery for Upper Tract Urothelial Cancer Study) registry.  The cohort was divided into elevated Creatinine:Hgb [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)/cancer-specific survival (CSS) and recurrence-free survival (RFS). Cox proportional hazards multivariable analysis (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: 829 patients were analyzed (744 non-elevated Cr:Hgb/85 elevated Cr:Hgb). Elevated Cr:Hgb patients had higher percentages of advanced stage (p=0.016) and high-grade tumors (89.4% vs. 72.8%, p<0.001). 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 were independently associated with worsened CSM. Elevated Cr:Hgb (HR=1.27, p=0.001) was independently associated with recurrence. Comparing patients with elevated vs. non-elevated Cr:Hgb, 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) for patients with elevated Cr:Hgb.

Conclusions: Baseline elevated Cr.Hgb ratio may predict worsened survival outcomes in UTUC patients undergoing nephroureterectomy and serve as a pre-operative marker to further stratify oncologic risk and guide patient counseling and management.

Source of Funding: The Stephen Weissman Kidney Cancer Research Fund