Objectives: This study aimed at investigating the prognostic impact of tumor necrosis and preoperative monocyte-to-lymphocyte ratio (MLR) in patients treated with radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC). Methods: A total of 521 patients with UTUC treated with RNU from January 2008 to June 2019 at our institution were enrolled. Histological tumor necrosis was defined as the presence of microscopic coagulative necrosis. The optimal value of MLR was determined as 0.4 by receiver operating characteristic (ROC) analysis based on cancer-specific mortality. The Kaplan–Meier method with log-rank test and Cox proportional hazards regression models were performed to evaluate the impact of tumor necrosis and MLR on overall (OS), cancer-specific (CSS), and recurrence-free survival (RFS). Furthermore, ROC analysis was used to estimate the predictive ability of potential prognostic factors for oncological outcomes. Results: Tumor necrosis was present in 106 patients (20%), which was significantly associated with tumor location, high pathological tumor stage, lymph node metastasis, high tumor grade, lymphovascular invasion, tumor size, and increased monocyte counts. On multivariate analysis, the combination of tumor necrosis and preoperative MLR was an independent prognosticator of OS, CSS, and RFS (all p < 0.05). Moreover, ROC analyses revealed the predictive accuracy of a combination of tumor necrosis and preoperative MLR for OS, CSS, and RFS with the area under the ROC curve of 0.745, 0.810, and 0.782, respectively (all p < 0.001). Conclusions: The combination of tumor necrosis and preoperative MLR can be used as an independent prognosticator in patients with UTUC after RNU. The identification of this combination could help physicians to recognize high-risk patients with unfavorable outcomes and devise more appropriate postoperative treatment plans.

We aimed to assess the prognostic importance of perinephric fat features in images of patients with non-metastatic renal cell carcinoma (RCC) undergoing surgery. We enrolled RCC patients who underwent surgical treatment between 2011 and 2019. Two characteristics, including perinephric fat thickness and perinephric fat stranding, were evaluated using preoperative computed tomography or magnetic resonance images. The association between perinephric fat characteristics and disease progression was examined by Kaplan-Meier survival analysis and Cox regression model. In a multivariate Cox proportional hazards model adjusting for tumor stage, intratumoral necrosis, and neutrophil-to-lymphocyte ratio, we found that patients in the thin perinephric fat group (<1 cm) had a poorer progression-free survival (PFS) compared to the thick perinephric fat group (≥1 cm) (HR 2.8; 95% CI 1.175-6.674, p = 0.02). Additionally, the fat stranding group had a poorer PFS than the non-stranding group (HR 3.852; 95% CI 1.082-13.704, p = 0.037). The non-stranding with thick perinephric fat group exhibits the highest cumulative PFS while the stranding with thin perinephric fat group has the lowest cumulative PFS. In receiver operating characteristic curve analysis, combing these two perinephric fat characteristics with tumor stage can achieve a better discriminatory power than tumor stage alone. Our study indicates that the evaluation of image-based perinephric fat features is a simple, straightforward, reproducible tool for predicting RCC prognosis and may assist in preoperative risk stratification.

Background: Accurate preoperative risk stratification remains challenging in older patients with upper tract urothelial carcinoma (UTUC) undergoing radical nephroureterectomy (RNU). This study evaluated whether preoperative Geriatric 8 (G8) score is associated with perioperative and oncologic outcomes. Methods: We retrospectively analyzed 338 patients aged ≥ 65 years who underwent RNU between 2013 and 2022. Patients were classified as G8-low (score ≤ 14) or G8-high (score > 14). Multivariable logistic and Cox regression analyses assessed the association between frailty, postoperative complications (Clavien–Dindo classification), and survival outcomes, including overall survival (OS), cancer-specific survival (CSS), and progression-free survival (PFS). Results: Overall, 178 patients (52.7%) were G8-low. G8-low patients exhibited significantly longer hospital stays and higher rates of minor (Clavien I-II: 60.1% vs. 35.6%, p < 0.001) and major complications (Clavien III-V: 12.4% vs. 3.7%, p = 0.004). Multivariable analysis identified G8-low as an independent predictor of postoperative complications (OR 2.51; 95% CI 1.50–4.20; p < 0.001), demonstrating superior prognostic value compared to ASA classification. Furthermore, G8-low remained an independent predictor of worse OS (HR 1.76, 95% CI 1.17–2.65; p = 0.006), CSS (HR 2.00, 95% CI 1.31–3.07; p = 0.001), and PFS (HR 1.73, 95% CI 1.20–2.50; p = 0.004). Conclusions: Preoperative G8-low status, is independently associated with increased postoperative complications and poorer oncologic outcomes in older UTUC patients undergoing RNU. Incorporating G8 screening into routine preoperative evaluation may facilitate accurate risk stratification, aiding shared decision-making regarding radical versus nephron-sparing approaches.