Elevated creatinine-to-hemoglobin ratio is a novel preoperative marker for worsened survival outcomes in upper tract urothelial carcinoma: analysis from the ROBUUST registry.

Authors

• Margaret F Meagher
• Clara Cerrato
• Mimi V Nguyen
• Riccardo Autorino
• Reza Mehrazin
• Daniel Eun
• Vitaly Margulis
• Robert Uzzo
• James Porter
• Chandru Sundaram
• Firas Abdollah
• Alexandre Mottrie
• Andrea Minervini
• Alessandro Antonelli
• Maria A Cerruto
• Matteo Ferro
• Hooman Djaladat
• Zhenjie Wu
• Alireza Ghoreifi
• Kevin Hakimi
• Cesare Saitta
• Ava Saidian
• Arman Walia
• Savio D Pandolfo
• Riccardo Tellini
• Alessandro Veccia
• Elio Mazzone
• Koon Rha
• Mark Gonzalgo
• Ithaar H Derweesh

Publication/Presentation Date

12-1-2025

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.

Volume

77

Issue

6

First Page

795

Last Page

802

ISSN

2724-6442

Published In/Presented At

Meagher, M. F., Cerrato, C., Nguyen, M. V., Autorino, R., Mehrazin, R., Eun, D., Margulis, V., Uzzo, R., Porter, J., Sundaram, C., Abdollah, F., Mottrie, A., Minervini, A., Antonelli, A., Cerruto, M. A., Ferro, M., Djaladat, H., Wu, Z., Ghoreifi, A., Hakimi, K., … Derweesh, I. H. (2025). 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 urology and nephrology, 77(6), 795–802. https://doi.org/10.23736/S2724-6051.25.05498-9

Disciplines

Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods

PubMedID

41410659

Department(s)

Administration and Leadership

Document Type

Article