Postoperatively increased splenic volume correlates with an unfavorable prognosis in patients after radical nephroureterectomy to treat upper tract urothelial carcinoma

Purpose: The aim of this study is to evaluate the impact of splenic volume change (ΔSV) on prognosis in patients with upper tract urothelial carcinoma (UTUC) after radical nephroureterectomy (RNU). Materials and methods: We included 300 nonmetastatic UTUC patients from 2010 to 2020 who underwent abdominal computer tomography within 3 months before RNU and within 24 months after RNU. SV on the computer tomography image was estimated using the cross-sectional area summed method. ΔSV was calculated as (post-RNU SV − pre-RNU SV)/pre-RNU SV. The optimal cutoff point of ΔSV was determined by receiver operating characteristic analysis based on cancer death. Subsequently, Kaplan-Meier analysis was performed to assess the association of ΔSV with overall survival (OS) and cancer-specific survival (CSS); Cox regression analysis was conducted to evaluate independent factors for predicting OS and CSS. Results: In this cohort study with 300 patients, 80 patients (27%) had ΔSV > 10% within 24 months after RNU, who had shorter OS and CSS, compared with the remaining without ΔSV > 10%, in Kaplan-Meier analysis. Furthermore, ΔSV > 10% was an independent factor for predicting worse OS and CSS ( P < 0.05) in multivariate analysis. Meanwhile, the occurrence rate of disease progression in ΔSV > 10% was as high as 53%. Conclusion: ΔSV > 10% within 2 years after RNU for UTUC was significantly associated with mortality. ΔSV > 10% was demonstrated as an independent prognosticator for unfavorable outcomes. Furthermore, the SV change can be feasibly applied to recognize patients with unfavorable outcomes, and appropriate treatment strategies will be considered earlier.