Serum -hydroxybutyrate dehydrogenase as a biomarker for predicting survival outcomes in patients with UTUC after radical nephroureterectomy

Purpose We aimed to determine the prognostic value of alpha-hydroxybutyrate dehydrogenase (alpha-HBDH) in upper tract urothelial carcinoma (UTUC) patients after radical nephroureterectomy (RNU). Materials and methods We retrospectively enrolled the data of 544 UTUC patients at West China Hospital from May 2003 to June 2019. Cancer-specific survival (CSS) was the endpoint of interest. The optimal cutoff value of alpha-HBDH was identified by X-Tile program. After propensity score matching (PSM), we utilized Kaplan-Meier curves to estimate survival and Cox proportional hazard model for risk assessment. A nomogram was built based on the results of multivariate analysis, and calibration curve, time-dependent receiver operating characteristic (ROC) curves and decision curve analysis were also performed to evaluate the predictive accuracy. Results Overall, 394 and 150 patients were divided into the alpha-HBDH-low group and alpha-HBDH -high group at the cutoff value of 158 U/L, respectively. After PSM, the two groups were well matched for all confounding factors. High alpha-HBDH was associated with inferior CSS (P = 0.006), and preoperative alpha-HBDH was an independent predictor for CSS (HR: 1.36; 95% CI:1.08, 1.80), especially in localized UTUC patients (HR: 2.04; 95% CI:1.11, 3.74). Furthermore, the nomogram based on alpha-HBDH achieved great predictive ability for CSS with areas under the curves of 0.800 and 0.778 for 3-year and 5-year CSS, respectively. Conclusion Serum alpha-HBDH was a novel and reliable biomarker for predicting survival outcomes in UTUC patients after RNU but should be further explored.