Evaluation of the Association between Serum Level of Alkaline Phosphatase, White Blood Cells and Tumor Grade in Transitional Cell Carcinoma (TCC) of the Ureter

Upper urinary tract transitional cell carcinoma (TCC) is a rare disease accounting for about 5% of all urothelial tumors. In comparison with other pelvic and renal malignancies, TCC has a poor prognosis with more recurrences and metastasis. Therefore, it is of great value to find prognostic factors in order to improve patient's prognosis. This study was aimed to evaluate the association between serum level of alkaline phosphatase and white blood cells and tumor grade in TCC of the ureter and to determine the diagnostic values of these factors. Patients and This analytical cross-sectional study was performed on 33 patients with TCC of ureter who were referred to Hasheminejad Hospital in Tehran from 1997 to 2007. Diagnosis of TCC was confirmed pathologically for all the patients. Rather than demographic data, main variables including tumour grade, number of white blood cells (WBC) and serum level of alkaline phosphatase (Alk-P) were recorded. Grades I and II were considered as low grade tumors, while grades III and IV were considered high. All data were collected and analyzed using SPSS v.15 software, Kruskal-Wallis, Mann-Whitney U- test, correlation and receiver operative curve (ROC) analysis. Out of 33 patients, 28 (84.8%) were male and 5 (15.2%) were female with the mean age of 61.70 years (SD=10.10). The highest number of WBC was significantly seen in grade IV patients with the mean of 11306 (SD=3591.4) /mm3 (P=0.002).The results of ROC analysis showed that the number of WBC (AUC=0.825, P=0.001) had a greater area under curve (AUC) compared with serum level of Alk-P (AUC=0.770, P=0.008). The cut-point value of 7800 /mm3 for WBC had the sensitivity of 81.3%, specificity of 76.5%, positive predictive value (PPV) of 76.5% and negative predictive value (NPV) of 81.2%. Moreover, the cut-point value of 178 IU/L for Alk-P had the sensitivity of 93.8%, specificity of 52.9%, PPV of 65.2% and NPV of 90% to detect high versus low grade patients. The study reveals that the number of WBC and serum level of Alk-P considerably increased as the tumor grade increased. Furthermore, the number of WBC has more value than serum level of Alk-P to be associated with high grade tumors. Our results may lead to detect the patients with higher tumor grades who are in need of more effective approaches.