SIRT7 expression predicts poor prognosis in upper tract urothelial carcinoma undergoing postoperative platinum-based adjuvant chemotherapy

Introduction To evaluates the expression of SIRT7 in UTUC as well as the predictive value for prognosis in patients undergoing radical nephroureterectomy followed platinum-based adjuvant chemotherapy. Methods Pathological samples of 146 UTUC with clinical stage T2 and above undergoing radical nephrectomy (RNU) were collected. All patients received adjuvant cisplatin-based chemotherapy and 40 UTUC patients received second-line immunotherapy after disease progression. The relationship between the expression level of SIRT7 by immunohistochemistry (IHC) and clinicopathological characteristics, disease-free survival (DFS), overall survival (OS) and overall survival after progression (POS) was analyzed. Results Over a mean follow‑up 47 months, 61 (41.8%) patients experienced recurrence and 42 (28.8%) patients died due to UTUC. The results revealed that 70.2% of UTUC tissue samples exhibited high expression levels of SIRT7. High expression of SIRT7 is associated with lymph node metastasis(P＜0.001), lymphovascular invasion (P=0.001) and histological differentiation (P =0.025). In addition, UTUC patients with elevated SIRT7 expression experienced significantly shorter DFS （hazard ratio[HR] 3.760, 95% CI 1.884-7.504, P＜0.001 and OS (HR 2.706, 95% CI 1.235-5.929, P=0.013). Multivariate analyses demonstrated that SIRT7 served as a significant predictor for DFS (HR 2.337, 95% CI 1.117-4.890, P = 0.024) in UTUC patients. Furthermore, we found SIRT7 high expression is associated with prolonged POS in patients progressed after adjuvant cisplatin-based chemotherapy and received second-line immunotherapy. Conclusion SIRT7 is an independent prognostic marker of poor DFS in locally advanced UTUC patients after RNU. Moreover, these data suggest that SIRT7 could potentially serve as a target for assessing the efficacy of chemotherapy and immunotherapy in UTUC.