1高雄市立大同醫院 泌尿科；2高雄醫學大學附設中和紀念醫院 泌尿科
Hydronephrosis independently predicts worse outcome of upper tract urothelial carcinoma in patients presenting with simultaneous flank pain
Hsin-Chih Yeh1,2, Ching-Chia Li1,2, Chun-Nung Huang2, Hung-Lung Ke2, Wei-Ming Li2, Wen-Jeng Wu2
1Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan; 2Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
Purpose: We aimed to investigate the impact of preoperative hydronephrosis (HN) and flank pain on prognosis of patients with upper tract urothelial carcinoma (UTUC).
Materials and Methods: In total, 472 patients with UTUC managed by radical nephroureterectomy were included from Kaohsiung Medical University Hospital Healthcare System. Clinicopathological data were collected retrospectively for analysis. The significance of HN, especially when combined with flank pain, and other relevant factors on cancer-specific survival (CSS) and overall survival (OS) were evaluated.
Results: Of the 472 patients, 292 (62%) had preoperative HN and 121 (26%) presented with flank pain. Preoperative HN was significantly associated with age, flank pain, tumor location, and pathological tumor stage. Preoperative HN and flank pain were significant predictors of non-organ-confined (NOC) UTUC (p = 0.020 and 0.013, respectively). Kaplan-Meier analysis showed significantly poorer OS and CSS in patients with preoperative HN (p = 0.005 and p = 0.026, respectively) and in patients with flank pain (p < 0.001 and p = 0.001, respectively) than those without. However, only simultaneous HN and flank pain independently predicted adverse outcome (HR = 2.47, p < 0.001 for OS and HR = 2.28, p = 0.002 for CSS, respectively) in multivariate Cox proportional hazards models. Notably, there was no difference in survival between patients with HN but devoid of flank pain and those without HN.
Conclusions: Both preoperative HN and flank pain predicted NOC UTUC. When accompanied with flank pain, HN represented an independent predictor for worse outcome in patients with UTUC.